Grimberg Dominic, Wang Sabrina, Carlos Evan, Nosé Brent, Harper Shelby, Lentz Aaron C
Division of Urology, Duke University Medical Center, Durham, NC, USA.
Duke University School of Medicine, Durham NC, USA.
Transl Androl Urol. 2020 Dec;9(6):2688-2696. doi: 10.21037/tau-20-923.
Alternative reservoir placement is increasingly popular during inflatable penile prosthesis (IPP) surgery to prevent intraperitoneal positioning, bowel, bladder, or vascular injury in patients with prior pelvic surgeries. Counter incision (CI) can be used for submuscular reservoir placement in high risk patients, however series exploring the safety remain limited.
A database of IPP surgeries was queried for use of a CI during reservoir placement to compare 90-day clinical outcomes in a retrospective case-control study. Primary outcome was device infections, with secondary outcomes including reservoir herniation, hematoma, device malfunction rates, and operative times. Groups were compared using Kruskal-Wallis and Chi-Squared tests, with multivariate logistic regression models to identify predictors of infectious complications.
A total of 534 cases met criteria, of which 51 (9.6%) used a CI for reservoir placement. The CI cohort included significantly more removal and replacements, 45.1% 20.9% (P<0.001). Thirty-one CI patients (61.0%) had undergone prior prostatectomy compared to 134 (27.7%) non-CI patients (P=0.001). The most common reasons for CI were prior prostatectomy and inguinal hernia repair. Median operative time was 17 minutes longer in the CI group (74 57 minutes, P<0.001). Device infection rates were similar (2.0% 4.1%, P=0.71), as were rates of hematoma (5.9% 2.7%, P=0.19), and device malfunction (0.0% 1.4% P=1.00).
Complication rates were similar between CI and non-CI cohorts, even in a subset where approximately half the cases were removal and replacements. For physicians not comfortable with alternative placement through a penoscrotal or infrapubic incision, this offers a reasonable alternative and permits use of three-piece devices in patients with a hostile pelvis.
在可膨胀阴茎假体（IPP）手术中，为防止既往盆腔手术患者出现腹膜内定位、肠道、膀胱或血管损伤，替代储液器放置越来越普遍。在高风险患者中，反切口（CI）可用于肌下储液器放置，然而，探索其安全性的系列研究仍然有限。
在一项回顾性病例对照研究中，查询IPP手术数据库中储液器放置时CI的使用情况，以比较90天临床结局。主要结局是器械感染，次要结局包括储液器疝、血肿、器械故障率和手术时间。使用Kruskal-Wallis检验和卡方检验对组间进行比较，并采用多因素逻辑回归模型确定感染并发症的预测因素。
共有534例病例符合标准，其中51例（9.6%）在储液器放置时使用了CI。CI队列中器械取出和更换的比例明显更高，为45.1%，而非CI队列中为20.9%（P<0.001）。31例CI患者（61.0%）曾接受过前列腺切除术，而非CI患者中有134例（27.7%）（P=0.001）。CI最常见的原因是既往前列腺切除术和腹股沟疝修补术。CI组的中位手术时间长17分钟（74对57分钟，P<0.001）。器械感染率相似（2.0%对4.1%，P=0.71），血肿发生率（5.9%对2.7%，P=0.19）和器械故障率（0.0%对1.4%，P=1.00）也相似。
CI组和非CI组的并发症发生率相似，即使在约一半病例为器械取出和更换的亚组中也是如此。对于不熟悉通过阴囊或耻骨下切口进行替代放置的医生来说，这提供了一种合理的替代方法，并允许在骨盆条件不佳的患者中使用三件式装置。
