222 Safety Tab: A Novel Approach to Intraoperative Inflatable Penile Prosthesis (IPP) Cylinder Resizing

Abstract

Proper sizing and positioning of inflatable penile implants (IPP) is upmost importance for cosmesis and patient satisfaction. Intra-operative measurements are often inaccurate, requiring cylinder size adjustment with rear-tip extenders after positioning within the corpora.When an IPP needs to be resized, the cylinders must be removed from the corpora by hooking the cylinder with a right-angle clamp or vein retractor. This semi-blind maneuver is not only challenging and time consuming, but can cause damage to either the implant, requiring replacement with a new device or injury to cavernosal muscle, which may increase risk of post-operative bleeding, hematoma, and infection. To describe our surgical technique and early experience for IPP cylinder repositioning using a “safety tab” mechanism. In this single surgeon, non-randomized, prospective trial, we evaluated different surgical materials to act as a “safety tab” to easily remove IPP cylinders intraoperatively when resizing was necessary. AMS or Coloplast devices were used for each patient based on surgeon preference. After the distal stay sutures and the proximal portions of the cylinders were seated, a loop of either large vessel loop, quarter-inch penrose, or quarter-inch umbilical tapewas passed around the cylinder and secured to itself using a small clamp. Only one type of material was used per implant. The distal portion of the cylinder was the inserted and cylinder inflated to check for sizing. If the size of the implant needed to be adjusted, slight traction was applied to the loop and the cylinder was withdrawn from the corporotomy. After size adjustment, the procedure was repeated until the proper size was achieved. The material was then cut close to where it wrapped around the cylinder and withdrawn, limiting the amount of material rubbing on the underside of the implant during removal. The materials were evaluated subjectively by surgeon, residents, and surgical PAs for ease of application, ease of removing the cylinder, and safety.