(544) Incidental Findings of Pre-Operative Cystoscopy Procedure prior to IPP
Authors: Suarez-Sarmiento A , Perito P , Ghomeshi A , Levit B , Castillo M P , Suarez-Sarmiento A 
Published: May 2023

Abstract

Introduction
Inflatable Penile Prosthesis (IPP) is a common treatment modality for Erectile Dysfunction (ED). Previous studies have advocated the importance of undergoing a cystoscopy prior to an IPP procedure and whether the costs outweigh the benefits. Cystoscopies assist in diagnosing Lower Urinary Tract Obstructions (LUTO) such as BPH with obstruction, urethral strictures, bladder stones, and bladder tumors. These pathologies can cause complications in patients who undergo IPP, as well as unnecessary costs for canceling or aborting surgery. Due to these risks, cystoscopies may be a necessary pre-operative procedure prior to implantation. However, cystoscopies can be costly and there is an increased risk of infection. As a result, the cost-benefit analysis of performing this procedure in patients prior to IPP placement remains controversial.

Objective
To evaluate the prevalence of incidental findings found during cystoscopy, to determine if this procedure should be routinely implemented in clinical practice prior to IPP placement

Methods
We performed a retrospective study which identified all patients undergoing “de novo” IPP surgery, performed from May 2019 until May 2022, by two high volume implant surgeons. A review of all patients who underwent direct vision internal urethrotomy, or cystoscopy procedure prior to surgery was performed. The study population consists of men who underwent cystoscopy procedure prior to inflatable penile prosthesis (IPP) surgery in the office setting. Only patients who had no previous history of penile implantation were included. All clinical notes, patient demographics, comorbidities and surgical outcomes were reviewed.

Results
224 patients met the inclusion criteria. Of the 224 patients who underwent cystoscopy, prior to implantation, 153 (68%) had no previous history of cystoscopy procedure, while 28 (12%) had prior robotic assisted laparoscopic prostatectomy (RALP). This cohort consisted of 40 (18%) patients whose cystoscopy findings lead to other urological procedures prior to IPP surgery. These findings included 15 patients with bladder outlet obstruction due to BPH, which required a TURP, 18 patients with previously unknown bladder tumors, which required a TURBT, and 7 patients with bladder stones which required cystolithotomy. Other incidental findings which did not require surgery included 24 (11%) patients found to have urethral strictures treated with traditional urethral dilation, with only 3 requiring cold knife therapy. 27 patients diagnosed with prostatic strictures secondary to previous prostatic procedures including TURP, Urolift, Microwave Therapy, cryotherapy, etc. These patients were dilated with the scope at the time of procedure. There were 3 patients that presented with kidney stones in the bladder which did not require additional procedures. Of this cohort, 8 (3.5%) patients had post-procedural infections that were treated with a conservative course of antibiotics and did not require further treatment.

Conclusions
In patients with no previous history of urologic evaluation, a pre-operative cystoscopy procedure can be an invaluable tool to help prevent unnecessary complications or misdiagnosed pathology, such as bladder cancer or urethral strictures. Unplanned intraoperative cystoscopies and interventions can be costly and may be avoided with a simple in office cystoscopy prior to penile implantation.

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