(172) MULTICENTER ANALYSIS OF PERIOPERATIVE COMPLICATIONS ASSOCIATED WITH ECTOPIC INFLATABLE PENILE PROSTHESIS RESERVOIR PLACEMENT
Authors: Alvermann T , Schammel J , Atwater BL , Welliver C , Gross MS 
Published: December 2024

Abstract

Introduction
Ectopic Inflatable Penile Prosthesis (IPP) reservoir placement has become increasingly common in prosthetic urology. Ectopic reservoir placement can be achieved via clamp passage or via counterincision. Clamp passage has previously been shown to result in malposition and other perioperative complications. Counterincision placement has not been thoroughly explored in the literature.

Objective
We compared perioperative complications between our patients who underwent clamp reservoir placement or counterincision reservoir placement posterior to the rectus abdominus muscle. We hypothesized that counterincision placement resulted in fewer perioperative complications.

Methods
This is a retrospective IRB-approved multicenter analysis of 199 primary IPP patients who had ectopic reservoir placement at four hospitals in our two practices. Patient information was extracted via chart review, and variables included: demographics, medical history, total surgical time, intraoperative and postoperative complications, and subsequent complication management. Complications were assessed via the Clavien-Dindo Classification. Surgical technique for penoscrotal IPP placement was similar for all patients. Clamp reservoir placement was performed by passing a long clamp up the inguinal canal. Counterincision reservoir placement was performed via 3 cm low transverse incision over either rectus abdominus muscle, with dissection carried down to allow for direct reservoir placement behind the rectus belly and tubing passage to the penoscrotal incision. Data were compiled and rigorous statistical analysis was completed using Microsoft Excel (Microsoft Corporation, Redmond, Washington).

Results
94 patients had clamp ectopic reservoir placement and 105 had counterincision ectopic reservoir placement. Both cohorts had similar demographics and comorbidities (p = 0.095). Clamp cases had more complications with a risk ratio of 1.55 compared to counterincision patients. There were 4 intraoperative complications in the clamp group (proximal perforation, intraperitoneal reservoir, palpable reservoir, and tubing break). There were 4 intraoperative complications in the counterincision group (all proximal perforations). Postoperatively there were 12 Clavien-Dindo grade 3b complications (including 2 infections) and 3 Clavien-Dindo grade 1 complications in the clamp group. Postoperatively there were 7 Clavien-Dindo grade 3b complications in the clamp group (with no infections) and 4 Clavien-Dindo grade 1 complications in the counterincision group. Counterincision cases took longer, with an average surgery time of 102.8 minutes compared to clamp cases (77.9 minutes p = 0.0003). Clamp and counterincision reservoir placement both took longer than retropubic reservoir IPP placement, which required a mean surgical time of 69.7 minutes (67.5-71.9 minutes, 95% CI). The time taken for counterincision surgery increased following subsequent surgeries at a rate of 38.4 seconds every surgical iteration (R squared of 0.06), however this may be influenced by the fact that BMI increased surgical time at a rate of 43.2 seconds every increase in BMI (R squared of 0.013), among other potential confounders.

Conclusions
Clamp ectopic reservoir placement has higher risk of perioperative IPP surgery complications in this cohort. Both maneuvers increase surgical time as compared to retropubic reservoir placement. Further investigation of the safety, utility, and efficacy of counterincision ectopic IPP reservoir placement is warranted.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, MenMD.