Proper Circumferential Sizing of Penile Implants

Abstract

ABSTRACT Introduction The Introduction: of narrow inflatable cylinders allows high volume implanters to correctly size patients despite anatomic limitations. Clinical manifestations of circumferential oversizing include pain associated with the inability to fully inflate the implant, noncompliance of cycling regiment, and isolated persistent phallic pain despite a deflated implant. Oversizing patients may negatively impact patient satisfaction and recovery efficacy which may ultimately lead to unnecessary surgical revision. Herein, we describe our experience with the role of narrow cylinders to address a common intraoperative occurrence of decreased corporal circumference using a decision tree to assist and alert the implanting surgeon on appropriate use of narrow cylinders. Objective Our goal is to establish a specific guideline for the proper circumferential sizing of penile implants, utilizing narrow based cylinders. Methods From May 2018- May 2021, 1,158 patients underwent penile implantation from two high volume surgeons. Data were collected prospectively. A total of 201 cases were identified in which narrow cylinders were required. Operative notes were reviewed for the cause of narrowing, method of corporal dilation, and decision to use narrow cylinders. We employed the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and the Visual Analog Scale (VAS) for Pain. Using a previously presented algorithm (Figure 1) by the authors for proper circumferential sizing, a cutoff of 12mm corporal dilation was established. If any resistance was met when passing the 12mm dilator, narrow cylinders were subsequently placed. We compared the VAS and EDITS scores for patients who underwent narrow base cylinder placement both prior to and after the strict implementation of the aforementioned algorithm. Results Prior to 2018, the use of narrow cylinders among these two high volume surgeons was <1%. Since the strict adoption of the algorithm, the use of narrow cylinders increased to 18%. Causes for corporal narrowing were congenital narrowing, fibrosis/scarring, revision surgery, Peyronie's plaques, and history of penile trauma. After implementation of the algorithm, we demonstrate a significant increase in narrow based cylinder placement usage, without the expense of reduced EDITS scores as well as reducing patient reported VAS scores. POD #1 VAS pain scores for the post-algorithm cohort, and pre-algorithm cohort demonstrated a mean of 1.9 (median 2, range 0-7), vs 3.9 (median 4, range 0-8), respectively. POD #10, scores for phallus-specific pain for the post-adoption algorithm cohort and pre-adoption algorithm cohort, demonstrated a mean of 0.25 (median 0, range 0-2) and 0.53 (median 0, range 0-3), respectively. Patient satisfaction scores for the post-adoption algorithm cohort and pre-adoption algorithm cohort were similar with mean EDITS scores of 93.2 on a 100-point scale (median 88.6, range 79.5-100) vs 94.5 (median 90.3, range 81-100), respectively. Conclusions In order to avoid corporal circumferential oversizing, we encourage the adoption of the aforementioned algorithm. Properly sized cylinders prevent increased operative times, reduce tissue manipulation, and may prevent unnecessary revision surgery. As a result of adhering to this algorithm, we believe we have been able to properly adjust for a narrow corporal body, thus decreasing VAS pain scores while maintaining penile implant patient satisfaction and efficacy. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast and Boston Scientific