Penoscrotal approach for IPP: still up-to-date after more than 40 years?

Houlihan, Matthew; Köhler, Tobias; Wilson, Steven K.; Hatzichristodoulou, Georgis

doi:10.1038/s41443-019-0206-z

Cited by 9 publications

(6 citation statements)

References 41 publications

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“…Also, numerous variations in surgical technique have been introduced over the past 5 decades. Many studies have presented different approaches (penoscrotal, infrapubic, or subcoronal) regarding accessing the corporal bodies during IPP surgery [13][14][15]. Moreover, the serious reservoir placement-related complications and increased application of surgical approaches, which compromise the space of Retzius, led prosthetic urologists to introduce innovative Retzius sparing reservoir placement techniques [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, RTEs were developed in 1981 and quickly became popular among implanters as a measure to minimize friction of the tubing against the cylinder wall. The reported high RTE use rate, from 58% up to 73%, during IPP surgeries suggests that this innovation gave surgeons flexibility 13.5 (12)(13)(14)(15) in placement of corporotomies and minimization of intracorporeal tubing [16]. However, it has separately reported that RTE utilization be kept to a minimum.…”

Section: Discussionmentioning

confidence: 99%

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Current practices regarding corporotomy localization during penoscrotal inflatable penile implant surgery: a multicenter cohort study

Renterghem

Jacobs²,

Yafi

et al. 2021

Int J Impot Res

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Literature concerning corporotomy location in multicomponent inflatable penile prosthetic surgery via a penoscrotal approach is scarce if not nonexistent. Aim of our study was to report practices in low-, moderate-, and high-volume penile implant centers regarding corporotomy location and evaluate its potential impact on intraoperative and short-term postoperative complications. Data from 18 (13 European and 5 American) implant centers were collected retrospectively between September 1st, 2018 and August 31st, 2019. Variables included: intraoperative proximal and distal corpus cavernosum length measurement, total corporal length measurement, total penile implant cylinder length, and length of rear tip extenders. Eight hundred and nine virgin penile implant cases were included in the analysis. Mean age of participants was 61.5 ± 9.6 years old. In total, 299 AMS 700™ (Boston Scientific, USA) and 510 Coloplast Titan® (Minneapolis, MN USA) devices were implanted. The mean proximal/distal corporal measurement ratio during corporotomy was 0.93 ± 0.29 while no statistical difference was found among low-, moderate-, and high-volume penile implant centers. A statistically significant correlation between lower proximal/distal measurement ratio and higher age (p = 0.0013), lower BMI (p < 0.0001), lower use of rear tip extenders (RTE) (p = 0.04), lower RTE length (p < 0.0001), and absence of diabetes (p = 0.0004) was reported. In a 3-month follow up period, 49 complications and 37 revision procedures were reported. This is the first study reporting the current practices regarding corporotomy location during IPP placement in a multicenter cohort, particularly when including such a high number of patients. Nevertheless, the retrospective design and the short follow up period limits the study outcomes. Corporotomy location during penoscrotal IPP implantation does not correlate with intraoperative or short-term postoperative complication rates. Future studies with longer follow up are needed in order to evaluate the association of corporotomy location with long-term complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Current practices regarding corporotomy localization during penoscrotal inflatable penile implant surgery: a multicenter cohort study

Renterghem

Jacobs²,

Yafi

et al. 2021

Int J Impot Res

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“…Penile prostheses (PPs) have been the chosen end-stage treatment for erectile dysfunction worldwide for many years, although increasingly there is now an appropriate move to discuss and offer implant surgery to patients earlier in their treatment journey so that patients can choose the treatment most acceptable to them. First performed in 1936 by Nicoli Bogoras, the surgical technique has vastly evolved and now involves the insertion of silicone and bioflex devices into the corpus cavernosa [1]. Implantation of foreign material into the body has long been associated with an increased risk of infection of prosthetic devices [2].…”

Section: Introductionmentioning

confidence: 99%

Is There a Role for Antifungal Prophylaxis in Patients Undergoing Penile Prosthesis Surgery? A Systematic Review

2022

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Objective: The aim of this study is to review the literature on the use of antifungal prophylaxis in penile prosthesis (PP) surgery and provide a summary on its efficacy as an adjunct to current prophylactic regimes in patients undergoing PP surgery. Materials and Methods: PubMed, Medline, and EMBASE databases were systematically searched up to May 2020. All included studies were analysed and the information extracted included author, title of study, year of publication, type of study, journal of publication, and main findings regarding post PP implantation fungal infections. Results: Nine relevant studies were included in this review, comprising retrospective single-centre studies and retrospective multicentre studies ranging from 2017 to 2020. Fungal infections were found responsible for 11.1% of all PP infections, with a greater risk in patients with diabetes, obesity, and from warmer climates. Current American Urological Association (AUA) and European Association of Urology (EAU) prophylaxis guidelines do not incorporate the use of antifungals. Trials of antifungal prophylaxis regimes combined with antibiotic prophylaxis have demonstrated a reduction in PP fungal infections. Conclusions: Fungal infections represent a significant proportion of implant infections and therefore antifungal prophylaxis is warranted. Future studies comparing the efficacy of traditional antibiotic prophylaxis as set out by AUA/EAU with novel prophylaxis regimes including the addition of an antifungal may provide more definitive guidance on this issue. Until then antifungal prophylaxis in all patients undergoing PP procedures may provide a significant cost-effect benefit.

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“…To date, the placement of an IPP can be done using various approaches, including infrapubic, subcoronal, and penoscrotal incisions. The most common approach is through a penoscrotal incision where up to 80% of IPPs are placed using this approach [2,3]. Generally, if another approach is used for IPP placement, infrapubic is utilized [4].…”

Section: Introductionmentioning

confidence: 99%

Complication rates in concurrent inflatable penile prosthesis and incontinence surgery: Comparing the penoscrotal versus perineal incision approach

et al. 2022

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Introduction: Limited data exist on in atable penile prosthesis (IPP) complication rates following dual implantation with an arti cial urinary sphincter (AUS) or bulbourethral male sling via a single perineal incision. Herein, we assess IPP complication rates after dual implantation via a single perineal incision versus more traditional penoscrotal approach.Methods: Patients with dual implantations of an IPP and AUS or sling between the 2011-2021 were identi ed. Postoperative IPP complications were assessed using the Clavien-Dindo (CD) classi cation at <30 days, 30 days-6 months, and >6 months. Treatment satisfaction was assessed using the validated EDITS questionnaire. IPP complication rates and mean EDITS scores were compared between the perineal and penoscrotal groups.Results: A total of 38 patients underwent dual implantation; 24 perineal vs 14 penoscrotal. There was no statistical difference in rate of complications between the two groups. The penoscrotal group had only two CD Grade I complications reported in the 30-day period and one Grade III complication in the >30 day to 6-month postoperative period. The perineal group had only two Grade III reported complications in the >6 month time frame. One patient in the perineal group and two in the penoscrotal group reported device malfunction at any point during follow-up, with no statistical difference in the rate of device malfunction.Conclusion: Patients undergoing dual IPP and AUS/sling placement via a perineal vs penoscrotal incision had similar IPP complication rates. A single perineal incision is a viable surgical approach for the dual implantation of an IPP and AUS or bulbourethral male sling.

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Penoscrotal approach for IPP: still up-to-date after more than 40 years?

Cited by 9 publications

References 41 publications

Current practices regarding corporotomy localization during penoscrotal inflatable penile implant surgery: a multicenter cohort study

Current practices regarding corporotomy localization during penoscrotal inflatable penile implant surgery: a multicenter cohort study

Is There a Role for Antifungal Prophylaxis in Patients Undergoing Penile Prosthesis Surgery? A Systematic Review

Complication rates in concurrent inflatable penile prosthesis and incontinence surgery: Comparing the penoscrotal versus perineal incision approach

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