Presentation Authors: Chirag Dave*, Ahmed Khalaf, Bruce Trock, Arthur Burnett, Baltimore, MD
Introduction: Inflatable penile prosthesis (IPP) placement is an effective treatment strategy for spinal cord injured patients with erectile dysfunction. These patients have poor mobility, and often suffer from urinary incontinence and/or retention. They often require prolonged catheterization after surgery and the optimal postoperative bladder management strategy is unknown. We compared suprapubic catheter to urethral Foley catheter placement at the time of surgery.
Methods: From 2008-2017, 15 patients with spinal cord injury and documented neurogenic bladder underwent IPP placement for the management of erectile dysfunction. Baseline patient characteristics, level and extent of spinal cord injury, as well as bladder management before and after IPP were recorded. Categorical variables were analyzed with Fisher's exact test and continuous variables with Wilcoxon rank sum test
Results: Six patients had suprapubic catheter placement at the time of IPP. Nine patients had urethral Foley catheter placed at the time of IPP. 1/6 (16.7%) of the patients in the suprapubic catheter group experienced a complication, which was due to an infected device. 5/9 (55.6%) of the patients in the urethral Foley catheter group experienced a complication (3 infection, 1 erosion, 1 mechanical failure) (p=0.119). There were no statistically significant differences in age, BMI, comorbidities, or level/extent of spinal cord injury between the two groups. More patients in the urethral Foley catheter group were ambulatory (88.9%; p=0.011) and voided spontaneously (77.8%; p=0.004) prior to surgery.
Conclusions: Urethral Foley catheter is a modifiable risk factor during inflatable penile prosthesis placement. In spinal cord injured patients with neurogenic bladder, suprapubic catheter placement at the time of inflatable prosthesis is associated with reduced complications.