(457) Comparing Longevity and Need for Revision Between 2- and 3-piece Inflatable Penile Prostheses

Abstract

Abstract Introduction The management of pharmacotherapy-refractory erectile dysfunction includes placement of an inflatable penile prosthesis (IPP). Although invasive, placement of an IPP is considered a safe procedure with high patient satisfaction rates. Broadly, these devices have two different inflation mechanisms: a two-piece (2p) device consisting of a pump and inflation cylinders, and a three-piece (3p) device, which incorporates a low-pressure reservoir. The relative difference in concealability has long been considered a major factor in patient decision-making. However, the difference in durability and subsequent need for revision amongst the two types of devices have not yet been explored. Objective To investigate differences in longevity and need for revision in patients with 2p and 3p IPPs. Methods After receiving institutional review board approval, a retrospective chart review was performed on all patients that underwent IPP revision or exchange for mechanical failure from 2001 to 2021 at our institution. Only patients who underwent revision of the initial device placed were included in the analysis. Men with retired IPP models or who underwent salvage protocol for infected prosthetics were excluded. Baseline characteristics, including history of diabetes or cardiovascular disease, smoking history, prior radical prostatectomy and/or pelvic radiation, and prior incontinence surgery were recorded. Cox proportional hazard models adjusted for age were developed comparing time to revision between 2p and 3p devices. Baseline characteristics were compared with descriptive statistics. Statistical significance was defined as p < 0.05. Results A total of 64 men underwent IPP exchange or revision during the study period, including 38 and 26 men undergoing revision of 2p and 3p devices, respectively. Baseline characteristics are included in Table 1. The median number of days until first revision was 2,695 for 2p IPP compared to 2,101 for 3p IPP (p = 0.27). On unadjusted proportional hazard analysis, there was a significant longevity benefit for 2p IPP compared to all 3p devices [HR: 1.80 95% CI (1.09, 3.00), p = 0.02]. When controlled for patient age, 2p IPPs continued to have a significant longevity benefit compared to 3p devices [HR 1.87 95% CI (1.13, 3.09), p = 0.02]. Conclusions Amongst our institutional cohort, 2p IPPs have significantly longer durability compared to 3p devices. These findings may be used to counsel patients who are deciding between different devices for management of their erectile dysfunction. Disclosure No