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Ricapito A, Sedigh O, Rubino M, Gobbo A, Falagario UG, Annese P, Mancini V, Ferro M, Buffi N, Cormio L, Carrieri G, Busetto GM, Bettocchi C. Penoscrotal approach for inflatable penile prosthesis implant: why it should be preferred. Minerva Urol Nephrol 2023; 75:711-717. [PMID: 38126284 DOI: 10.23736/s2724-6051.23.05475-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Inflatable penile prosthesis are the definitive treatment for erectile dysfunction. The two most used surgical approaches to position the implants are the penoscrotal and the infrapubic. Current trends showed that the penoscrotal approach is extensively preferred however, there is not conclusive evidence demonstrating the superiority of one technique over the other. The aim of this review is to summarize the scientific evidence available and to underline strengths and weaknesses of the two techniques. EVIDENCE ACQUISITION We conducted a comprehensive search of MEDLINE, Cochrane Library, and National Center for Biotechnology Information PubMed to identify relevant published articles. The included studies had to explicitly examine the use of three-piece inflatable penile prosthesis with a focus on the surgical access method and complications. EVIDENCE SYNTHESIS Twenty-six articles were included in the review: seven narrative reviews, five retrospective observational studies, five prospective observational studies, and nine mixed methodology studies. The most frequent approach was the penoscrotal, which was also found more comfortable (RG1) by the operators in one study. The infrapubic approach lasts less and one study demonstrated higher satisfaction by the patients. CONCLUSIONS There is no evidence of significant differences in complications among the penoscrotal and infrapubic approaches. While the infrapubic approach is faster and patients were more satisfied, the penoscrotal approach is the most used by far. This is likely related to the more straightforward procedure through this access and the excellent surgical field exposure. For these reasons, it is also preferred in the most complex cases.
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Affiliation(s)
- Anna Ricapito
- Andrology Unit, Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Omid Sedigh
- Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
- Department of Urology and Reconstructive Andrology, Humanitas Gradenigo Hospital, Turin, Italy
| | - Matteo Rubino
- Andrology Unit, Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Andrea Gobbo
- Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ugo G Falagario
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Pasquale Annese
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Vito Mancini
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Matteo Ferro
- European Institute of Oncology (IEO) - IRCCS, Milan, Italy
| | - Nicolò Buffi
- Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luigi Cormio
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy -
| | - Carlo Bettocchi
- Andrology Unit, Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
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Abstract
INTRODUCTION Management protocols for treatment of severe erectile dysfunction have changed little in the last 20 years. Most algorithms consider penile prostheses as the last option of treatment in patients who have failed medical management. Despite multiple advances in current devices, prosthetic infection remains the most feared complication by implanting surgeons and patients. This report tries to make a compilation of the factors that can be impacted to prevent penile implant infections, and to make penile implantation a safer and more reliable way to solve an erection deficit. PURPOSE OF REVIEW List events related to the surgical act (pre-operative, intra-operative, and post-operative) that are related to the risk of infection to contextualize possible actions/measures used to avoid prosthetic infection. RECENT FINDINGS The impact of coated implants on reduction of infection rates. The recommendation to use chlorhexidine-based solutions over iodine solution for preoperative skin preps. Appears to be no difference in infection rates according to the approach chosen by the surgeon (infrapubic vs penoscrotal). The change in the microbial colonies that are colonizing implants in recent years are dramatic. Lack of evidence of which solutions to use for salvage or revision washout surgery: Chemical eradication or mechanical lavage cleansing?. Despite the importance of metabolic control in the literature, there is a disparity in exact glycemic values prior to the intervention in our literature. Factors such as preparation of the operative site, presence of comorbidities or previous surgeries, surgical time, or additional maneuvers during surgery can negatively impact the final result of penile prosthetic surgery.
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