Damage Control Considerations During IPP Surgery
Purpose of Review
This review summarizes the latest reports in inflatable penile prosthesis (IPP) complication management.
IPP complications are rare, and reports are limited to retrospective studies. However, recent multi-institutional studies and use of national databases have provided further insight into risk factors for complications. Guidance on complication management is largely limited to techniques recommended by experts within the field.
American Urological Association guidelines place IPP implantation as a first line erectile dysfunction treatment. However, the majority of cases are performed by low-volume (≤ 4 cases/year) surgeons. Herein, we summarize the IPP literature and our personal experience to provide guidance on managing IPP complications.
KeywordsComplications Inflatable penile prosthesis Erectile dysfunction Outcomes
Compliance with Ethical Standards
Conflict of Interest
David Y. Yang declares no potential conflicts of interest.
Tobias S. Kohler is a consultant for Coloplast and Boston Scientific.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Capogrosso P, Pescatori E, Caraceni E, et al. Satisfaction rate at 1-year follow-up in patients treated with penile implants: data from the multicentre prospective registry INSIST-ED. BJU Int. 2018.Google Scholar
- 4.•• Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol. 2018; Having a strong knowledge of current guideline recommendations is essential for appropriate patient workup, couseling and management.Google Scholar
- 6.• Antonini G, Busetto GM, Del Giudice F, et al. Distal corporal anchoring stitch: a technique to address distal corporal crossovers and impending lateral extrusions of a penile prosthesis. J Sex Med. 2017;14:767 This article describes a reproducable technique for managing impending lateral extrusion and distal corporal crossover.CrossRefGoogle Scholar
- 10.• Brant W, Köhler T, Henry G, Karpman E, Kansas B, Jones L, et al. “Unexpected” corporal fibrosis should be “expected”: the prevalence of significant corporal fibrosis encountered during penile prosthetics. J Sex Med. 2015;12 This abstract reported that even in "straight-forward" cases, corporal fibrosis requiring specialized techniques or instruments occurred in >25% of cases.Google Scholar
- 15.Perito P. Urethral injury during inflatable penile prosthesis: a new repair. Video J Prosthet Urol. 2014;1.Google Scholar
- 24.• Wilson SK, Mora-Estaves C, Egydio P, et al. Glans necrosis following penile prosthesis implantation: prevention and treatment suggestions. Urology. 2017;107:144 This article is the only article that summarizes all previous reports of glans necrosis and highlights the need for immediate device explantation.CrossRefGoogle Scholar
- 27.Clavell Hernandez J, Trost L, Kohler T, et al. Emerging complications following alternative reservoir placement during inflatable penile prosthesis placement: a 5-year multi-institutional experience. J Urol. 2018.Google Scholar
- 28.• Henry G, Hsiao W, Karpman E, et al. A guide for inflatable penile prosthesis reservoir placement: pertinent anatomical measurements of the retropubic space. J Sex Med. 2014;11:273 This article provides objective measurments demostrating that vital structures within the pelvis are suprising close to the ring but can be protected with use of bladder decompression and trendelenberg positioning.CrossRefGoogle Scholar
- 36.Cefalu CA, Deng X, Zhao LC, Scott JF, Mehta S, Morey AF. Safety of the "drain and retain" option for defunctionalized urologic prosthetic balloons and reservoirs during artificial urinary sphincter and inflatable penile prosthesis revision surgery: 5-year experience. Urology. 2013;82:1436–9.CrossRefGoogle Scholar
- 38.• Sadeghi-Nejad H, Ilbeigi P, Wilson SK, et al. Multi-institutional outcome study on the efficacy of closed-suction drainage of the scrotum in three-piece inflatable penile prosthesis surgery. Int J Impot Res. 2005;17:535 This retrospective study demonstrates the minimal risk of infection and hematoma when using closed suction scrotal drains post-operatively.CrossRefGoogle Scholar
- 44.• Lopategui DM, Balise RR, Bouzoubaa LA, et al. The impact of immediate salvage surgery on corporeal length preservation in patients presenting with penile implant infections. J Urol. 2018;200:171 This study highlights the significant difference in penile length in patients treated with immediate salvage surgery following implant infection. CrossRefGoogle Scholar
- 46.• Gross MS, Phillips EA, Balen A, et al. The malleable implant salvage technique: infection outcomes after mulcahy salvage procedure and replacement of infected inflatable penile prosthesis with malleable prosthesis. J Urol. 2016;195:694 This multi-center study discusses the use of MIST technique for salvaging infected IPP with use of a malleable device.CrossRefGoogle Scholar