(159) Factors and Management Strategies for Addressing Reduced Glans Engorgement Following Inflatable Penile Prosthesis: A Scoping Review
Authors: Khalaf Alla K , Calopedos R , Mahdi M , Slovacek H , Wang R 
Published: March 2024

Abstract

Introduction
Inflatable penile prosthesis (IPP) provides a reliable stiffness along the length of the penile shaft, yet patients may express dissatisfaction as it may still differ from their recollection of their previously normal erections. A common complaint is reduced engorgement of the glans penis, which can manifest as subjective reduction in penile length or the feeling of a cold insensitive glans. Patient factors often ensure a sound justification for this complaint, namely vasculogenic erectile dysfunction (ED) or their corporo-glandular morphology despite a well-sized and well-positioned implant.

Objective
In this study, we sought to identify factors that may contribute to reduced glans engorgement and possible management strategies.

Methods
Intervention: Any method of treating or avoiding reduced glans engorgement post-IPP. Population: Men undergoing IPP insertion or men with glans complaints post-operatively Inclusion Criteria: Articles published in English with full text available and objective outcome measures Search Strategy: Literature search was performed in June 2023 using Medline, PubMed, Embase and Scopus. PubMed search included both “Mesh” protocols and “free text” to capture the correct study population and intervention utilized. Review Type & Analysis: Although an initial systematic model was considered, a scoping model was ultimately selected due to the limited literature and inconsistent outcome measures. This approach aimed to identify gaps in knowledge and provide an overview of the existing literature, thus informing future studies in this area. The variability in outcome measures across studies prevented higher-powered analyses from being conducted.

Results
Initial search strategy retrieved 98 non-duplicate studies with 40 being selected for initial screening after applying inclusion criteria. Ultimately, a total of 7 articles were included and categorized by theme: Cavernous-sparing technique (1–3); Pharmacotherapy for post-IPP glans complaints (4–7) (Table 1 & 2). The cavernous-sparing technique described aims to limit disruption of cavernous tissue around the implanted cylinder. This was achieved by omitting dilatation and using Furlow directly for measurements, or by intraoperative intracavernosal (IC) prostaglandin followed by dilatation only with size 7 or 8 Hegar alone. In all studies that compared penile dimensions, girth was significantly greater in the cavernous-sparing group. A higher proportion of men in this group also had detectable cavernous arteries, thicker residual corporal tissue, better residual tumescence post-IPP and demonstrated significant increases in both PSV and EDV post-PDE5i, compared to no PDE5i. Men who had standard dilatation also responded to post-IPP PDE5i but fewer had identifiable cavernous artery and had significant increase in only PSV, compared to no PDE5i. Other articles relating to post-IPP pharmacotherapy unanimously demonstrated that post-IPP glans engorgement was improved. This equated to reported statistically improved satisfaction when compared to the IPP alone groups, as measured by IIEF and EDITS questionnaires. Post-IPP PDE5i were better tolerated than intraurethral alprostadil, which was associated with discomfort.

Conclusions
Post-IPP pharmacotherapy appears to enhance residual erectile tissue engorgement. It can be used as an adjunctive after-care measure. Cavernous-sparing techniques show the importance of viable residual tissue for improved prosthetic erections. More comprehensive studies are needed to enhance patient experience and explore the microanatomical and hemodynamic role of residual tissue post-IPP.

Disclosure
No.