Corporotomy site of no safety consequence in IPP implantation

The location of corporotomy during the implantation of inflatable penile prostheses (IPP) does not seem to affect the incidence intraoperative or short-term postoperative complication, according to a recent study.

“While the majority of studies describing IPP implantation techniques focus mainly on IPP reservoir placement or on surgical methods of managing difficult virgin or revision cases, in our knowledge, the current literature lacks assessment of the crucial step of corporotomy location during IPP implantation,” the researchers said.

Drawing data from 13 European and five US penile implant centres, the current retrospective analysis included 809 patients (mean age 61.5 years) who underwent virgin placement of a multicomponent IPP.  Overall, 299 AMS 700 and 510 Coloplast Titan devices were implanted at a mean proximal/distal measurement ratio of 0.93 during corporotomy. [Int J Impot Res 2022;34:302-307]

The researchers then compared practices across high-volume (>50 IPP/year), moderate-volume (10–50 IPP/year), and low-volume (<10 IPP/year) surgeons and found no significant difference in the proximal/distal measurement ratio (p=0.44). Most procedures had ratio values ranging from 0.45–1.2.

Of note, the researchers detected a significant interaction between a lower proximal/distal measurement ratio and higher age (p=0.0013), lower body mass index (BMI; p<0.0001), and the absence of diabetes (p=0.0004). Similarly, lower use of the rear tip extender (RTE; p=0.04) and shorter RTE length (p<0.0001) were both associated with a lower proximal/distal measurement ratio.

In addition, the average proximal/distal measurement ratio did not significantly differ between the AMS 700 and Coloplast Titan devices (0.84 vs 0.95; p=0.42).

“Our data regarding the significant correlation of lower proximal/distal measurement ratio with lower BMI and absence of diabetes could be attributed to the fact that performing a more proximal corporotomy is more challenging in obese patients,” the researchers said, adding that fibrosis is also more likely in diabetics, further making the procedure challenging.

In terms of complications, the researchers documented 49 such cases that occurred over 3 months of follow-up, along with 39 revision procedures. None were related to corporotomy location. Moreover, there were no corporotomy-related complications. Only 30 cases (3.7 percent) of IPP infection and 19 (2.3 percent) of scrotal haematoma were reported.

Overall, the present study was able to describe the current IPP implantation practices, revealing that during corporotomy, surgeons deliver the device at an average proximal/distal measurement ratio of 0.93, “without deferring significantly among high-, moderate-, and low-volume IPP surgeons.”

“Future prospective studies with longer follow-up periods investigating the relationship between the corporotomy site and the use of RTE, the long-term complication rate, and patient satisfaction may further elucidate the importance of corporotomy location choice during IPP insertion,” the researchers said.