(183) NEW FINDINGS REGARDING THE LEARNING CURVE FOR INFLATABLE PENILE PROSTHESIS RESERVOIR PLACEMENT VIA COUNTERINCISION
Authors: Atwater BL , Gross MS , Madden-Fuentes RJ 
Published: December 2024

Abstract

Introduction
Inflatable penile prosthesis reservoirs can be placed in a variety of locations. Historically, placement was exclusively in the retropubic space, and in the last decade implanters have moved to ectopic reservoir placement in patients with history of prior pelvic surgery. Placement in the retropubic space or ectopic reservoir placement can be accomplished with blind clamp passage or via counterincision, depending on surgeon preference and comfort level. Scant literature exists regarding counterincision IPP reservoir placement, and no prior research examines how the learning curve for this technique may impact overall operative time.

Objective
The primary objective was assessing how counterincision IPP reservoir placement affects operative time for a surgeon newly learning and applying this technique.

Methods
A multicenter retrospective review was performed including patients undergoing primary IPP insertion with counterincision reservoir placement from 2017-2024. Data was compiled from two experienced implant surgeons with similar IPP operative techniques at two separate hospitals. One surgeon performed counterincision (CI) placement as standard protocol, while the other (new to counterincision, NCI) began utilizing this technique during the study period with no prior experience in this method. Operative times for the NCI surgeon were compared before and after implementation. All patients had a 3-piece Coloplast Titan Touch IPP (Coloplast, Minneapolis, MN, USA) or a Boston Scientific AMS CX or LGX IPP (Boston Scientific, Marlborough, MA, USA) implanted. Operative times, intraoperative complications, postoperative complications, and postoperative emergency room visits were analyzed. Revision cases and concomitant surgeries were excluded. Rigorous statistical analysis was performed using Microsoft Excel (Microsoft, Redmond, WA, USA).

Results
There were 362 patients total between both surgeons at both sites. For the experienced implanter NCI surgeon, all patients had a 3-piece Coloplast Titan Touch IPP device implanted. The average operative time for cases for the learning surgeon without counterincision reservoir placement was 70 ± 18 minutes (n = 287) whereas cases for this surgeon where the reservoir was implanted via counterincision were 89 ± 19 minutes (n = 32) (p = 0.0001). The extended time needed for counterincision gradually diminished over the study period (from 90 minutes to 82 minutes). For comparison, 37 cases performed by the CI experienced implanter had an average operative time of 109 ± 37 minutes (n = 37), compared to 99 ± 22 minutes (n = 6) for those without counterincision (p = 0.509). The CI surgeon’s patients were all implanted with a Boston Scientific AMS IPP (Boston Scientific, Marlborough, MA, USA). There were no statistically significant differences in intraoperative complications, postoperative complications, or postoperative emergency room visits within each surgeon’s cohort of between surgeon cohorts.

Conclusions
Counterincision IPP reservoir placement is a safe and effective technique for successful reservoir insertion. Learning counterincision IPP reservoir placement may increase operative time but this difference does not appear to result in increased intraoperative and postoperative complications in this patient series. Further research is needed to explore the utility, safety, and efficacy of counterincision IPP reservoir placement.

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