Fuentes Jorge L, Yi Yooni A, Davenport Michael T, Bergeson Rachel L, Ward Ellen E, Morey Allen F
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Transl Androl Urol. 2020 Feb;9(1):38-42. doi: 10.21037/tau.2019.08.30.
Impending distal cylinder tip extrusions (DCTE) make up approximately 5-33% of all inflatable penile prosthesis (IPP) reoperations. While there have been a few case reports of DCTE in patients with diabetes and trauma, the current literature regarding risk factors for DCTE is limited. In this study, we examined the long-term sequelae among a large cohort of IPP patients to identify clinical risk factors for impending DCTE.
A retrospective review was completed of our single surgeon IPP database of 797 IPP placement cases from the years 2007 to 2018. We identified those who had a surgical intervention for a confirmed DCTE. Infected prostheses were excluded. The primary clinical end point of this study was to identify the time to extrusion repair from original penile prosthesis placement. Secondary clinical end points included location of extrusion and presence of corporal fibrosis.
Between the years 2007 to 2018, 26 cases (3%) of impending or complete cylinder extrusions were identified in our IPP database (n=797). The mean age at initial IPP placement was 58 years, compared to a mean of 66 years at the time of extrusion. The mean time from initial placement to extrusion repair surgery was 8.4 years (median 5.5 years). Most patients (15/26, 57.7%) had a history of prior IPP placement, five of whom had two or more prior prostheses. Location among the 26 extrusions varied-12 (46.2%) lateral, 9 (34.6%) distal urethra, 2 (7.7%) glanular, 2 (7.7%) mid-shaft, and 1 (3.8%) coronal sulcus. Concomitant pathologies identified include Peyronie's disease (7, 26.9%), idiopathic corporal fibrosis (7, 26.9%) and sickle cell disease with priapism induced erectile dysfunction (3, 11.5%).
The risk of IPP extrusion appears to be associated with increased time from initial prosthesis placement, prior history of IPP placement, and the presence of corporal fibrosis or deformity. Patients should be counseled to recognize this important long-term sequela of IPP surgery.
即将发生的阴茎假体远端圆柱体尖端挤出（DCTE）约占所有可膨胀阴茎假体（IPP）再次手术的5%-33%。虽然有一些关于糖尿病和创伤患者发生DCTE的病例报告，但目前关于DCTE危险因素的文献有限。在本研究中，我们检查了一大群IPP患者的长期后遗症，以确定即将发生DCTE的临床危险因素。
对我们单一外科医生的IPP数据库进行回顾性分析，该数据库包含2007年至2018年期间797例IPP植入病例。我们确定了那些因确诊DCTE而接受手术干预的患者。排除感染的假体。本研究的主要临床终点是确定从最初阴茎假体植入到挤出修复的时间。次要临床终点包括挤出位置和海绵体纤维化的存在情况。
在2007年至2018年期间，我们的IPP数据库（n=797）中发现了26例（3%）即将发生或完全发生的圆柱体挤出病例。初次IPP植入时的平均年龄为58岁，而挤出时的平均年龄为66岁。从初次植入到挤出修复手术的平均时间为8.4年（中位数为5.5年）。大多数患者（15/26，57.7%）有过先前IPP植入史，其中5人有两个或更多先前的假体。26例挤出的位置各不相同——12例（46.2%）在侧面，9例（34.6%）在远端尿道，2例（7.7%）在龟头，2例（7.7%）在阴茎体中部，1例（3.8%）在冠状沟。确定的合并病症包括佩罗尼氏病（7例，26.9%）、特发性海绵体纤维化（7例，26.9%）和镰状细胞病伴阴茎异常勃起所致勃起功能障碍（3例，11.5%）。
IPP挤出的风险似乎与初次假体植入后的时间延长、先前IPP植入史以及海绵体纤维化或畸形的存在有关。应建议患者认识到IPP手术这一重要的长期后遗症。
