(507) Predictors of Postoperative IPP Length: A Multicenter, Multinational Analysis
Authors: Barham D , Huynh L , Hammad M , Swerdloff D , Andrianne R , Gross M , Hatzichristodoulou G , Hotaling J , Hsieh T , Jenkins L , Lentz A , Osmonov D , Park S H , Pearce I , Perito P , Sadeghi-Nejad H , Simhan J , Warner J N , Ziegelmann M , Yafi F 
Published: May 2023

Abstract

Introduction
Inflatable penile prosthesis (IPP) placement is associated with high postoperative patient satisfaction. Patients often express concerns about postoperative penile length. There is scant evidence in the literature of clinical and surgical factors that predict IPP length.

Objective
To evaluate predictors of cylinder length for men undergoing primary IPP placement in a large multicenter cohort.

Methods
Patients undergoing primary IPP placement for treatment of erectile dysfunction at 16 high-volume implant centers were included. All patients had preoperative demographics, surgical characteristics, and device length retrospectively collected at their respective institutions and combined for analysis. Descriptive statistics were reported for the full group. Univariate analysis was utilized to isolate variables significantly associated with device length and all variables reaching p&lt;0.1 were included in linear regression modeling.

Results
3,953 men underwent primary IPP placement. The mean age was 61.8±10.4 years and BMI was 29.8±4.2 kg/m2. The mean total device length was 20.6±2.1cm. 1291 (32.7%) had diabetes mellitus, 641 (16.2%) were smokers, 705 (17.8%) had a prior radical prostatectomy, 195 (4.9%) had prior radiation, 549 (13.9%) had Peyronie’s disease, and 884 (22.4%) had a history of intracavernosal injections. In univariate analysis, BMI (B=0.05, 95%CI 0.04 to 0.07, p&lt;0.001), a history of Peyronie’s disease (20.4 vs 20.6cm, p=0.02), and use of intracavernosal injection (20.7 v 20.9cm, p=0.02) were predictors of shorter total device length. Use of rear tip extenders (20.7 v 20.0cm, p&lt;0.001), penoscrotal approach (21.0 v 20.3, p&lt;0.001), and single corporal dilation (20.8 v 20.4cm, p&lt;0.001) were associated with longer length. In multivariable analysis, a history of Peyronie’s disease (B=-0.29, 95%CI -0.47 to -0.11, p=0.002) and greater BMI (B=0.05, 95%CI 0.03 to 0.07, p&lt;0.001) were predictors of shorter total device length. Independent predictors of longer device length were penoscrotal approach (B=-0.85, 95%CI -1.03 to -0.65, p&lt;0.001), rear tip extender use (B=1.00, 95%CI 0.84 to 1.17, p&lt;0.001), and single corporal dilation (B=-0.5, 95%CI -0.67 to -0.34, p&lt;0.001).

Conclusions
In this series, Peyronie’s disease and greater BMI are independent predictors of shorter IPP device length, while use of rear tip extenders, single corporal dilation, and penoscrotal approach are independent predictors of longer device length. These results are important in counseling patients regarding expectations of postoperative length.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Intuitive Surgical, Fidelis, Urofill, Boston Scientific, Endo Pharma, Coloplast, Cynosure, Antares Pharma, Clarus Pharmaceuticals, Acerus Pharma