Session: MP62: Sexual Function/Dysfunction: Surgical Therapy I
MP62-18: New Findings Regarding Independent Predictors of Poor Corporal Integrity in a Large Series of Penile Implant Recipients: A Multicenter International Investigation
Introduction: Inflatable penile prosthesis (IPP) offers high satisfaction rates for patients, but this procedure is not without complications that can be encountered either intraoperatively or postoperatively. Particularly, predictors of intraoperative corporal perforation and delayed cylinder complications in IPP placement have not been well-delineated. We hypothesize that preoperative and intraoperative variables may impact the integrity of the corporal bodies long-term and thus implant viability. Methods: We retrospectively reviewed a large, multi-institutional collaborative study of IPP surgeries performed by expert implanters from 2016-2021. All primary and revision cases were included. Salvage cases for infection were excluded. Demographic characteristics, intraoperative variables, and postoperative outcomes were assessed. PCI was defined as intraoperative corporal complications (proximal and/or distal perforation of the corpora, corporal crossover) or postoperative corporal complications (cylinder erosion, extrusion, impending erosion, or deformity). Risk factor analysis and multivariate analysis were performed to identify independent predictors of PCI. Results: After excluding salvage cases for infection, we identified 5,153 patients undergoing IPPs, of which 149 were diagnosed with PCI. The rates of diabetes (p=0.19), immunosuppression (p=0.79), priapism (p=0.06), history of radiation (p=0.29), and prior use of intracavernosal injections (p=0.19) all had no significant effect on corporal integrity. Patients with PCI were more likely to have active coronary artery disease (CAD) or peripheral vascular disease (PVD) (p=0.02), be current smokers (p=0.003), and have a history of IPP infection (p < 0.001). On multivariate analysis, predictors of PCI included older age (OR 1.02 (1.00-1.04), p=0.03), CAD/PVD (OR 1.58 (1.06-2.35), p=0.025) and history of IPP infection (OR 5.82 (3.27-10.34), p<0.001). Obesity (OR 0.582 (0.40-0.86), p=.006) and non-Caucasian race (OR 0.60 (0.41-0.88), p=0.01) were found to be protective. Conclusions: Our multicenter analysis found that CAD/PVD, current smoking, and history of IPP infection were risk factors for complications associated with poor corporal integrity. Recognizing these risk factors preoperatively can allow for improved patient-specific counseling and changes in surgical strategy to potentially promote longer term device viability. SOURCE OF Funding: None
