(147) Multicenter Evaluation of Inflatable Penile Prosthesis Placement in Men with a History of Priapism
Authors: Barham D , Hammad M , Swerdloff D , Gross K , Hatzichristodoulou G , Jones J , Hotaling J , Pearce I , Sadeghi-Nejad H , Simhan J , Yafi F , Gross M 
Published: May 2023

Abstract

Introduction
Inflatable penile prosthesis (IPP) can be used in both acute and delayed management of priapism-induced erectile dysfunction. Prolonged priapism may result in corporal fibrosis that makes IPP placement more difficult. The current literature on IPP placement in men with a history of priapism is limited to small series and often single-center experiences.

Objective
We sought to evaluate a multicenter experience of IPP placement in men with a history of priapism.

Methods
We performed a multicenter, retrospective cohort study of patients with a history of priapism undergoing IPP placement by 7 highly experienced implant surgeons. Malleable prosthesis placement patients were excluded. Demographic, intraoperative, and postoperative variables were collected. Descriptive statistics were performed using mean and standard deviation for continuous variables, whereas frequencies and percentages were used for categorical variables. We evaluated differences in complication rates in those undergoing early or delayed IPP placement. We defined early placement as ≤4 months from priapism to IPP.

Results
31 patients underwent IPP placement at a mean of 97.4 ± 26.7 months following ischemic priapism. The mean duration of priapism was 52.3 ± 21.2 hours. The mean age of the cohort was 52.4 ± 4.2 years with a mean follow-up of 11.6 ± 1.3 mo. Overall, 25 patients (48.3%) had a prior shunt for priapism and 6 (19.4%) had penoscrotal decompression. Four patients (12.9%) underwent early placement and 27 (87.1%) delayed placement. Intraoperative urethral injury occurred in 1 (3.2%) patient. Infection occurred in 1 (3.2%) patient at 4 months postoperatively and was explanted without salvage. Seven (22.5%) implants were revised or removed for infectious or non-infectious complications at a mean 8.8 ± 1.0 months after implantation, of which 5 (71.4%) were cylinder-related (2 displacements of a cylinder through the corporotomy, 1 lateral displacement of the distal cylinders requiring revision, 1 proximal cylinder migration, 1 cylinder leak). No complications occurred in those undergoing early IPP placement. Full-sized cylinders (Boston Scientific CX or Coloplast Titan) were used in all cases that resulted in cylinder extrusion or migration. Narrow cylinders (Coloplast Titan NB or Boston Scientific CXR) were used in only 9 (29.1%) cases.

Conclusions
IPP placement in men with a history of priapism carries a notable incidence of non-infectious complications, especially in men undergoing delayed placement or when full-sized cylinders are used. Few IPPs in this series were placed early after the priapism episode, as our surgeons are predominantly at tertiary referral centers. Priapism patients should be referred to prosthetic experts early to decrease future morbidity.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Antares Pharma: SpeakBoston Scientific, Clarus Therapeutics, Coloplast, Cynosure, Promescent, Sprout, Viome