(175) Shorter Duration of Postop IPP Inflation Following Manual Modeling May Lead to Curvature Regression
Authors: Atwater B , Alvermann T , Rezaee M , Gross M 
Published: February 2024

Abstract

Introduction
Patients with concomitant erectile dysfunction (ED) and PD are best served by insertion of an inflatable penile prosthesis (IPP) in order to adequately treat both conditions. There are multiple methods of curvature treatment during IPP surgery, and manual modeling is the predominant method in our practice. We elect to leave the IPP inflated postoperatively to maintain curvature reduction improvements, but the ideal duration of postoperative inflation for this purpose has not been determined. There is also little data regarding how the duration of postoperative IPP inflation may affect penile curvature.

Objective
The primary objective was assessing the impact of postoperative IPP inflation on penile curvature postoperatively over time.

Methods
All IPP patients with known preoperative penile curvature undergoing IPP placement by a single surgeon from January 2017 to June 2023 were included in this IRB-approved (IRB 00031589) retrospective series. All patients received a 3-piece Coloplast Titan Touch IPP (Coloplast, Minneapolis, MN, USA). Goniometer was used to assess curvature during preoperative intracavernosal injection and duplex Doppler ultrasound. All patients followed a standard postoperative follow-up protocol of visits at 2 weeks, 6 weeks and 6 months, although some were also seen sooner than anticipated or with additional unplanned follow-up. Our practice is to leave the device partially (to 60-70%) inflated for2 weeks postoperatively and perform device teaching at 6 weeks postoperatively if feasible. Patients who cannot tolerate device inflation due to pain or other extenuating circumstances are deflated earlier than two weeks. The change in penile curvature, as determined by goniometry at various timepoints, was evaluated relative to the duration of IPP inflation postoperatively. SPSS (IBM, Armonk, NY, UA) was used for statistical analyses, which included t-tests, chi-squared tests, and ANOVA.

Results
Sixty-one patients were included. The average preoperative penile curvature was 40° ± 16° (0° to 80°). At the time of surgery, all IPPs were left inflated on average 11 ± 5.2 days with device deflation at &lt;2 weeks for 31.3% patients (n=19) and at ≥2 weeks for 68.9% patients (n=42). There was no curvature regression for either group at 2 weeks or 6 months; however, both groups had a subset of patients with worsened curvature at 6 weeks. Penile curvature was worse at 6 weeks for 26.3% (n=5) of patients with a shorter IPP inflation period compared to 12.8% (n=5) of patients with device inflation of at least two weeks. Sample size precluded assessment of statistical significance among groups.

Conclusions
Patients with IPP deflation &lt;2 weeks had a higher incidence of curvature regression 6 weeks postoperatively compared to patients with IPP deflation ≥2 weeks. Curvature did not regress while device was inflated or between the 6 week and 6 month postoperative visits. Additional studies are needed to elucidate the optimal timeframe for, and degree of, IPP inflation to avoid postoperative penile curvature regression.

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