Previous use of intracavernosal injections is not associated with higher rates of intraoperative or postoperative inflatable penile prosthesis complications: A large multi-institutional analysis
James M. Jones, BA1, Martin Gross, MD2, David Barham, MD3, Daniel Swerdloff, MD4, Robert Andrianne, MD5, Georgios Hatzichristodolou, MD6, Aaron Lentz, MD7, Jeffrey Loh-Doyle, MD8, Koenraad van Renterghem, MD9, Sung Hun Park, MD10, Maxime Sempels, MD5, Jonathan N. Warner, MD11, Jay Simhan, MD4, Faysal Yafi, MD3.
1Geisel School of Medicine at Dartmouth, Hanover, NH, USA, 2Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, 3University of California Irvine Medical Center, Irvine, CA, USA, 4Einstein Healthcare Network, Philadelphia, PA, USA, 5University Hospital of Liège, Liège, Belgium, 6Krankenhaus Martha-Maria, Nürnberg, Germany, 7Duke Health, Durham, NC, USA, 8Keck School of Medicine, Los Angeles, CA, USA, 9UZ Leuven, Leuven, Belgium, 10Sewum Prosthetic Urology Center of Excellence, Seoul, Korea, Republic of, 11Mayo Clinic, Rochester, MN, USA.
Introduction and Objective: Intracavernosal injections (ICI) are a standard treatment for men with erectile dysfunction refractory to oral medications. ICI can be associated with corporal scarring which theoretically could make insertion of penile prosthesis more difficult. We sought to evaluate whether a history of ICI increased complications from inflatable penile prosthesis (IPP) using a large multi-institutional database.
Methods: A retrospective review was performed of IPPs from 9 implanters across 5 countries from 2016-2021. Patients who had a 2 or 3 piece IPP were included. If ICI status could not be determined, the patient was excluded. Patients were stratified into two groups: those who have previously used ICI and those who have not. Intraoperative and postoperative complications were assessed between groups using Fisher exact tests.
Results: A total of 1321 patients met inclusion criteria of which 555 (42.0%) had a history of ICI use and 766 (58.0%) did not. There was no difference in overall intraoperative complications between groups (2.2% vs. 2.5%, p=0.854). When broken down by specific complication, there remained no difference between groups with regards to proximal/distal perforation, proximal/distal crossover, and urethral injury. Proximal perforation and distal crossover were the most common occurring complications in 0.9% vs. 0.7% and 0.7% vs. 0.9%, respectively. There were no differences in postoperative infectious or non-infectious complications. Infection was the most common postoperative complication occurring in 2.2% vs. 3.3%, p=0.243. There was a higher rate of diabetes (42.5% vs. 34.6%, p=0.04) and prostate cancer treatment (40.0% vs. 28.0%, p<0.001) in the ICI group.
Conclusion: In a large multi-institutional analysis overall intra and postoperative complications occurred at a very low rate. Despite a risk of corporal fibrosis, ICI does not appear to increase the risk of infectious or non-infectious IPP complications.
|ICI (n=555)||No ICI (n=766)||p value|
|Proximal Perforation||5 (0.9%)||5 (0.7%)||0.75|
|Distal Perforation||1 (0.2%)||4 (0.5%)||0.45|
|Proximal Crossover||1 (0.2%)||2 (0.3%)||1.00|
|Distal Crossover||4 (0.7%)||7 (0.9%)||0.76|
|Urethral Injury||1 (0.2%)||1 (0.1%)||1.00|
|Total Intraoperative Complications||12 (2.2%)||19 (2.5%)||0.85|
|Non-infectious Postoperative Complications||16 (2.9%)||17 (2.2%)||0.48|
|Infection||12 (2.2%)||25 (3.3%)||0.24|
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