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The Efficacy of Durasphere as a New Agent for the Treatment of Hypermobile Glans
Martin S. Gross, MD1, Jared Wallen, MD2, SriGita Madiraju, MD3, Kevin Tayon, MD3, Rafael E. Carrion, MD2, Paul E. Perito, MD4.
1Dartmouth-Hitchcock Medical Center/Dartmouth-Hitchcock Keene, Lebanon, NH, USA, 2USF Morsani College of Medicine, Tampa, FL, USA, 3FAU Charles E. Schmidt College of Medicine, Boca Raton, FL, USA, 4Perito Urology, Coral Gables, FL, USA.
BACKGROUND: Despite proper sizing and placement of a penile implant, a subset of patients present postoperatively with glanular hypermobility. This is characterized by sensation of a soft glans penis, pain during intercourse associated with cylinder tip pressure, or the appearance of droopy glans with maximal inflation. Previous studies have discussed the use of PDE5 inhibitors and/or intraurethral alprostadil to treat the hypermobile glans. In this study we present our results of subcoronal Coloplast (Minneapolis, MN) Durasphere® injections as a surgical treatment for the hypermobile glans.
METHODS: Durasphere is a safe, sterile bulking agent composed of carbon-coated zirconium beads suspended in a water based beta-glucan gel. It has long been used as a bulking agent in the treatment of urinary incontinence caused by intrinsic sphincter deficiency (ISD). This is a retrospective review of 17 patients who underwent glanular bulking with Durasphere by a single surgeon from 2014-16. Patient data were compiled after extensive review of operative reports, inpatient notes, consult notes, and follow-up visits.
RESULTS: Seventeen patients underwent a total of 61 subcoronal Durasphere injections (mean 3.6, range 2-8). Twelve of these patients have been seen in follow-up on average 13.5 weeks (range 1-36) since their injections. All patients reported satisfaction with their treatment regimen, reduced or absent pain during intercourse, and subjectively improved appearance of their erect penis. No patients have reported any adverse events.
CONCLUSIONS: Durasphere has a safe and effective history in ISD treatment and our initial data suggests that similarly successful results are obtainable for glanular hypermobility treatment in experienced hands. We believe subcoronal Durasphere injections should be a viable option in the armamentarium of treatments for glanular hypermobility due to high patient satisfaction, ease of intervention, and low adverse events. Proper diagnosis requires expert evaluation to ensure that the penile implant is appropriately sized and positioned in order to rule out floppy glans syndrome and SST deformity. As opposed to glanular hypermobility, these conditions are caused by an undersized implant and require surgical revision.
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