To evaluate the pre- and intraoperative variables that impact the integrity of the corporal bodies over time after inflatable penile prosthesis (IPP) placement, as predictors of intraoperative corporal perforation and delayed cylinder complications have not been well characterized.

Patients and Methods

We retrospectively reviewed a 16-centre multi-institutional database of IPP surgeries performed by experienced implanters from 2016 to 2021. Poor corporal integrity (PCI) was defined as intraoperative (iPCI) corporal complications or postoperative (pPCI) corporal complications. Multivariable analysis was performed to identify independent predictors of PCI, iPCI, and pPCI. Primary outcomes included intra- and postoperative corporal complications.

Results

We identified 5153 patients for analysis from 5406 IPP cases, finding 152 (2.95%) cases of PCI. On multivariable analysis, predictors of PCI included revision IPP surgery (odds ratio [OR] 8.16, 95% confidence interval [CI] 5.15–12.92; P < 0.001), sequential dilatation (OR 2.12, 95% CI 1.32–3.39; P = 0.002), coronary artery disease (CAD)/peripheral vascular disease (PVD) (OR 1.81, 95% CI 1.18–2.77; P = 0.006), older age (OR 1.02, 95% CI 1.01–1.04; P = 0.013), and corporal scarring (OR 1.58, 95% CI 1.0–2.5; P = 0.049). Predictors of iPCI included revision IPP surgery (OR 7.34, 95% CI 4.18–12.88; P < 0.001), corporal scarring (OR 2.77, 95% CI 1.64–4.69; P < 0.001), radiation therapy (OR 2.25, 95% CI 1.0–5.04; P = 0.049), and older age (OR 1.03, 95% CI 1.0–1.05; P = 0.025). Revision IPP surgery (OR 7.92, 95% CI 3.69–17.01; P < 0.001), sequential dilatation (OR 3.4, 95% CI 1.61–7.19; P = 0.001), CAD/PVD (OR 2.98, 95% CI 1.56–5.72; P = 0.001), and history of priapism (OR 3.59, 95% CI 1.08–11.99; P = 0.038) were predictive of pPCI.

Conclusion

Coronary artery disease/PVD, being of older age, having corporal scarring, undergoing IPP revision surgery and sequential dilatation were predictive risk factors for complications associated with PCI. Identifying patients who are at risk of having PCI may improve patient-specific counselling, consideration of referral to more experienced implanters, and surgical planning to potentially promote longer-term device viability.

Supporting Information

References

1Levine LA, Becher EF, Bella AJ et al. Penile prosthesis surgery: current recommendations from the international consultation on sexual medicine. J Sex Med 2016; 13: 489–518
10.1016/j.jsxm.2016.01.017
PubMedWeb of Science®Google Scholar
2Montague DK, Angermeier KW, Lakin MM. Penile prosthesis infections. Int J Impot Res 2001; 13: 326–328
10.1038/sj.ijir.3900768
CASPubMedWeb of Science®Google Scholar
3Hebert KJ, Kohler TS. Penile prosthesis infection: myths and realities. World J Mens Health 2019; 37: 276–287
10.5534/wjmh.180123
PubMedGoogle Scholar
4Gross MS, Phillips EA, Carrasquillo RJ et al. Multicenter investigation of the micro-organisms involved in penile prosthesis infection: an analysis of the efficacy of the AUA and EAU guidelines for penile prosthesis prophylaxis. J Sex Med 2017; 14: 455–463
10.1016/j.jsxm.2017.01.007
PubMedGoogle Scholar
5Gross MS, Reinstatler L, Henry GD et al. Multicenter investigation of fungal infections of inflatable penile prostheses. J Sex Med 2019; 16: 1100–1105
10.1016/j.jsxm.2019.05.003
PubMedWeb of Science®Google Scholar
6Barham DW, Pyrgidis N, Gross MS et al. AUA-recommended antibiotic prophylaxis for primary penile implantation results in a higher, not lower, risk for postoperative infection: a multicenter analysis. J Urol 2023; 209: 399–409
10.1097/JU.0000000000003071
PubMedGoogle Scholar
7Clavell-Hernández J. Proximal extracapsular tunneling: a simple technique for the Management of Impending Cylinder Erosion and Complications Related to corporal dilation. Sex Med 2021; 9: 100379
10.1016/j.esxm.2021.100379
PubMedGoogle Scholar
8Antonini G, Busetto GM, Del Giudice F et al. Distal corporal anchoring stitch: a technique to address distal corporal crossovers and impending lateral extrusions of a penile prosthesis. J Sex Med 2017; 14: 767–773
10.1016/j.jsxm.2017.04.669
PubMedGoogle Scholar
9Minervi A, Ralph DJ, Pryor JP. Outcome of penile prosthesis implantation for treating erectile dysfunction: experience with 504 procedures. BJU Int 2005; 97: 129–133
10.1111/j.1464-410X.2005.05907.x
Web of Science®Google Scholar
10Carson CC, Mulcahy JJ, Govier FE. Efficacy, safety, and patient satisfaction outcomes of the AMS 700CX inflatable penile prosthesis: results of a long-term multicenter study. J Urol 2000; 164: 376–380
10.1016/S0022-5347(05)67364-8
CASPubMedWeb of Science®Google Scholar
11Li K, Brandes ER, Chang SL et al. Trends in penile prosthesis implantation and analysis of predictive factors for removal. World J Urol 2019; 37: 639–646
10.1007/s00345-018-2491-4
PubMedGoogle Scholar
12Chan EP, Punjani N, Campbell JD, Abed H, Brock G. Indications for penile prosthesis revision: lessons learned to limit technical causes of reoperation. J Sex Med 2019; 16: 1444–1450
10.1016/j.jsxm.2019.06.003
PubMedGoogle Scholar
13Mirheydar H, Zhou T, Chang DC, Hsieh TC. Reoperation rates for penile prosthetic surgery. J Sex Med 2016; 13: 129–133
10.1016/j.jsxm.2015.11.013
PubMedGoogle Scholar
14Gonzalez-Cadavid NF. Mechanisms of penile fibrosis. J Sex Med 2009; 6(Suppl 3): 353–362
10.1111/j.1743-6109.2008.01195.x
PubMedWeb of Science®Google Scholar
15Miller JA, Bennett NE Jr. Comparing risk factors for adverse outcomes in virgin inflatable penile prosthesis implantations and revisions: a retrospective cohort study. Sex Med 2020; 8: 388–395
10.1016/j.esxm.2020.05.004
PubMedGoogle Scholar
16Lotan Y, Roehrborn CG, McConnell JD, Hendin BN. Factors influencing the outcomes of penile prosthesis surgery at a teaching institution. Urology 2003; 62: 918–921
10.1016/S0090-4295(03)00665-4
PubMedWeb of Science®Google Scholar
17Fuentes JL, Yi YA, Davenport MT, Bergeson RL, Ward EE, Morey AF. Long-term sequelae of inflatable penile prosthesis: clinical characteristics of patients who develop distal cylinder tip extrusion. Transl Androl Urol 2020; 9: 38–42
10.21037/tau.2019.08.30
PubMedGoogle Scholar
18Wynn TA. Cellular and molecular mechanisms of fibrosis. J Pathol 2008; 214: 199–210
10.1002/path.2277
CASPubMedWeb of Science®Google Scholar
19Kim J, Drury R, Morenas R, Raheem O. Pathophysiology and grayscale ultrasonography of penile corporal fibrosis. Sex Med Rev 2022; 10: 99–107
10.1016/j.sxmr.2021.07.005
PubMedGoogle Scholar
20Chang C, Barham DW, Dalimov Z et al. Single dilation in primary inflatable penile prosthesis placement is associated with fewer corporal complications than sequential dilation. Urology 2023; 181: 150–154
10.1016/j.urology.2023.06.037
PubMedGoogle Scholar
21Golan R, Patel NA, Sun T, Barbieri CE, Sedrakyan A, Kashanian JA. Impact of pelvic radiation therapy on inflatable penile prosthesis reoperation rates. J Sex Med 2018; 15: 1653–1658
10.1016/j.jsxm.2018.09.009
PubMedGoogle Scholar
22Wilson SK, Delk JR, Mulcahy JJ, Cleves M, Salem EA. Upsizing of inflatable penile implant cylinders in patients with corporal fibrosis. J Sex Med 2006; 3: 736–742
10.1111/j.1743-6109.2006.00263.x
PubMedWeb of Science®Google Scholar
23Martínez-Salamanca JI, Mueller A, Moncada I, Carballido J, Mulhall JP. Penile prosthesis surgery in patients with corporal fibrosis: a state of the art review. J Sex Med 2011; 8: 1880–1889
10.1111/j.1743-6109.2011.02281.x
PubMedWeb of Science®Google Scholar
24Pearlman AM, Terlecki RP. Proximal corporal perforation during penile prosthesis surgery: prevention, recognition, and review of historical and novel management strategies. J Sex Med 2018; 15: 1055–1060
10.1016/j.jsxm.2018.04.635
PubMedGoogle Scholar
25Barham DW, Chang C, Hammad M et al. Delayed placement of an inflatable penile prosthesis is associated with a high complication rate in men with a history of ischemic priapism. J Sex Med 2023; 20: 1052–1056
10.1093/jsxmed/qdad075
PubMedGoogle Scholar
26Zacharakis E, Raheem AA, Freeman A et al. The efficacy of the T-shunt procedure and intracavernous tunneling (snake maneuver) for refractory ischemic priapism. J Urol 2014; 191: 164–168
10.1016/j.juro.2013.07.034
PubMedWeb of Science®Google Scholar
27Zacharakis E, Garaffa G, Raheem AA, Christopher AN, Muneer A, Ralph DJ. Penile prosthesis insertion in patients with refractory ischaemic priapism: early vs delayed implantation. BJU Int 2014; 114: 576–581
10.1111/bju.12686
CASPubMedWeb of Science®Google Scholar
28Henry GD, Kansal NS, Callaway M et al. Centers of excellence concept and penile prosthesis: an outcome analysis. J Urol 2009; 181: 1264–1268
10.1016/j.juro.2008.10.157
PubMedWeb of Science®Google Scholar

Early View

Online Version of Record before inclusion in an issue

New findings regarding predictors of Poor Corporal Integrity in Penile Implant Recipients: A Multicenter International Invesigation

Abstract

Objectives

Patients and Methods

Results

Conclusion

Supporting Information

References

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

New findings regarding predictors of Poor Corporal Integrity in Penile Implant Recipients: A Multicenter International Invesigation

Abstract

Objectives

Patients and Methods

Results

Conclusion

Supporting Information

References

References

Related

Information