The International Penile Prosthesis Implant Consensus Forum: clinical recommendations and surgical principles on the inflatable 3-piece penile prosthesis implant

Chung, Eric; Bettocchi, Carlo; Egydio, Paulo H.; Love, Chris; Park, Sean S.; Ralph, David; Xin, Zhong Cheng; Brock, Gerald

doi:10.1038/s41585-022-00607-z

Cited by 24 publications

(44 citation statements)

References 90 publications

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“…The size of the IPP reservoir depends on the size of the cylinders. 17 The average IPP cylinder size was 21.1 and 21.2 cm in the SOR and MSMR groups, respectively ( p = 0.93). We use a 125-mL reservoir and fill it between 90 and 110 mL according to the prosthesis size.…”

Section: Discussionmentioning

confidence: 90%

Midline submuscular penile prosthesis reservoir placement for patients with bilateral inaccessible inguinal rings: technique and outcomes

Zisman

Razdan

Siegal

et al. 2022

Therapeutic Advances in Urology

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Introduction: One of the most challenging aspects of inflatable penile prosthesis (IPP) surgery is reservoir placement. The traditional space of Retzius (SOR) is not suitable for all patients. For example, radical cystectomy or prostatectomy may alter the anatomical SOR. Hence, traditional placement of the reservoir in this space increases the risk of bowel or vascular injury. Also, patients with bilateral inguinal hernias repaired with mesh, or those with previous reservoirs that have been retained, are not eligible for a Retzius reservoir. Our study reports on the use of midline sub-rectus muscle placement of a penile prosthesis reservoir in these patients as an alternative to high submuscular placement commonly used. Methods: A retrospective chart review of male patients who underwent IPP surgery between June 2017 and 2021 was conducted. Patients were divided into two groups based on the location of the reservoir: SOR versus Midline Submuscular Reservoir (MSMR). Complication rates were compared, including herniated reservoirs, infections, bowel injuries, and vascular injuries. Results: Our cohort included 461 patients who underwent IPP surgery between June 2017 and 2021 in one tertiary center. SOR was used in 89% of patients and MSMR in 11% of patients ( n = 413 and 48, respectively). Median follow-up for all patients was 28 months. The mean age was 67 ± 8 years. There was no statistically significant difference between the two groups regarding age or comorbidities (BMI, diabetes mellitus, hypertension, hyperlipidemia, and coronary artery disease). The complication rate was low in both the SOR and MSMR groups, with device malfunction being the most common (2% versus 4%, respectively; p = 0.32). The infection rate was 0.5% in the SOR group with no infections in the MSMR group (NS). There was only one case of herniation requiring surgical revision in the SOR group and no cases of bowel or vascular injury. Conclusion: Placement of a penile prosthesis reservoir within a midline rectus submuscular space is a safe and effective technique when the SOR is compromised by previous surgery or bilateral inguinal canals are not accessible.

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Section: Discussionmentioning

confidence: 90%

Midline submuscular penile prosthesis reservoir placement for patients with bilateral inaccessible inguinal rings: technique and outcomes

Zisman

Razdan

Siegal

et al. 2022

Therapeutic Advances in Urology

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“…Standard approaches to minimize hematomas postoperatively after IPP include watertight corporotomy closure, meticulous hemostasis, use of a Mummy wrap, and partial device in ation 5,6,11,38 . Other factors remain controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Despite advancements in prosthetic devices, surgical techniques and postoperative management strategies over the past decade, hematoma formation remains a major postoperative complication 5,7,11,[25][26] . Our series demonstrates an overall rate of 5% hematoma formation, and we further identify complex IPP cases as a risk factor for clinically signi cant scrotal hematoma formation with an incidence of 10% among complex IPP cases 27 .…”

Section: Discussionmentioning

confidence: 99%

Defining the Incidence and Management of Postoperative Scrotal Hematoma after Primary and Complex Three-piece Inflatable Penile Prosthesis Surgery

Simhan

Braun

Swerdloff³

et al. 2022

Preprint

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Background: Scrotal hematoma is a challenging complication of penile prosthesis surgery. We characterize the risk of hematoma formation with implementation of standardized techniques to mitigate hematomas and assess for any associated factors in a large multi-institutional penile implant cohort. Materials and Methods: A retrospective review from February 2018 to December 2020 of all patients who underwent inflatable penile prosthesis (IPP)implantation at 2 high volume implant centers was conducted. Cases were defined as ‘complex’ if they involved revision, salvage with removal/replacement, or were performed with concurrent penile, scrotal or intra-abdominal surgeries. The incidence of scrotal hematoma among primary and complex IPP recipients was measured and modifiable and innate risk factors associated with hematoma formation within the two cohorts were tracked. Results: Of 246 men who underwent IPP, 194 (78.9%) patients underwent primary implantation and 52 (21.1%) were complex. Although patients in the complex group had comparable drain outputs to non-hematoma patients on POD0 (66.8cc vs 49.6, p=0.488) and POD1 (20.0cc vs 40.3, p=0.114), hematomas in the complex group had a higher propensity for OR evacuation (p=0.03). Difference in duration of temporary device inflation between 2 and 4 weeks did not contribute to hematoma formation. Postoperative hematoma formation in complex cases (5/52, 9.6%) trended towards a higher incidence than primary cases (7/194, 3.1%) (HR=2.61, p=0.072). Conclusions: Complex IPP surgery performed for revision or with ancillary procedures are more likely to result in clinically significant hematomas that require surgical management, suggesting a need for heightened caution in managing these individuals.

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“…Penile prostheses have been the gold-standard treatment for medically refractory ED since they became popular, and most of the men treated with penile prostheses have organic causes [ 65 , 66 ]. However, penile prosthesis surgery is an invasive procedure with potential complications that can increase the overall economic burden on patients [ 67 , 68 ]. More importantly, strong evidence suggests that high-risk patients, including those with uncontrolled diabetes mellitus, corporal fibrosis, and those undergoing salvage penile implants, are at greater risk of complications [ 69 ].…”

Section: Hydrogels Could Be the New Expectation For The Repairment Of...mentioning

confidence: 99%

Advanced hydrogels: New expectation for the repair of organic erectile dysfunction

Ren

Yuan

Xue

et al. 2023

Materials Today Bio

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The International Penile Prosthesis Implant Consensus Forum: clinical recommendations and surgical principles on the inflatable 3-piece penile prosthesis implant

Cited by 24 publications

References 90 publications

Midline submuscular penile prosthesis reservoir placement for patients with bilateral inaccessible inguinal rings: technique and outcomes

Midline submuscular penile prosthesis reservoir placement for patients with bilateral inaccessible inguinal rings: technique and outcomes

Defining the Incidence and Management of Postoperative Scrotal Hematoma after Primary and Complex Three-piece Inflatable Penile Prosthesis Surgery

Advanced hydrogels: New expectation for the repair of organic erectile dysfunction

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