Multicenter Evaluation of Inflatable Penile Prosthesis (IPP) Placement in Men with a History of Priapism
Britney L. Atwater, MD1, Thomas Alvermann, BS2, David W. Barham, MD3, Muhammed A.M. Hammad, MBBS3, Chrystal Chang, MD4, Daniel Swerdloff, MD4, Jake Miller, MD3, Kelli Gross, MD5, Georgios Hatzichristodoulou, MD6, James M. Jones, BA2, James M. Hotaling, MD5, Vaibhav Modgil, MD7, Ian Pearce, MD7, Hossein Sadeghi-Nejad, MD8, Jay Simhan, MD4, Faysal A. Yafi, MD3, Martin S. Gross, MD1.
1Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, 2Geisel School of Medicine at Dartmouth, Hanover, NH, USA, 3University of California, Irvine, Orange, CA, USA, 4Fox Chase Cancer Center, Philadelphia, PA, USA, 5University of Utah, Salt Lake City, UT, USA, 6Martha-Maria Hospital Nuremberg, Nuremberg, Germany, 7Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom, 8Rutgers New Jersey Medical School, Newark, NJ, USA.
Background: Prolonged priapism can result in corporal fibrosis which may make IPP placement more difficult. The current literature on IPP placement in men with a history of priapism is limited to small and often single-center experiences. We sought to evaluate a multicenter experience of IPP placement in men with a history of priapism. Methods: We performed a multicenter, retrospective cohort study of patients with a history of priapism undergoing IPP placement by 9 experienced implant surgeons. We excluded patients who underwent IPP in the acute priapism event. Demographic, intraoperative, and postoperative variables were collected. Descriptive statistics were performed using mean and standard deviation for continuous variables, whereas frequencies and percentages were used for categorical variables. We evaluated differences in complication rates in those undergoing early or delayed IPP placement. We defined early placement as less than or equal to 4 months from priapism to IPP. Results: 53 patients underwent IPP placement at a median of 29.5 months following ischemic priapism. The mean duration of priapism was 42.6 ± 14.1 hours. The mean age of the cohort was 51.5 ± 1.4 years with a mean follow-up of 16.4 ± 9.5 mo. Overall, 19 patients (36%) had a prior shunt for priapism and 7 (13%) had penoscrotal decompression. Only 5 (9%) patients underwent early placement (less than or equal to 4 mo) whereas 48 (91%) underwent late placement. No complications occurred in those undergoing early IPP placement. Complications occurred in 19 (39%) of patients undergoing delayed placement. Intraoperative urethral injury and proximal perforation occurred in 1 patient each. Infection occurred in 3 (6%) men. Postoperative complications occurred in 17 (35%). Cylinder related complications accounted for 8 (47%) (3 displacements of a cylinder through the corporotomy, 1 lateral displacement of the distal cylinders requiring revision, 2 proximal cylinder migration, 2 cylinder leaks). Fifteen (22.5%) implants were revised or removed for infectious or non-infectious complications. Conclusions: IPP placement in men with a history of priapism carries a notable incidence of complications, especially in men undergoing delayed placement. Few IPPs in this series were placed early after the priapism episode, as our surgeons are predominantly tertiary referral centers. Priapism patients should be referred to prosthetic experts early to decrease future morbidity
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