(418) Corpora Cavernosa Reconstruction for Penile Prosthetics Surgery Using a Lightweight Mesh: A Viable Alternative? A Single Center Experience

Abstract

Abstract Introduction Options for reconstruction of the corpora cavernosa are limited. Synthetic grafts like Dacron™ and GORE-TEX™ are used but have high infection rates. Lightweight macroporous mesh is a promising alternative due to better integration and surrounding tissue ingrowth. We present the first experience of using a lightweight mesh for this indication in a single high-volume institution. Objective To evaluate long term outcomes of corporal reconstruction using a lightweight mesh measuring where previous options had failed. Methods The medical records of all patients undergoing insertion or revision of penile prosthesis between May 2016 and November 2019 were reviewed retrospectively. Patient characteristics, management and outcomes (including patient satisfaction) including any complications were extracted with long term follow up (24-month minimum) Results Twenty patients required corpora cavernosa reconstruction during penile prosthesis surgery (median age 56, range 18 to 74 years). Reasons for reconstruction included severe corporal fibrosis due to multiple revisions and deficient tunica (n=7), impending erosion (n=6), congenital corporal agenesis (n=2), aneurysm of cylinder (n=1) ossified Peyronie’s disease plaque excision grafting (n=1) and crossover/perforation (n=3). All but two patients (with corporal agenesis) presented for revision penile prosthesis surgery. Coloplast Titan® OTR inflatable penile prostheses were used in all patients. Two patients (13%) required explant after a mean follow-up period of 7.4 months (+/−2.6 SEM). The first experienced erosion of the prosthesis through the distal corpora 6 months after surgery while the other required explant due to debilitating chronic pain after 3 months. There was no other complication (including infection). All patients (who did not require explantation) were satisfied with their penile prosthesis and are currently sexually active. Conclusions Our early results suggest that a lightweight macroporous mesh may be an alternative synthetic graft for corporal reconstruction in experienced high-volume hands experienced in revision, reconstruction and salvage procedures. The poliglecaprone-25/polypropylene mesh (ULTRAPRO®, Ethicon LLC, USA) is ideal because it is partially absorbable while providing a strong scaffold, easy to handle and not bulky. Further long-term follow-up is required, and with increasing advances in stem cell tissue engineering perhaps even better graft material choices will be available in the future. Disclosure No