Abstract
Forceful corporal dilatation amidst penile prosthesis implantation may injure cavernosal arteries compromising penile vasculature. In this study, we aimed to compare the conventional and cavernosal sparing techniques regarding cavernosal artery preservation. Overall, 33 patients underwent inflatable penile prosthesis implantation with Coloplast Titan Touch® three-piece inflatable penile implants. 16 patients had conventional implantations with serial vigorous dilatations, while 17 patients were implanted with the cavernosal sparing technique, consisting of a single minimal corporal dilatation after an intraoperative intracavernosal injection (ICI) of Alprostadil. Postoperatively, a penile duplex Doppler ultrasound study was performed. Whenever a cavernosal artery was spared and thus successfully probed, its hemodynamics were studied before and after an oral administration of a phosphodiesterase type 5 inhibitor (PDE5i). A cavernosal artery was successfully probed in 16/17 (94%) of patients in the cavernosal sparing group compared to 5/16 (31%) of patients in the conventional group with a significant statistical difference (P=0.001). This demonstrated that the cavernosal sparing technique was superior to the conventional approach in preserving the cavernosal artery (odds ratio 35.2, 95% IC 3.5–344.2; P=0.0022). Whenever a cavernosal artery could be probed, its hemodynamic responsiveness was also preserved. This trial is registered with NCT03733860.
Highlights
Since the advent of the inflatable penile prosthesis (IPP) in 1973, it has become the surgical gold standard in treating patients with refractory erectile dysfunction (ED) [1, 2].ree-piece inflatable implants have shown greater satisfaction among patients compared to the semi-rigid rods, due to their better concealability and more natural erections [3]
Postoperative loss of subjective penile tumescence and decreased penile girth often occur due to corporal tissue damage [6]. e erection obtained by means of a penile implant may be perceived as “artificial” when it is uncoupled from physiological tumescence
No perforations were encountered in the cavernosal sparing group
Summary
Since the advent of the inflatable penile prosthesis (IPP) in 1973, it has become the surgical gold standard in treating patients with refractory erectile dysfunction (ED) [1, 2]. Ree-piece inflatable implants have shown greater satisfaction among patients compared to the semi-rigid rods, due to their better concealability and more natural erections [3]. Corporal dilatation during penile prosthesis implantation procedures can injure the cavernosal arteries. Cavernosal arteries play an indirect role in glandular tumescence. Glandular tumescence is partly caused by compression of the Advances in Urology deep dorsal and circumflex veins between the engorged corpora cavernosa, supplied by the cavernosal arteries, and the surrounding tissues [6]. Us, a lack of glans engorgement might be one of the indirect sequelae of cavernosal artery injury during penile prosthesis implantation. Postoperative loss of subjective penile tumescence and decreased penile girth often occur due to corporal tissue damage [6]. e erection obtained by means of a penile implant may be perceived as “artificial” when it is uncoupled from physiological tumescence
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