USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Tricounty Urology Associates, Washington, PA, USA.
J Sex Med. 2018 Jul;15(7):1049-1054. doi: 10.1016/j.jsxm.2018.04.634. Epub 2018 May 3.
Pelvic radiation is a known risk factor for the development and progression of erectile dysfunction. When medical therapy fails, the 3-piece inflatable penile prosthesis (IPP) can offer patients a definitive treatment option. Because of radiation-induced vascular changes and tissue fibrosis, a careful surgical approach is necessary to avoid intraoperative complications and attain successful outcomes. Despite its widespread use in prostate cancer treatment, there are no contemporary studies examining the effects that pelvic radiation can have on 3-piece IPP placement and device survival.
To present technical considerations and contemporary outcomes of placing a 3-piece IPP for refractory erectile dysfunction in patients with a history of pelvic radiation.
We retrospectively reviewed 78 patients who underwent placement of a 3-piece IPP (AMS 700; Boston Scientific, Marlborough, MA, USA) after being treated with pelvic radiotherapy from 2003 through 2016. All patients had been treated with external beam and/or brachytherapy for treatment of prostate malignancy. An infrapubic approach was used in all patients, with reservoir placement in the space of Retzius or in the lateral retroperitoneal space. Patient demographics, perioperative data, and postoperative outcomes including prosthetic infection and mechanical failure were examined and statistical analysis was performed.
Rates of device infection, revision surgery, and reservoir complications.
No intraoperative complications were observed. After a mean follow-up of 49.0 months (6.6-116.8), 2 patients developed an infection of their prosthesis that required explantation. These patients underwent successful IPP removal and immediate reimplantation. 11 patients (14.1%) required revision surgery (pump replacement, n = 4; pump relocation, n = 2; cylinder replacement, n = 4; reservoir replacement owing to leak, n = 1). No reservoir-related complications such as herniation or erosion into adjacent structures were observed.
The 3-piece IPP can be placed safely in a broad range of patients treated with pelvic radiotherapy.
This study describes contemporary long-term outcomes of the IPP in patients treated with pelvic radiation and includes patients with prior pelvic surgery and artificial urinary sphincter, which are commonly encountered in practice. It is limited by its single-center experience and lacks a comparison group of patients. Objective patient satisfaction data were not available for inclusion.
The 3-piece IPP can be placed successfully in patients with a history of pelvic radiation without a significant increase in infectious complications, reservoir erosion, or mechanical failure compared with the global literature. Loh-Doyle J, Patil MB, Nakhoda Z, et al. Three-Piece Inflatable Penile Prosthesis Placement Following Pelvic Radiation: Technical Considerations and Contemporary Outcomes. J Sex Med 2018;15:1049-1054.
盆腔放疗是导致勃起功能障碍发生和进展的已知危险因素。当药物治疗失败时，三件式可膨胀阴茎假体（IPP）可为患者提供明确的治疗选择。由于放射性诱导的血管变化和组织纤维化，需要谨慎的手术方法来避免术中并发症并获得成功的结果。尽管在前列腺癌治疗中广泛使用，但目前尚无研究探讨盆腔放疗对三件式 IPP 放置和器械存活率的影响。
介绍有盆腔放疗史的难治性勃起功能障碍患者植入三件式 IPP 的技术要点和近期结果。
我们回顾性分析了 78 例患者的资料，这些患者于 2003 年至 2016 年期间接受盆腔放疗后，植入了三件式 IPP（AMS 700；波士顿科学，马萨诸塞州马尔伯勒）。所有患者均接受外照射和/或近距离放疗治疗前列腺恶性肿瘤。所有患者均采用耻骨下入路，将储液器置于 Retzius 间隙或外侧腹膜后间隙。检查了患者的人口统计学数据、围手术期数据以及包括假体感染和机械故障在内的术后结果，并进行了统计学分析。
器械感染、翻修手术和储液器并发症的发生率。
术中未观察到并发症。平均随访 49.0 个月（6.6-116.8）后，2 例患者发生假体感染，需要取出。这些患者成功地取出了 IPP，并立即重新植入。11 例（14.1%）患者需要进行翻修手术（更换泵，n=4；更换泵位置，n=2；更换圆柱体，n=4；因漏液更换储液器，n=1）。未观察到与储液器相关的并发症，如疝出或侵蚀到相邻结构。
三件式 IPP 可安全植入广泛的盆腔放疗患者，且感染并发症、储液器侵蚀或机械故障的发生率与全球文献报道相比无显著增加。Loh-Doyle J, Patil MB, Nakhoda Z, et al. Three-Piece Inflatable Penile Prosthesis Placement Following Pelvic Radiation: Technical Considerations and Contemporary Outcomes. J Sex Med 2018;15:1049-1054.
