Corporotomy localization in inflatable penile implant surgery: learning curve and comparing different surgical approaches in high volume surgeons

Abstract

Inflatable penile prostheses (IPP) is a viable solution for patients with erectile dysfunction unresponsive to or with contraindications for conservative treatment. In contrast to rapporting of IPP design and material modifications, no data exist regarding the effect of different surgical approaches during IPP implantation on the corporotomy site. The purpose of the present multi-center study was to investigate different IPP implantation surgical approaches and their influence the corporotomy site, while the effect of learning curve on the corporotomy site was also evaluated. Data was collected from 6 high-volume IPP surgeons. Surgical notes were searched for incision site, proximal and distal corporal length measurement, total length measurement, total cylinder length, length of rear tip extenders (RTE), surgery time, type of implant and reservoir placement while postoperative complications were also reported. The association between proximal/distal corporal length, the recorded covariates and infectious complications were examined. 1757 patients with virgin 3-piece IPP implantation were included in the analysis. The proximal/distal ratio averaged at 0.829 (SD ±0.293) in penoscrotal incisions (N=782), 0.687 (SD± 0.245) in infrapubic (N=1664) and 0.724 (SD± 0.179) in subcoronary (N=972) incisions. No significant differences where observed in the three highest volume surgeons. Correcting for significant covariates (diabetes mellitus, RTE, age) did not change this outcome. In the three highest volume surgeons, a more proximal incision resulted in significantly less RTE use. There was no difference in infectious complications with different surgical techniques (p = 0.280). Focusing on the data of the principal center, we found a decrease in the proximal/distal ratio of 8.41% per additional year of experience. We were unable to draw a firm conclusion about the difference in corporotomy site between different surgical approaches as such, but we found no significant difference between the highest volume surgeons using different techniques. Nevertheless, a significant effect of experience on the proximalization of the corporotomy was reported. none