(021) POST-IPP ENHANCEMENT USING UROFILL® TECHNIQUE – SAFETY AND FEASIBILITY
Authors: Suarez-sarmiento Jr. A , Perito P , Calopedos R , Brennan M , Dinerman B 
Published: December 2024

Abstract

Introduction
While inflatable penile prosthesis (IPP) restores sexual function with reliable axial rigidity, perceived or real penile morphological changes are frequent sources of complaint. In the inflated state, mechanical/pharmacological treatments are known to ameliorate reduced glans engorgement. Despite this, loss of spongiosal engorgement of the shaft (urethral visibility) remains an issue for some. Some men are distressed by the ovoid-shaped/flat prosthetic erection, whereby erection width is maintained by cylinder expansion but dorsoventral thickness is lost. Peri-prosthetic cavernosal thinning and corpus spongiosal tissue atrophy are likely contributory. Etiology is unclear and may include mechanical compression, hormonal changes of ageing or underlying vascular processes. Additionally, cylinder palpability is a common complaint in the deflated state. The patented UroFill® technique for hyaluronic acid (HA) injections has been shown to be reproducible and safe for girth enhancement. In this study, we interrogated this new application to address these complaints and enhance the natural feel and appearance of the post-IPP phallus in both the flaccid and inflated state.

Objective
To evaluate the effectiveness of the patented UroFill® technique for hyaluronic acid (HA) injections in addressing penile morphological changes and enhancing the natural feel and appearance of the post-inflatable penile prosthesis (IPP) phallus. This study specifically aims to improve patient satisfaction by mitigating issues such as reduced glans engorgement, loss of spongiosal engorgement, and cylinder palpability in both the flaccid and inflated states.

Methods
A retrospective, single-center study of men undergoing IPP was undertaken. Between October 2021 and January 2024, 1085 individuals underwent virgin IPP placement. 271 (24.7%) later presented with morphological complaints related to hypermobile glans or loss of periprosthetic erectile tissue engorgement. All men were initially managed with PDE5i (daily/PRN), intraurethral Trimix with or with mechanical therapy (vacuum device). 15 underwent glanspexy (5.4%) and 121 (44.6%) elected for subsequent hyaluronic injections using the UroFill® technique protocols for their post-IPP morphological complaints. Data on HA usage, HA retention, adverse events and patient satisfaction were collected and analyzed. Satisfaction was measured using validated questionnaires.

Results
In this cohort, the primary reason for undergoing UroFill® was perceived loss of girth in 68/121 (56.2%), ovoid shaped “flatter” erection in 28/121 (23.1%), and desire for a more natural looking and feeling flaccid penis in 21/121 (17.4%). Creation of neo-urethral prominence along shaft was requested by 45/121 (37.1%). No patients in this cohort experienced adverse events such as localized skin infections or incidental damage to their penile implants. This group required fewer units of hyaluronic acid on average compared to those without penile implants (12.2 ml vs 15.8 ml), as well as fewer visits (3 visits vs. 4 visits). Patient satisfaction was notably higher in this cohort (97.4%) compared to the general population of UroFill® patients (92.7%). Additionally, the retention rate of hyaluronic acid was perceived to be higher in patients with penile implants (96%) compared to those without (90%).

Conclusions
Post-IPP morphological complaints were effectively treated using the UroFill® technique with high patient satisfaction. We speculate that increased retention is due to less vascularity in IPP patients, compared to those with normal erectile function undergoing UroFill® girth enhancement. The procedure is safe and reproducible when performed by implanting urologists who are trained in the patented technique. Use of other injection techniques are not recommended given the severe consequences of violating the underlying prosthesis.

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