PD28-02: Multicenter Comparison of Single Dilation Versus Sequential Dilation in Primary Inflatable Penile Prosthesis Placement

Daniel Swerdloff*, Zafardjan Dalimov, Philadelphia, PA, David Barham, Irvine, CA, Joshua Ghoulian, Glendale, AZ, Robert Andrianne, Thomas Deprez, Liege, Belgium, Zachary Dionise, Durham, NC, Martin Gross, Lebanon, NH, Georgios Hatzichristodolou, Nuremberg, Germany, Hossein Sadeghi-Nejad, Hackensack, NJ, Sherry Huang, Los Angeles, CA, Aaron Lentz, Durham, NC, Jeffrey Loh-Doyle, Los Angeles, CA, Jake Miller, Irvine, CA, Koenraad van Renterghem, Leuven, Belgium, Sung Hun Park, Seoul, Korea, Republic of, Maxime Sempels, Liege, Belgium, Jonathan N Warner, Rochester, MN, Faysal A Yafi, Irvine, CA, Jay Simhan, Philadelphia, PA

Introduction: 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)

Conclusions: 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.

Source of Funding: none