Three-Piece Inflatable Penile Prosthesis Placement Following Pelvic Radiation: Technical Considerations and Contemporary Outcomes

Abstract

Background Pelvic radiation is a known risk factor for the development and progression of erectile dysfunction. When medical therapy fails, the 3-piece inflatable penile prosthesis (IPP) can offer patients a definitive treatment option. Because of radiation-induced vascular changes and tissue fibrosis, a careful surgical approach is necessary to avoid intraoperative complications and attain successful outcomes. Despite its widespread use in prostate cancer treatment, there are no contemporary studies examining the effects that pelvic radiation can have on 3-piece IPP placement and device survival. Aim To present technical considerations and contemporary outcomes of placing a 3-piece IPP for refractory erectile dysfunction in patients with a history of pelvic radiation. Methods We retrospectively reviewed 78 patients who underwent placement of a 3-piece IPP (AMS 700; Boston Scientific, Marlborough, MA, USA) after being treated with pelvic radiotherapy from 2003 through 2016. All patients had been treated with external beam and/or brachytherapy for treatment of prostate malignancy. An infrapubic approach was used in all patients, with reservoir placement in the space of Retzius or in the lateral retroperitoneal space. Patient demographics, perioperative data, and postoperative outcomes including prosthetic infection and mechanical failure were examined and statistical analysis was performed. Outcomes Rates of device infection, revision surgery, and reservoir complications. Results No intraoperative complications were observed. After a mean follow-up of 49.0 months (6.6–116.8), 2 patients developed an infection of their prosthesis that required explantation. These patients underwent successful IPP removal and immediate reimplantation. 11 patients (14.1%) required revision surgery (pump replacement, n = 4; pump relocation, n = 2; cylinder replacement, n = 4; reservoir replacement owing to leak, n = 1). No reservoir-related complications such as herniation or erosion into adjacent structures were observed. Clinical Implications The 3-piece IPP can be placed safely in a broad range of patients treated with pelvic radiotherapy. Strengths and Limitations This study describes contemporary long-term outcomes of the IPP in patients treated with pelvic radiation and includes patients with prior pelvic surgery and artificial urinary sphincter, which are commonly encountered in practice. It is limited by its single-center experience and lacks a comparison group of patients. Objective patient satisfaction data were not available for inclusion. Conclusions The 3-piece IPP can be placed successfully in patients with a history of pelvic radiation without a significant increase in infectious complications, reservoir erosion, or mechanical failure compared with the global literature.

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

“…Similar to previous reports, we did not find any correlation between patient age, history of urinary diversion, history of pelvic radiotherapy, obesity, and EPI. 12 24 25 26 27 28 29 30 31 32 33 Furthermore, we failed to find any association between EPI and active smoking status. Despite this, the negative effect of tobacco smoking in the immediate postoperative setting has been well documented.…”

Penile Prosthesis Infection: Myths and Realities

“…However, radiated sphincter infection data is confounded by higher rates of urethral cuff erosion which is linked with infection. In the IPP literature, no contemporary studies have shown a statistically significant difference in infections rates [183839]. Thus, there is level 3 evidence that infection rates are not affected by radiation.…”

Erectile Dysfunction in Pelvic Cancer Survivors and Current Management Options

“…Satisfaction after a penile prosthesis is very high (over 90%) compared to those receiving pharmacologic treatment, and it is associated with the improvement in EF measured with IIEF-5 [ 9 , 15 , 57 , 58 ]. Similarly high satisfaction rates are described in IPP after pelvic radiation without an increase in infections, erosion, or mechanical failures [ 57 , 85 ].…”