PD20-12 SAFETY PROFILE OF COUNTER INCISION FOR RESERVOIR PLACEMENT DURING INFLATABLE PENILE PROSTHESIS SURGERY

Abstract

INTRODUCTION AND OBJECTIVE: Non-traditional reservoir placement is increasingly popular during penile prosthesis (PP) surgery to prevent intraperitoneal positioning and bowel, bladder, or vascular injury. A variety of locations have been described including submuscular, high-submuscular, and subcutaneous. In this study we present our experiences using a counter incision for submuscular reservoir placement and compare these to patients who underwent traditional reservoir placement. METHODS: A single institution database of PP surgeries was queried for use of a counter incision (CI) during reservoir placement from July 2011 to 2019. Demographic, medical, and surgical histories as well as 90-day outcome data were extracted. Primary outcome was device infections, with secondary outcomes including cellulitis, reservoir herniation, hematoma, device malfunction rates, and operative times. Additionally, a descriptive analysis of the reasons for CI was performed. Groups were compared using Kruskal Wallis and Fisher’s exact tests for continuous and categorical variables respectively. RESULTS: A total of 432 cases met inclusion criteria of which 46 (10.6%) used a CI for reservoir placement. Twenty-six CI patients (56.5%) had undergone a prior prostatectomy compared to 108 (28.0%) non-CI patients (p<0.001). The CI cohort included significantly more removal and replacement procedures, 54.3% vs. 26.4% (p<0.001). Most common reasons for CI were prior prostatectomy and inguinal hernia repair. Device infection rates were similar between groups (CI 2.2 vs. non CI 3.6%), as were rates of hematoma (2.2 vs 3.6%), cellulitis (4.3 vs 0.5%), and device malfunction (0.0 vs 0.7%). An internal iliac artery injury, one intravesical reservoir placement, and one reservoir herniation were seen in the non-CI cohort, but no similar complications occurred in the CI group. Of wound complications, only one was of the CI with a total CI wound complication rate of 1/46 (2.2%). Median operative time was 15 minutes longer in the CI cohort (69.6 vs 84.0 minutes, p = 0.007). CONCLUSIONS: Use of a CI is a safe and effective means of reservoir placement in patients with a compromised space of Retzius, albeit with a slightly higher operative time. Complication rates were similar between groups, even in a subset where approximately half the cases were removal and replacements. Of wound complications, the vast majority did not occur at the CI, rather at the penoscrotal or infrapubic incisions. Source of Funding: None