Different approaches in penile tri-component prosthesis surgery. A single Italian centre experience
Among different approaches proposed through time, peno-scrotal and infrapubic ones are the most common performed for penile prosthesis implantation. Those are generally shorter in dimension than that of the past and allows to implant the prosthesis with a single incision of few centimeter. In scientific literature works comparing both approaches are lacking. Aim of this study is to compare advantages and disadvantages of each peno-scrotal and infrapubic approach in order to assess whether there is one to prefer on the other.
Materials and Methods
This was a retrospective analysis on 69 consecutive patients who all have been implanted between 2010 and 2013. Among these 10 received and implantation via infrapubic incision and other 59 via peno-scrotal one. Quality of Life(QoL) was determined using the validated questionnaire QoLSPP. Data were analyzed using SPSS software for statistical analysis.
Samples were homogeneous according to age ((60.3 A vs 67.1 B; p= 0.12).In Group A (peno-scrotal) 9 patients of 59 had concomitant IPP vs none in Group B (infrapubic). Mean of total implant length showed no difference, with differences in lenght of the extensor which is higher in group A. Operation time is 8 minutes shorter in group B (77.5 minutes A vs 85.2 minutes B; p<0,05). Penis length after surgery showed not significant difference (13.48 cm A vs 13.6 cm B; p=0,9). Few complications was observed all belonging to Dindo 1 with no significant difference between the groups. As well, QoLSPP scores showed no difference in the 4 domains: functional (3.9 A vs 4.0 B; p=0,32), relational (4,2 A vs 4,1 B; p=0.8), social (3.7 A vs 4,1 B; p=0.47) and personal (4.0 A vs 4.3 B; p=0.18).
The peno-scrotal approach was largely more frequently performed (6:1).Operation time was barely shorter with the infrapubic approach, although its effectiveness in reducing infections has been questioned (1). The peno-scrotal approach allows a better exposition of the corpora cavernosa and it should be preferred in complex cases (like concomitant IPP). Using one approach or another did not affect patients QoL after the implantation(2).
Both approaches are safe, effective and should be considered minimally invasive if any ancillary procedure has been performed; the decision on which is to choice actually depends on surgeon or patient preference, evaluating every single case. In our centre, peno-scrotal approach is more frequently used as it is, in general, in Italy. (3)
(1) Garber , Markus. Urology 1998 Aug 52(2):291-3.
(2) Caraceni, Utizi et al. J Sex Med 2014; 11:1005-1012
(3) INSIST-ED. Archivio italiano Urologia Andrologia 2016; 88-2