Paradigm Shift in Inflatable Penile Prosthesis Sizing

[fredgermanholes]

POD-02.02 Paradigm Shift in Inflatable Penile Prosthesis Sizing? Single Surgeon Outcome Analysis and Nationwide Database Analysis Evaluating Contemporary Surgical Trends
G Henry2 and A Bella1
1Division of Urology, University of Ottawa, Ottawa, ON;
2Regional Urology, Shreveport, LA, USA
Abstract
Introduction and Objective:
The primary patient source of dissatisfaction following inflatable penile prostheses (IPP) surgery is penile length compromise, which can be due to broad underlying patholphysiologies including post-prostate cancer treatment (surgery, radiation or brachytherapy) and diabetes. Traditional teaching dictates that the implanting surgeon choose shorter sizing when measuring corporal length at the time of IPP placement if there is a discrepancy in the measuring of the two sides of the corpora or, as more commonly occurs, sizing that equals the symmetrical corporal lengths measured. In fact, some prosthetic surgeons advocate using shorter than measured corporal lengths. Recently, a novel New Length Measurement Technique (NLMT) has been developed and we present patient outcome data and an evaluation of current sizing trends. Methods: Retrospective primary IPP chart reviews of 57 IPP patients comparing a multi-surgeon practice (n = 10, the multisurgeon group (MSG)) versus 57 IPP patients from a single surgeon (SS) prior to using the NLMT technique versus 283 patients with more that one year follow up done by the same single surgeon [GH] (SS NLMT). American Medical Systems (AMS) and Coloplast data on cylinder sizes used nationwide over the past several years was also analyzed.
Results:
The average cylinder size plus rear tip extender length utilized by the MS group was 19.05 cm, compared to SS 20.11 cm and SS NLMT 23.37 cm. A single distal erosion in the MS group (semi rigid rod) was noted, with none in the SS or NLMT surgery groups. AMS data suggests an increase in percentage sales of 21 and 24 cm IPP cylinders with a resultant decrease in percentage sales of 12 and 15 cm IPP cylinder over the past 2 years. Coloplast cylinder distribution is similar (Fig. 1).
Conclusions:
There appears to be a paradigm shift in utilizing longer cylinders when analyzing changes in cylinder size sales for IPP implantation. No increases for distal erosion in the SS experience with NLMT is evident when compared to traditional sizing outcomes.