V07-08 PENILE DOPPLER DELINEATES SEVERE CORPORAL FIBROSIS MAKING CORPORAL EVACUATIONA VIABLE OPTION

Abstract

You have accessJournal of UrologyLower-Tract Reconstruction II: ED/Infertility & Transgender Surgery (V07)1 Apr 2020V07-08 PENILE DOPPLER DELINEATES SEVERE CORPORAL FIBROSIS MAKING CORPORAL EVACUATIONA VIABLE OPTION Yooni Yi* and Bahaa Malaeb Yooni Yi*Yooni Yi* More articles by this author and Bahaa MalaebBahaa Malaeb More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000897.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Many techniques have been described for the management of severe penile fibrosis in the setting of a penile prosthesis (PP) placement. Since the introduction of the corporeal evacuation, no further reports have been published on outcomes. We sought to utilize this technique in patients with severe corporal fibrosis after ischemic priapism. METHODS: Penile Doppler(PD) is performed in patients with erectile dysfunction (ED) and history of priapism to determine parameters related to ED. Cross sectional images of the corpora were obtained to assess the degree of fibrosis within the corpora. Once fibrosis was identified, patients were counseled on the insertion of the PP along with the need for corporal evacuation. This was performed as the primary approach to the penile implant without attempts at dilation, counter incisions, endoscopic resection or grafting. Operative time is reported as time from incision to end of dressing. Preoperative antibiotics are standardized for implants and follow-up time remained the same as other implants (6-week activation and 3-month follow-up). RESULTS: Two patients underwent the corporal evacuation with PP implant. Patient 1 is a 25-year-old male with a history of longstanding priapism. PD showed no response to injection and good flow. However, with severe fibrosis there was no space to fill within the corpora. An LGX implant 18 + 3.5 was placed bilaterally with an operative time of 2 hours and 42 minutes. Fibrotic core measurements were 10.3 cm and 10.4 cm. Patient 2 was a 57-year-old male with a history of recurrent priapism. Penile Doppler showed no identifiable flow and severe corporal fibrosis. An LGX implant 18 + 2 was placed bilaterally with an operative time of 2 hours and 41 minutes. Fibrotic core measurements were 9 cm and 8.7 cm. In addition, there was removal of peyronies plaque within the septum secondary to concerns with possible tearing of the implant. No 30-day complications were reported. Devices were in good position at time of activation and at the 3-month follow-up. At 11 months, patient 2’s prosthesis was replaced secondary to a leak identified in the device. CONCLUSIONS: The corporal fibrosis identified on penile ultrasound indicates a plane of dissection for corporal evacuation. Though operative time is longer than a standard PP implant, this method avoids many concerns with severe penile fibrosis and standard methods–cross over, injury to the urethra, downsizing of implant, future infection with graft, and need for special equipment. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e645-e645 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yooni Yi* More articles by this author Bahaa Malaeb More articles by this author Expand All Advertisement PDF downloadLoading ...