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New Data Regarding Penile Length Preservation After IPP Implantation
Martin S. Gross, MD1, Jared Wallen, MD2, Hajar Ayoub, MD3, O. Lenaine Westney, MD3, Paul E. Perito, MD4.
1Dartmouth-Hitchcock Medical Center/Dartmouth-Hitchcock Keene, Lebanon, NH, USA, 2USF Morsani College of Medicine, Tampa, FL, USA, 3University of Texas Health Sciences Center at Houston, Houston, TX, USA, 4Perito Urology, Coral Gables, FL, USA.

BACKGROUND: The inflatable penile prosthesis (IPP) is the gold standard for the treatment of erectile dysfunction refractory to medical management. Loss of penile length after IPP implantation is a concern for many patients with ED who choose surgical treatment. Evidence of preservation of penile length in the postoperative setting would enhance functional outcomes and could remove a potential barrier to intervention. The purpose of the study was to evaluate the effectiveness of the Coloplast (Minneapolis, MN) Titan® cylinders in maintaining penile length post-IPP implantation in patients treated for ED.
METHODS:
A single-armed, multi-center, multi-surgeon, prospective study was conducted with 117 patients. These surgeries were performed via both an infrapubic and a penoscrotal approach. Each penis was measured via flaccid stretch using a Furlow device from the dorsal penile base (pressed against pubic bone) to the tip of the glans. The corpora were engorged intra-operatively with an artificial saline erection (ASE). Corporal cylinders were selected based on measured corporal length without upsizing. Erect measurements were taken during both the ASE and after inflating the implanted device, in both instances from the same positions as preoperatively. Statistical difference and correlation coefficients between the preoperative penile stretch test (PST), intra-operative artificial saline erection (ASE) and erect prosthetic length (EPL) were calculated.
RESULTS: The mean patient age was 65.42 +/- 7.8 years. The average preoperative penile stretch was 15.03 cm, artificial erection 14.76 cm, and average erect prosthetic length was 15.28 cm. The differences between all three of these measurements reached statistical significance based on the 95% confidence intervals. On average the EPL was 0.25 cm greater than the PST.
CONCLUSIONS: Preoperative penile length was preserved and exceeded in our series, which challenges the conventional wisdom that loss of penile length is a foregone conclusion after IPP placement. This suggests that chronic hypoxia due to lack of neurovascular inputs, or scarring from Peyronie’s disease, radiation, previous surgery, or medical conditions, are the main culprits of loss of penile length as males age. We recommend early intervention in patients that fail conservative therapy for erectile dysfunction to preserve maximal length.


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