Multicenter Comparison of Single Dilation Versus Sequential Dilation in Primary Inflatable Penile Prosthesis Placement
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: In primary implant patients without significant corporal fibrosis, penile implant surgical technique varies in implementation of either single dilation (SingD) or sequential dilation (SeqD). Vigorous debate exists regarding both methods, but there is no robust evidence supporting one technique over the other in the literature. We compared intraoperative complications and postoperative outcomes from a large international database of inflatable penile prostheses (IPP) performed by expert implant surgeons utilizing either approach.
METHODS: IPP cases performed by six international implanters from 2016-2021 were identified. All primary implant cases were included, while revision cases, salvage operations, and patients with evidence of corporal fibrosis were excluded. Intraoperative complications and postoperative noninfectious outcomes were assessed between the two groups. These included proximal/distal perforation, cylinder crossover, and urethral injury.
RESULTS: 2050 IPP cases were identified, and 1527 (75%) primary IPP cases with no evidence of corporal fibrosis (mean age 60 ± 10) were included. SingD was performed in 906 (59%) of cases while SeqD was performed in 619 (41%) of cases. There were no differences between groups with respect to demographic variables. Cylinder length was longer in the SeqD group vs the SingD group (18.1 cm ± 3 vs. 19.2 cm ±2 p<0.001). There were 9 (0.6%) intraoperative complications in total, all of which were in the SeqD group (p=0.123). Of these intraoperative complications, 6 (67%) patients sustained a distal crossover while 1 (11%) experienced a distal perforation and 1 (11%) had a proximal crossover. Postoperatively, 75 (89%, p<0.01) of complications were in the SeqD group and 9 (11%) in the SingD group. Of these postoperative complications, there were 21 (28%) erosion events, 14 (67%) of which were in the SeqD group vs 7 (33%) in the SingD group (p=0.02)
CONCLUSION: In our international multicenter assessment of primary IPPs without corporal fibrosis performed by expert surgeons, patients undergoing sequential dilation appear to have an overall benefit in total cylinder length. Sequential dilation, however, may confer greater risk of postoperative complications, including corporal erosion.
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