3-piece Inflatable Penile Prosthesis Research Articles

Penoscrotal inflatable penile prosthesis recipients often fully recover from pain at two weeks following placement.

The symptoms and duration of pain following inflatable penile prosthesis (IPP) surgery remains poorly understood. We characterize postoperative pain following penoscrotal 3-piece inflatable penile prosthesis placement in patients managed with a standardized pain management protocol. This is a single-center prospective analysis of 96 virginal penoscrotal 3-piece IPP recipients (9/2019 to 9/2021) excluding patients with chronic pain, IPPs performed with alternative approaches or concomitantly with other surgeries and those with infections. Standardized pain questionnaire was performed by phone on post-operative day (POD) 2, 7, 14, and 30. The primary outcome was self-reported pain scores, measured by pain score 0-10 (0 = no pain, 10 = unbearable, "worst pain you have ever felt") at various locations (incision, penile, scrotal, abdominal) over the first 30 days postoperatively. A majority of pain reported was outside the scrotal area with 67.6% of complaints in the shaft, glans, abdomen and incision. From POD2 to POD30, there was a significant decrease in severe pain from 46.2 to 11.1% (p = 0.05) with an increase in mild pain from 23.1 to 62.4% (p = 0.05). Roughly half of the participants (47.9%, n = 46) reported no pain by POD14. Penoscrotal IPP recipients often fully recover from pain at the two-week period following surgery and those with lingering discomfort predominantly complain of penile shaft and glans pain.

(099) A Preliminary Investigation on the Incidence of Complications and Patient Contentment Following the Surgical Implantation of Inflatable Penile Prosthesis After Salvage Radical Prostatectomy

Abstract Introduction Erectile dysfunction (ED) is a common complication post salvage radical prostatectomy (RP). Yet, there is scant data in the literature on complication rates and patient satisfaction in those that undergo inflatable penile prosthesis (IPP) insertion post salvage radical prostatectomy (RP) following targeted radiotherapy for treatment of localized prostate cancer. It is understood that these patients have a higher rate of complications as they have experienced both radiation and prostatectomy adverse events which could alter their overall satisfaction after prosthetic surgeries. Objective Our aim is to conduct a preliminary analysis of IPP complication rates and satisfaction rates in patients that had 3-piece IPP implantation following salvage radical prostatectomy. Methods A retrospective chart review from our institutional database was done from 2018 to 2021. The inclusion criteria were patients that had an inserted 3-piece IPP and a history of salvage RP following radiation therapy. Only patients that participated Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire at least 6 months from implant date were included. Data on satisfaction, IPP infection rates, mechanical failure rates, and overall complications was also collected. Complications include hematoma, erosion, reservoir hernia. Results A total of 22 patients were included in the study. The median age (IQR) is 65 (64–67) years and the median time (IQR) from RP to IPP insertion is 23 (11–49) months. All patients were approached in a penoscrotal manner with submuscular placement of reservoir (Table 1). The satisfaction rate was high at 91.8% on follow up. Overall complications rate was observed in 2 patients. One patient had a mechanical pump failure at 37.9 months while another patient had signs and symptoms of scrotal wall infection at 15 months. Both devices were easily replaced with no post op complication and remained functional on further follow up. Conclusions In patients that underwent salvage prostatectomy IPP insertion, they reported high satisfaction rates and low complication rates despite the exposure to both prostate cancer treatments adverse events. Further research is needed to confirm the results obtained and to investigate the underlying causes for the observed outcomes. The scientific process is iterative, and the answers obtained from one study often lead to more questions and the need for additional investigations. Disclosure No.

(284) A Preliminary Investigation on the Incidence of Complications and Patient Contentment Following the Surgical Implantation of Inflatable Penile Prosthesis After Salvage Radical Prostatectomy

Abstract Introduction Erectile dysfunction (ED) is a common complication post salvage radical prostatectomy (RP). Yet, there is scant data in the literature on complication rates and patient satisfaction in those that undergo inflatable penile prosthesis (IPP) insertion post salvage radical prostatectomy (RP) following targeted radiotherapy for treatment of localized prostate cancer. It is understood that these patients have a higher rate of complications as they have experienced both radiation and prostatectomy adverse events which could alter their overall satisfaction after prosthetic surgeries. Objective Our aim is to conduct a preliminary analysis of IPP complication rates and satisfaction rate in patients that had 3-piece IPP implantation following salvage radical prostatectomy. Methods A retrospective chart review from our institutional database was done from 2018 to 2021. The inclusion criteria were patients that had an inserted 3-piece IPP and a history of salvage RP following radiation therapy. Only patients that participated Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire at least 6 months from implant date were included. Data on satisfaction, IPP infection rates, mechanical failure rates, and overall complications was also collected. Complications include hematoma, erosion, reservoir hernia. Results A total of 22 patients were included in the study. The median age (IQR) is 65 (64-67) years and the median time (IQR) from RP to IPP insertion is 23 (11-49) months. All patients were approached in a penoscrotal manner with submuscular placement of reservoir (Table 1). The satisfaction rate was high at 91.8% on follow up. Overall complications rate was observed in 2 patients. One patient had a mechanical pump failure at 37.9 months while another patient had signs and symptoms of scrotal wall infection at 15 months. Both devices were easily replaced with no post op complication and remained functional on further follow up. Conclusions In patients that underwent salvage prostatectomy IPP insertion, they reported high satisfaction rates and low complication rates despite the exposure to both prostate cancer treatments adverse events. Further research is needed to confirm the results obtained and to investigate the underlying causes for the observed outcomes. The scientific process is iterative, and the answers obtained from one study often lead to more questions and the need for additional investigations. Disclosure No.

(140) Penile Length and Girth Restoration in Mb Peyronie: Less Invasive Approach for Complex Composite Graft Corporplasty and Implantation of Inflatable Penile Prosthesis

Abstract Introduction Peyronie's disease (PD) is a fibrotic disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, narrowing and shortening, which eventually compromise sexual function. Objective The presented technique is a less invasive approach that gives few complications, has a natural cosmetic outcome with preserved preputium, and high patient satisfaction. Methods In the period between December 2017 and May 2022, 65pts aged 33y to 78y underwent complex corporoplasty with inflatable penile prosthesis implantation. Mean penile curvature was 70 o (60 o -95 o ). Average penile shortening was 3.2cm (1 - 5.5cm), and girth narrowing 2.5cm (0 - 4cm). The surgical approach was thru penos-crotal incision, followed by direct dissection of NVB from tunica albuginea, penile eversion, composite corporoplasty (for transversal grafting 0.5mm thick porcine dermal graft, and for longitudinal graft composite semi-resorbable soft mash), and 3-piece inflatable penile prosthesis implantation. Postoperative vacuum drainage and compressive dressing were left in place for one week. Results Follow-up was 2-58 months (mean 21). Penile shape (corrected curvature, length and girth) was restored in all patients. In the first 4 weeks postoperatively 12pts had mild scrotal oedema; 8pts developed mild scrotal haematoma; 7pts developed penile skin oedema; 5pts had a transitory loss of sensitivity. All patients 5 weeks postoperatively started with sexual intercourse. All patients 12 weeks after surgery reported satisfactory aesthetical and functional results with no visible scaring related to surgery. Five pts (12-23 months after surgery) had prosthesis malfunction that needed reimplantation of the prosthesis. Conclusions Penile eversion thru peno-scrotal incision with preserving the prepuce for complex reconstructive surgery of PD is safe and gives the natural aesthetic appearance and good functional result with low complication rate. The high satisfaction rate for the patients is the most important aspect of this surgical method. Disclosure No

PD28-10 CONCOMITANT UROLOGIC PROCEDURES DURING PENILE PROSTHESIS SURGERY

You have accessJournal of UrologyCME1 May 2022PD28-10 CONCOMITANT UROLOGIC PROCEDURES DURING PENILE PROSTHESIS SURGERY Jason Levy, Ridwan Alam, William Ducomb, and Arthur Burnett Jason LevyJason Levy More articles by this author , Ridwan AlamRidwan Alam More articles by this author , William DucombWilliam Ducomb More articles by this author , and Arthur BurnettArthur Burnett More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002576.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is a paucity of literature investigating outcomes for patients who undergo concomitant non-reconstructive urologic procedures at the time of 3-piece inflatable penile prosthesis (IPP) placement. Our aim is to analyze outcomes including risk factors, complications, and procedure types for patients who underwent IPP placement with concomitant non-reconstructive urologic procedures at a high-volume institution. METHODS: A retrospective IRB approved (IRB00205900) review of patients undergoing IPP placement at Johns Hopkins from January 2007-July 2021 was conducted. We identified 330 patients who underwent IPP placement and a concomitant urologic procedure. We excluded patients who had concomitant penile straightening procedures, artificial urinary sphincter (AUS), and reconstructive penile procedures. The remaining cohort included 45 patients who had a non-reconstructive urologic procedure done concurrently. A control group of 127 patients who underwent IPP placement after 2015 with no concomitant procedures was utilized. All patients underwent penoscrotal approach. RESULTS: Concomitant procedure type was divided into endourology (n=24; 53.3%), penile (n=9; 20.0%), scrotal (n=10; 22.2%), neuromodulation (n=1; 2.2%), and oncologic (n=1; 2.2%). Compared to the control group, patients in the concomitant group were younger (p=0.04) but more overweight (p=0.02) and less healthy, as measured by comorbidities (p=0.03). Between the two groups (Table 1), there was no significant difference in device infections (concomitant 2.2% vs control 1.6%, p=0.78) or device erosions (4.4% vs 3.2%, p=0.68). There was no difference in the proportion of patients requiring future IPP revision (13.3% vs 10.2%, p=0.50). CONCLUSIONS: This retrospective analysis demonstrates the largest cohort of patients undergoing non-reconstructive urologic procedures at the time of IPP placement. Our results demonstrate that concomitant non-reconstructive procedures confer no increased risk of prosthetic adverse events, regardless of procedure type. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e502 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jason Levy More articles by this author Ridwan Alam More articles by this author William Ducomb More articles by this author Arthur Burnett More articles by this author Expand All Advertisement PDF DownloadLoading ...

Single Port Robotic-Assisted Removal of an Eroded Inflatable Penile Prosthesis Reservoir and Repair of an Associated Bladder Fistula

ABSTRACT Introduction We present the case of a 73-year-old man who underwent single port robotic removal of a retained Inflatable Penile Prosthesis (IPP) reservoir with intravesical erosion and repair of an associated bladder fistula. The patient had a 3-piece IPP placed in 2014 for erectile dysfunction after radical prostatectomy for prostate cancer. He underwent device explant two years later for infection, at which time the IPP reservoir was “drained and retained”. He developed re-infection one year later and was again taken to the operating room; however, surgery was aborted due to vascular injuries. He presented to us for evaluation of dysuria and gross hematuria six years after initial IPP placement. Work-up with CT imaging and cystoscopy demonstrated intravesical erosion of the retained reservoir. Objective We aim to provide a step-by-step video demonstration of our technique for single port robotic-assisted removal of the eroded penile prosthesis reservoir and repair of an associated bladder fistula. Methods Procedures were performed using the da Vinci SP single port robotic system. The SP robot port was placed through a 3 cm incision superior to the umbilicus, and an additional 12 mm assistant port was placed in the Right Lower Quadrant (RLQ). The peritoneum was incised anteriorly lateral to the medial umbilical ligament, and the space of Retzius was developed by sharp and blunt dissection through densely adherent tissue planes. The pseudocapsule surrounding the eroded reservoir was incised, and the exposed reservoir was removed. Two fistulous tracts identified between the pseudocapsule and bladder were circumferentially excised, and the resultant bladder wall defect was repaired in a single layer with running 3-0 V-Loc suture. A drain was placed alongside the bladder repair and externalized through the RLQ assistant port. Results The patient tolerated these procedures well and without complications. He was admitted for routine postoperative observation overnight after surgery. On postoperative day one, the drain was removed, and the patient was discharged home with the Foley catheter remaining in place. At 2-week follow-up, the patient was recovering well and a cystogram was obtained showing no leaks, and the Foley catheter was removed. Conclusions This surgical case report demonstrates the feasibility and safety of performing removal of an eroded IPP reservoir through a minimally invasive approach with the da Vinci SP surgical system. The accompanying video provides a step-by-step demonstration of our technique. Disclosure No

Ethnic Disparities in Penile Prosthesis Surgery: An Analysis of Hispanic Patients

ABSTRACT Introduction Disparities in disease incidence and outcomes are common in sexual medicine including erectile dysfunction (ED). As limited studies evaluate how ethnic disparities affect the way ED is treated, we used data from a high-volume center to investigate differences between Hispanic and non-Hispanic men following 3-piece inflatable penile prosthesis surgery. Objective To investigate differences between Hispanic and non-Hispanic patients undergoing Penile Prosthesis Surgery. Methods We performed a retrospective cohort study of two high volume implanters using records and data collected prospectively. Patient characteristics, comorbidities, and surgical outcomes were compared. Ethnicity was identified as Hispanic, non-Hispanic white, African American, and other. All patients completed a Sexual Health Inventory for Men (SHIM) questionnaire and had a penile doppler ultrasound (PDUS) performed preoperatively. We also employed the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and the Visual Analog Scale (VAS) for Pain. Multivariate Analysis and logistic regression were used to identify the association between ethnicity, comorbidities, and surgical outcomes. Results 1,158 patients who underwent penile prosthesis surgery from April 2018 to June 2021, were evaluated. Most study participants were Hispanic (68.2%), with non-Hispanic whites counting for 22.5% of population followed by African Americans (8.6%) and other ethnicities (<1%). Hispanics were found to have penile prosthesis surgery at a younger mean age (58.6 vs 64.3 years) when compared to NHW. Overall Hispanics were found to have a greater incidence of comorbidities such as diabetes mellitus (DM), and vascular disease. The most common patient comorbidities among Hispanics were DM (34.2% v 27% NHW), cardiovascular disease (CVD) (20.2% v 18.1% NHW), and Peyronie's disease (12.4% vs 10.2% NHW). Primary etiology of ED among Hispanics was found to be DM (32.3%), CVD (24.1%), Radical Prostatectomy (12.4%), Peyronie's disease (5.3%), priapism (3.3%) and others (22.6%). Pain scores prior to discharge on POD #1 were a mean of 3.2 (median 3, range 0-6) in Hispanics vs 4.1in NHW (median 4, range 0-8). At POD #10, scores for the Hispanic cohort were a mean of 0.53 (median 0, range 0-2) versus a mean of 0.73 (median 0, range 0-2). Hispanic men rate satisfaction with their IPP very high when compared to NHW, (94% vs 89%) according to validated testing. Conclusions Despite younger age of disease progression at time of surgery, Hispanic ethnicity was an independent predictor of higher satisfaction rates and lower pain scores. Conversely Hispanics were found to suffer from more incidence of comorbidities when compared to NHW. This study suggests there may be disparities in disease progression and surgical outcomes between Hispanics and non-Hispanic whites. Further work is necessary to confirm this health disparity in other large datasets. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast and Boston Scientific

Intravesical reservoir erosion as a late complication of a 3-piece inflatable penile prosthesis: ectopic placement in a high-subrectus space: a rare case report

Background: Inflatable penile prosthesis (IPP) is the mainstream treatment of refractory erectile dysfunction (ED). Usually, Space of Retzius (SOR) is the usual IPP reservoir placement space, however, more concerns regarding this space complication have emerged due to its anatomical proximity to some major structures. Intravesical reservoir erosion is the most common reported reservoir complication. Hematuria is the main presentation, sometimes, dysuria and urinary tract infection take place. We present a case of late intravesical reservoir erosion after 3 years of IPP implantation. Methods: Revision surgery was made including placement of AMS Conceal® reservoir in an ectopic high-subrectus space and anterior to transversalis fascia, contralaterally. Results: Recently, ectopic placement has gained popularity among implanters due to its safety and efficacy. Specifically, submuscular space placement, after inventing the lock-out valve to avoid undesirable auto-inflation due to the high back-pressure. Conclusion: Ectopic placement utilizes more choices in cases like hostile pelvis for implanting a 3-piece IPP instead of a malleable prosthesis. Ectopic placement is safe and highly acceptable between high-volume implanters, which may prime a new era of reservoir placement.

The Anatomical Relationships in the Space of Retzius for Penile Implants: An MRI Analysis

The 3-piece inflatable penile prosthesis includes an easy-to-use pump and fluid filled reservoir which is placed in either the space of Retzius (SOR) or in an alternative ectopic location. Reservoir placement in the SOR is a blind procedure despite the SOR being surrounded by many critical structures. To date only a handful of cadaveric studies have described the relevant anatomy. To use magnetic resonance imaging (MRI) as an in-vivo model to study relevant retropubic anatomy critical for SOR reservoir placement. The study population included men with elevated prostate specific antigen or biopsy proven prostate cancer who (i) underwent pelvic MRI, (ii) without prior pelvic or inguinal surgery, and (iii) without pelvic radiation therapy. All MRIs were completed with a 3-Tesla scanner and endorectal coil. Both T1 and T2 weighted images were captured in both axial and sagittal planes. All images were reviewed by 2 independent reviewers under the supervision of a dedicated body MRI radiologist. Bladder volume was calculated using an ellipsoid formula. Relevant measurements included (i) the distance between the external inguinal ring (EIR) at the level of the pubic tubercle to the external iliac vein (EIV), (ii) the distance from the EIR at the pubic tubercle to the bladder (accounting for bladder volume) and (iii) the distance from the midline pubic symphysis to the bladder (accounting for bladder volume). Pearson correlation was used to determine correlated measurements. A total of 24 patients were included. Median participant age was 63 years (interquartile range, 59-66). The mean EIR-EIV distance was 3.0 ± 0.4 cm, the mean EIR-bladder distance was 1.8 ± 1.0 cm and the mean distance from the superior pubic symphysis to bladder was 0.9 ± 0.3 cm. There was a weak correlation between bladder volume and distance between the EIR and bladder (r = -0.30, P = .16). The use of MRI as an in-vivo model is a high-fidelity tool to study real time unaltered anatomy and allows for surgical preparation, diagnosis of anatomic variants and acts as a valuable teaching tool. This is the first in-vivo model to report relevant retropubic anatomy in penile implant surgery. Our study is limited by sample size and inclusion of participants with no history of prior pelvic intervention. We demonstrate the utility of MRI as an in-vivo model, as opposed to cadaveric models, for the understanding of relevant retropubic anatomy for implant surgeons.

MP57-18 FEASIBILITY AND SAFETY OF STANDARD RETROPUBIC PENILE PROSTHESIS RESERVOIR PLACEMENT FOR HIGH-RISK PATIENTS

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy (MP57)1 Sep 2021MP57-18 FEASIBILITY AND SAFETY OF STANDARD RETROPUBIC PENILE PROSTHESIS RESERVOIR PLACEMENT FOR HIGH-RISK PATIENTS Elizabeth Boes, Parth Thakker, Rahul Dutta, Adam Cohen, Kyle Scarberry, and Ryan Terlecki Elizabeth BoesElizabeth Boes More articles by this author , Parth ThakkerParth Thakker More articles by this author , Rahul DuttaRahul Dutta More articles by this author , Adam CohenAdam Cohen More articles by this author , Kyle ScarberryKyle Scarberry More articles by this author , and Ryan TerleckiRyan Terlecki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002087.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Traditional reservoir placement for the 3-piece inflatable penile prosthesis (IPP) has involved the space of Retzius (SOR). Developing this space may be daunting for infrequent implanters, especially in the setting of prior inguinal or pelvic surgery. As such, some have advocated for ectopic reservoir placement, with potential risks for visibility, palpability, and possibly less predictable complications. We chose to review our experience to determine the feasibility and safety of SOR reservoir placement. METHODS: Our IRB-approved single-surgeon database was reviewed for all cases of three-piece penile implant placement from 2011-2020. Demographics, patient history, operative details, and outcomes were reviewed. Cases involving a history of robotic prostatectomy (RP), mesh-based inguinal hernia repair (MIHR), renal transplant (TX), cystectomy (CX), or pelvic fracture (PF) were deemed high-risk for SOR reservoir placement. RESULTS: 554 men underwent 3-piece IPP placement during the studied interval, all via a penoscrotal approach. Age at time of implant ranged from 38 - 86 years and mean BMI was 29.94 (17.7-52.4) kg/m2. Mean follow-up was 1623 (370-3710) days. 209 men (37.7%) were deemed high risk for SOR reservoir placement based on prior RP (166; 28.7%) MIHR (43; 7.43%), TX (15; 2.59%) CX (2; 0.345%), or PF (11; 1.9%). SOR placement required a counter-incision in 5 men (0.9%), and ectopic placement was required in 10 (1.8%). Ectopic placement was significantly associated with prior PF (p=0.014), but not with RP, MIRH, TX, or CX. High-risk patients were more likely to require a counter-incision to access the SOR (1.91 vs 0.29%, respectively; p=0.049). No bowel or bladder complications were encountered. One case involving SOR placement required repositioning due to iliac vein compression. CONCLUSIONS: Even in high-risk patients, penoscrotal SOR reservoir placement is feasible and safe, without the need for a counter-incision in 99% of patients. Ectopic placement was statistically more common in men with prior PF. A high-volume multicenter comparison seems warranted to determine if one approach is superior or if ectopic placement should be reserved for more well-defined populations. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e986-e986 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Boes More articles by this author Parth Thakker More articles by this author Rahul Dutta More articles by this author Adam Cohen More articles by this author Kyle Scarberry More articles by this author Ryan Terlecki More articles by this author Expand All Advertisement Loading ...

Ten-year experience with penile prosthetic surgery for the treatment of erectile dysfunction: outcomes of a tertiary referral center and predictors of early prosthetic infection.

We aimed to evaluate ten-year outcomes of penile prosthesis (PP) implantation for the treatment of erectile dysfunction and to assess predictors of early prosthetic infection (EPI). We identified 549 men who underwent 576 PP placements between 2008 and 2018. Univariate and multivariate analyses were used to identify potential predictors of EPI. An EPI predictive nomogram was developed. Thirty-five (6.1%) cases of EPI were recorded with an explant rate of 3.1%. In terms of satisfaction, 82.0% of the patients defined themselves as “satisfied,” while partner's satisfaction was 88.3%. Diabetes (P = 0.012), longer operative time (P = 0.032), and reinterventions (P = 0.048) were associated with EPI risk, while postoperative ciprofloxacin was inversely associated with EPI (P = 0.014). Rifampin/gentamicin-coated 3-piece inflatable PP (r/g-c 3IPP) showed a higher EPI risk (P = 0.019). Multivariate analyses showed a two-fold higher risk of EPI in diabetic patients, redo surgeries, or when a r/g-c 3IPP was used (all P < 0.03). We showed that diabetes, longer operative time, and secondary surgeries were the risk factors for EPI. Postoperative ciprofloxacin was associated with a reduced risk of EPI, while r/g-c 3IPP had higher EPI rates without an increased risk of PP explant. After further validation, the proposed nomogram could be a useful tool for the preoperative counseling of PP implantation.

151 Comparative Analysis of Long-term Outcomes of Two-piece versus Three-piece Inflatable Penile Prosthesis

Penile prosthesis is considered a definitive surgical treatment for medically refractory erectile dysfunction, as per the American Urological Association; however, there is a paucity of published literature regarding long-term outcomes comparing 2- vs 3-piece inflatable penile prosthesis (IPP).

New Advancements in Inflatable Penile Prosthesis.

Inflatable penile prosthesis (IPP) technology is a mainstay in the treatment of erectile dysfunction refractory to medical management. Technological advancements in the design of 3-piece IPPs have been improved to optimize concealability and surgical placement since the 1980s. Recent advancements over the past 10 years include pump, reservoir, tubing, and cylinder updates. This review examines the latest updates in IPP technology, reviews recent relevant research, and is based on over 32 years of experience performing IPP surgery in addition to concurrent postoperative management. A literature review was conducted for studies published over the last 10 years through March 2020 with an emphasis on technical updates of IPP, specifically the pump, reservoir, tubing, and cylinder, and their functional outcomes. Anti-infective coating and transgender innovations, in addition to postoperative management, are also reviewed. Technological advancements include a flat reservoir designed for improved discreteness and a prosthesis with optimized tubing length, a one-touch deflatable3-piece system, narrow-base cylinders, a 0° angle design between the cylinders and tubing to aid in cylinder placement, a soft molding cylinder tip redesign that better mimics human anatomy, and a 3-piece IPP specifically designed for neophallus use. Furthermore, the Food and Drug Administration approved the submuscular reservoir placement. Penile prosthesis has evolved over time to improve functional outcomes, ease of use, and minimize postoperative complications and pain. Penile prosthesis implantation continues to be a life-changing procedure for patients and it is imperative for surgeons to be up-to-date on the latest developments and research in order to provide the best functional outcomes for those they take care of. Dinerman BF, Telis L, Eid JF. New Advancements in Inflatable Penile Prosthesis. Sex Med Rev 2021;9:507-514.

"Pumpology": the Realistic Issues Associated with Pump Placement in Prosthetic Surgery.

The goal of this paper was to discuss the issues and/or overt complications associated with the 3-piece inflatable penile prosthesis (3-IPP) pump. We also addressed how to resolve such issues with or without surgical intervention. Numerous modifications of the 3-IPP pump have been introduced with multiple techniques to place the pump. These are largely dependent on the approach to place the 3-IPP. Pump issues may inevitably occur, and there are numerous special maneuvers that can be performed to resolve pump issues. It is important for urologists to know maneuvers for pump malfunctions to prevent unnecessary surgical procedures and pump revision. Several studies are reviewed regarding pump issues and patient satisfaction; however, a more structured prospective research project is warranted to further evaluate these issues.

Immediate Inflatable Penile Prosthesis Implantation in a Case of Neglected Delayed Idiopathic Ischemic Priapism—a Novel Approach

Long-standing ischemic priapism leads to cavernosal smooth muscle necrosis and erectile dysfunction [1]. We report a 28-year-old gentleman who presented with 3-week duration of neglected idiopathic ischemic priapism. As his stretched penile length was 9 cm, he was taken up for immediate implantation of penile prosthesis. With minimal difficulty in corporal dilation due to scarring, a 3-piece inflatable penile prosthesis was placed. He developed fever with chills and generalized rash in the immediate postoperative period and it responded to change of antibiotics and antihistaminics. He has good intercourse satisfaction with antegrade ejaculation at the end of 2 years.

VS-1-5 Penile Eversion and Multiple Slit Technique Corporoplasty With Inflatable Penile Prosthesis - Minimally Invasive Surgical Treatment of Severe MB Peyronie: No Circumcision, No Graft

Peyronie´s disease (PD) is a disorder of the tunica albuginea that diminishes sexual function. The penoscrotal approach for multiple slit technique and penile prosthesis placement without circumcision and without dissection of Dartos fascia from NVB is less common, yet less invasive method that has a natural cosmetic outcome, and delivers very high patient satisfaction. The surgical approach was thru small penoscrotal incision (3-4cm); direct dissection of NVB from tunica albuginea without mobilization of Dartos fascia from NVB; penile eversion thru penoscrotal incision; multiple slit corporoplasty; and 3-piece inflatable penile prosthesis implantation thru the same penoscrotal incision. Postoperative vacuum drainage and compressive penile and scrotal dressing were left in place for one week. In first 2 weeks the patient had a mild scrotal edema that resolved spontaneously. The patient started with normal sexual intercourse 6 weeks after the surgery. The patient reported natural esthetical appearance 10 weeks after surgery with no visible or palpable scars.

A Modified Surgical Technique for Reservoir Placement During Inflatable Penile Prosthesis Implantation.

IntroductionAt the moment, there is an ongoing debate regarding the controversial issue of the ideal reservoir placement (RP) surgical technique during implantation of a 3-piece inflatable penile prosthesis, but a definitive winner has not yet emerged.AimIn this light, we herein describe our modified technique for RP into the space of Retzius through the external oblique muscle fascia and present its results.MethodsIn total, 253 inflatable penile prosthesis procedures (110 AMS 700 and 143 Coloplast Titan) via a single transverse penoscrotal incision were retrospectively reviewed. 2 Kocher-Langenbeck retractors were placed over the right side of the penoscrotal incision and were used to retract the incision superior to the pubic bone. Then, the external oblique muscle fascia was incised medially to the spermatic cord which was retracted laterally. Next, a “W”, Vicryl 1, stay suture was placed to the incision, and under direct visualization, external oblique muscle fibers were dissected and fascia transversalis was perforated using a Metzenbaum scissor. A Foerster lung grasping clamp was then used to dissect further into the extraperitoneal space and create the reservoir space. The reservoir was placed into the created space and fascia incision was closed using the prepositioned stay suture. The procedure was then completed in a standard fashion.OutcomesThe main outcome measures were intraoperative or postoperative complications of our modified RP technique.ResultsAll 253 patients were available for short-term follow-up (average 9.1 months, range 3–22 months). No intraoperative or postoperative complications were reported. Reservoir-related prolonged pain (1 month) was reported by 1 patient, resolving completely after treatment with non-steroidal analgesics.ConclusionWe are, surely, not proposing that our modified RP technique should supplant all other methods; rather, it should be considered another useful option for RP in the implanter’s armamentarium.Mykoniatis I, Osmonov D, van Renterghem K. A Modified Surgical Technique for Reservoir Placement During Inatable Penile Prosthesis Implantation. Sex Med 2020;8:378–382.

Inflatable Penile Prosthesis in the Ambulatory Surgical Setting: Outcomes From a Large Urological Group Practice

BackgroundThe definitive treatment for erectile dysfunction is the surgical implantation of a penile prosthesis, of which the most common type is the 3-piece inflatable penile prosthesis (IPP) device. IPP surgery in outpatient freestanding ambulatory surgical centers (ASC) is becoming more prevalent as payers and health systems alike look to reduce healthcare costs. AimTo evaluate IPP surgical outcomes in an ASC as compared to contemporaneously-performed hospital surgeries. MethodsA database of all patients undergoing IPP implantation by practitioners in the largest private community urology group practice in the United States, from January 1, 2013 to August 1, 2019, was prospectively compiled and retrospectively reviewed. Cohorts of patients having IPP implantation performed in the hospital vs ASC setting were compared. Main Outcome MeasureThe primary outcome measure was to compare surgical data (procedural and surgical times, need for hospital transfer from ASC) and outcomes (risk for device infection, erosion, and need for surgical revision) between ASC and hospital-based surgery groups. ResultsA total of 923 patients were included for this analysis, with 674 (73%) having ASC-based surgery and 249 (27%) hospital-based, by a total of 33 surgeons. Median procedural (99.5 vs 120 minutes, P < .001) and surgical (68 vs 75 minutes, P < .001) times were significantly shorter in the ASC. While the risk for device erosion and need for surgical revision were similar between groups, there was no higher risk for prosthetic infection when surgery was performed in the ASC (1.7% vs 4.4% [hospital], P = .02), corroborated by logistic regression analysis (odds ratio 0.39, P = .03). The risk for postoperative transfer of an ASC patient to the hospital was low (0.45%). The primary reason for mandated hospital-based surgery was medical (51.4%), though requirement as a result of insurance directive (39.7%) was substantial. Clinical ImplicationsIPP implantation in the ASC is safe, has similar outcomes compared to hospital-based surgery with a low risk for need for subsequent hospital transfer. Strengths & LimitationsThe strengths of this study include the large patient population in this analysis as well as the real-world nature of our practice. Limitations include the retrospective nature of the review as well as the potential for residual confounding. ConclusionASC-based IPP implantation is safe, with shorter surgical and procedural times compared to those cases performed in the hospital setting, with similar functional outcomes. These data suggest no added benefit to hospital-based surgery in terms of prosthetic infection risk.Weinberg AC, Siegelbaum MH, Lerner BD, et al. Inflatable Penile Prosthesis in the Ambulatory Surgical Setting: Outcomes From a Large Urological Group Practice. J Sex Med 2020;17:1025–1032.

302 Outcomes Related to Penile Prosthesis Reservoir Removal: A Multi-institutional Experience

Removal of an inflatable penile prosthesis (IPP) reservoir deep in the space of retzius (SOR) or alternate/ectopic space (AES) can be difficult, even for the experienced surgeon. The purpose of this study was to look at outcomes and complications related to reservoir removal during revision or explant surgery. We retrospectively reviewed databases of 3-piece IPP revision and removal surgeries from 7 high-volume prosthetic surgeons at 6 institutions from January 2011 to December 2018. Concurrent urinary sphincter, sling or Mini-jupette placement were excluded. Outcomes and complications related to IPP reservoirs during revision and removal surgery were analyzed. A total of 171 revisions and 44 explants (215 total cases included) were performed of which 172 reservoirs (80%) were in the SOR and 43 (20%) in an AES. Thirty-five cases were secondary to infection (16.3%), 49 (22.8%) had malposition and 131 (60.9%) were due to malfunction. There were 44 cases (20.5%) during which the reservoir was retained. Reasons for retaining reservoirs included difficult dissection (9.1%), avoid injuring surrounding structures (18.2%), reuse of the reservoir for a new IPP (59.1%), and unspecified (13.6%). Reservoir-related postoperative complications included a delayed infection (n=1) of a retained AES reservoir that developed a cutaneous fistula 4 years after revision surgery. Among removed reservoirs (N=171), 15 (8.8%) required a counter-incision. Reservoir-related intraoperative complications included a bladder perforation (N=1) in the SOR group, and an avulsion of the epigastric vessels requiring abdominal exploration (N=1) in the AES group.

Clinical Outcome: Patient and Partner Satisfaction after Penile Implant Surgery

Background: Erectile dysfunction (ED) is a common disorder, which affects at least 50% of males aged 50-70 years. According to EAU Guidelines on male sexual dysfunction, implantation of an inflatable penile prosthesis (IPP) is a valid, third-line therapeutic option for treatment of ED. Objective: We conducted a retrospective single centre study to analyze mechanical reliability, complication rate, patient satisfaction and quality of life after penile prosthesis implantation. Materials and Methods: A total of 126 electronic patient files after primary implantation of an IPP during a 5-year period were investigated. A structured telephone interview concerning patient and partner satisfaction was conducted at least 1 year after implant surgery. Results: We found that 15 patients (11.9%) had revision surgery for various reasons. Mechanical failure occurred in 7.14% of the patients and was the main reason for revision surgery. Other major complications and complaints were loss of penile length (18.53%), postoperative pain (11.9%) and altered sensation (8.73%). No patients required explantation for infection, and 1 patient (0.79%) underwent revision surgery for an imminent erosion. One year or more after surgery, the patient and partner satisfaction rates, were 83.2 and 85.4%, respectively. We observed very high patient and partner satisfaction rates for the implantation of an IPP, with improvement of the general quality of life. These rates are negatively influenced by the occurrence of postoperative complications and complaints such as postoperative penile length shortening, pain and floppy glans syndrome. Most patients regain sexual function 6 weeks after surgery with no or minimal effect on the orgasm. Conclusion: The implantation of a 3-piece IPP has proven an effective, third-line treatment for patients with ED.