New Findings Regarding Independent Predictors of Poor Corporal Integrity in Penile Implant Recipients: A Multicenter International Investigation
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.
BACKGROUND: Predictors of intraoperative corporal perforation and delayed cylinder complications in inflatable penile prosthesis (IPP) placement have not been well-delineated in the literature. We evaluated our retrospective multi-institutional database of IPP surgeries performed by expert implant surgeons to identify risk factors that are predictive of the development of these non-infectious complications.
METHODS: IPP cases performed by six international implanters from 2016-2021 were identified. All primary and revision cases were included. Salvage cases for infection were excluded. Demographic characteristics, intraoperative variables, and postoperative outcomes were assessed. Poor corporal integrity (PCI) was defined as intraoperative corporal complications (proximal and/or distal perforation of the corpora, corporal crossover) or postoperative corporal complications (cylinder erosion, extrusion, impending erosion, or deformity). Risk factor analysis and stepwise linear regression were performed to identify predictors of PCI.
RESULTS: A total of 2050 cases (mean age 61.3 ± 10), across 6 separate institutions were assessed. There were 57 (2.8%, mean age 64± 9, p=0.07) cases of PCI. Intraoperative perforations comprised 29 (50.9%) of these complications, while the other 28 (49.1%) were either cylinder erosion, extrusion, impending erosion, or deformity due to PCI. The rates of diabetes (p=0.94), vascular disease (p=0.388), HTN (p=0.53), smoking (p=0.064), presence of corporal fibrosis (p=0.15), history of ICI (p=0.60) and history of priapism (p=0.34) all had no statistically significant effect on corporal integrity. The only independent risk factor for PCI was a prior history of penile implant infection (OR 13.6, 95% CI 2.4-76.3, p=0.003).
CONCLUSIONS: Our multicenter analysis found that prior history of penile implant infection is the lone independent risk factor for complications associated with poor corporal integrity in our series. Recognizing this risk factor preoperatively can allow for improved patient-specific counseling and changes in surgical strategy to potential prevent these complications.
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