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Multicenter Evaluation on the Use of Down-Sized Cylinders in Penile Prosthesis Surgery
Remington Lim, MD1, Jeffrey Lee, BA
2, Elia Abou Chawareb, MD
2, Muhammad Hammad, MD
2, Daniar Osmonov, MD
3, Hossein Sadeghi-Nejad, MD
4, Arthur Burnett, MD
5, Ian Pearce, MD
6, Aaron Lentz, MD
7, Kelli Gross, MD
8, James Hotaling, MD
9, Maxime Sempels, MD
10, Sung Hun Park, MD
11, Koenraad van Renterghem, Dr. med.
12, Georgios Hatzichristodoulou, Dr. med.
13, Robert Andrianne, MD
10, James Jones, MD
14, Tung-Chin Hsieh, MD
15, J Nicholas Warner, MD
16, Matthew Ziegelmann, MD
16, Paul Perito, MD
17, Jay Simhan, MD
18, Faysal Yafi, MD
2, Martin Gross, MD
1, David Barham, MD
2.
1Dartmouth Hitchcock, LEBANON, NH, USA,
2University of California Irvine, Orange, CA, USA,
3University Hospital Schleswig Holstein, Campus Kiel, Germany,
4Hackensack University Medical Center, Hackensack, NJ, USA,
5Johns Hopkins University, Baltimore, MD, USA,
6Manchester Andrology Centre, Manchester, United Kingdom,
7Duke University, Durham, NC, USA,
8University of Utah, Salt Lakek City, UT, USA,
9University of Utah, Salt Lake City, UT, USA,
10University Hospital of Liège, Liège, Belgium,
11Sewum Prosthetic Urology, Seoul, Korea, Democratic People's Republic of,
12Jessa Hospital, Hasselt, Belgium,
13'Martha-Maria' Hospital, Nuremberg, Germany,
14Boston Medical Center, Boston, MA, USA,
15University of California San Diego, La Jolla, CA, USA,
16Mayo Clinic, Rochester, MN, USA,
17Perito Urology, Coral Gables, FL, USA,
18Fox Chase, Philadelphia, PA, USA.
Background: Down-sized inflatable penile prosthesis (IPP) cylinders are used in challenging penile fibrosis scenarios, such as after priapism or prior implant infection. However, their role in primary penile prosthesis surgery is not well studied. This study aims to identify factors associated with the use of down-sized cylinders in men undergoing primary IPP placement.
Methods: We conducted a multicenter, retrospective study on men undergoing primary IPP surgery, categorizing them into a down-sized cylinder group (AMS 700 CXR and Coloplast NB) and a standard cylinder group (AMS 700 CX, AMS 700 LGX, and Coloplast Titan). We collected demographic, intraoperative, and postoperative variables and performed a multivariable analysis.
Results: 4,389 men were included in the study with a mean age of 62.3 ± 10.3 years. 1,485 (34%) men had diabetes and 2,131 men (49%) had hypertension. Down-sized cylinders were placed in 406 men (174 CXRs, 232 NBs), while standard cylinders were placed in 3,983 men. Down-sized cylinders were more commonly used in men with diabetes (OR 2.6 [1.9, 3.7], p<0.001) and less frequently in those with hypertension (OR 0.5 [0.4, 0.7], p<0.001). A history of priapism did not significantly impact the use of down-sized cylinders (p≥0.152). Sequential dilation was performed more often with the use of down-sized cylinders (OR 4.0 [2.8, 5.7], p<0.001). Down-sized cylinders were associated with an increased rate of non-infectious complications (OR 1.9 [1.3, 2.9], p<0.001) with no significant association with implant infection (OR 2.1 [0.9, 4.6], p=0.07). Non-infectious complications occurred in 44 men with down-sized cylinders, including 10 hematomas, 7 wound-related complications, 7 cylinder-related complications, and 8 device-related malfunctions.
Conclusion: This study demonstrates that down-sized cylinders are more frequently used in diabetics. Urologists are also more likely to use down-sized cylinders in men requiring sequential dilation. Down-sized cylinders are associated with a low overall complication rate.
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