1. Penile Prosthesis Complications: Planning, Prevention, and Decision Making
- Author
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Andrew T. Gabrielson, Laith Alzweri, Brian Dick, Wayne Jg Hellstrom, and Nickolas D. Scherzer
- Subjects
Male ,medicine.medical_specialty ,Urology ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Decision Making ,Perforation (oil well) ,030232 urology & nephrology ,Intraoperative Period ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Endocrinology ,Hematoma ,medicine ,Humans ,Glans ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,Penile prosthesis ,Perioperative ,medicine.disease ,Surgery ,Health Planning ,Psychiatry and Mental health ,Erectile dysfunction ,medicine.anatomical_structure ,Reproductive Medicine ,Quality of Life ,Penile Prosthesis ,business ,Complication - Abstract
Introduction Inflatable penile prosthesis (IPP) is an established treatment option for men with erectile dysfunction (ED) refractory to medical therapy. Standardization of surgical technique and improvements in device construction have reduced all-cause complication rates to less than 5% in recent reports. Nonetheless, complications do exist, and can strongly impact morbidity and the quality of life of patients. Prosthetic urologists must be aware of the constellation of complications that can arise during or after IPP placement. Aim To provide a comprehensive review of penile prosthesis complications and discuss preventative strategies, as well as proper preoperative, intraoperative, and postoperative decision making. Methods A review of the available literature from 1973 to 2018 was performed using PubMed with regard to IPP complications. Main Outcome Measures We reviewed publications that outlined preoperative planning strategies and the following IPP complications: hematoma, floppy glans, corporal fibrosis, corporal perforation and crossover, urethral injury, infection, impending erosion, and glandular ischemia. Results Careful patient and device selection, setting realistic expectations of postsurgical outcomes, and adherence to a perioperative checklist is essential in the preoperative period. Intraoperatively, anticipate corporal fibrosis situations and always dilate laterally during corporal passage to reduce the risk of crossover and urethral injury. Limit perioperative antiplatelet therapy, apply compressive dressing, use a closed suction drain if indicated, and leave the device partially inflated postoperatively to reduce risk of hematoma. After surgery, monitor patients for potential complications that may warrant device explantation or salvage: IPP infection, glans ischemia, and impending erosion. Conclusions By using evidence and expert opinion-based decision-making strategies in the preoperative, intraoperative, and postoperative period of IPP placement, surgeons can reduce the risk of complications and dissatisfaction, even in ED patients with multiple comorbid conditions. Scherzer ND, Dick B, Gabrielson AT, et al. Penile Prosthesis Complications: Planning, Prevention, and Decision Making. Sex Med Rev 2019;7:349–359.
- Published
- 2019