Presentation Authors: Alfredo Suarez-Sarmiento Jr.,*, Matthew Brennan, Edward Gheiller, Alfredo Suarez-Sarmiento, Paul Perito, Coral Gables, FL
Introduction: Hypermobile glans deformity has been considered a â€œcomplicationâ€ of penile prosthesis implantation (IPP) in which the glans penis does not mount on the anterior tip of the prosthesis. Previous literature has stated that this deformity usually results from the surgeon incorrectly sizing the prosthesis or inadequate distal dilation. We sought to evaluate our single institutional experience to determine the incidence of true hypermobility. Post-operative outcomes without intraoperative resolution of the deformity are evaluated.
Methods: From April to October, 2018, patients undergoing penile prosthesis implantation were identified from our institutional database. All clinical notes, patient demographics, comorbidities and surgical outcomes were reviewed. Hypermobility was determined and agreed upon independently by all Board-Certified surgeons operating in our high-volume training program where we devised a scale which gauges the existence and character of the deformity. True hypermobile glans deformity was detected and evaluated intraoperatively and postoperatively. No patients underwent glanulopexy at the time of the procedure. Post-operative treatment options included: no treatment, PDE5 inhibitors, Trimix gels and Durosphere injection. Patients that failed all conservative approaches then underwent glanulopexy.
Results: Of 232 patients undergoing IPP, 58 (25.1%) were determined to have true hypermobility by all surgeons present. Dorsal hypermobility was found more frequently in patients, compared to ventral (58.6% vs 17.2%) respectfully, while 24.2% had both dorsal and ventral hypermobility. 44 (75.6%) patients required no postoperative treatment and were satisfied with their outcome. Of those requiring treatment, 9 (15.5%) needed PDE5 inhibitors or Trimix gels for stability, while only 2 (3.7%) underwent Durosphere injections of the glans for support. Only 3 (5.2%) patients needed glanulopexy using an anchoring suture with or without penile shaft skin reduction.
Conclusions: Ensuring adequate distal dilation and correct penile prosthesis sizing is important and can be the determining factor regarding the development of a true SST deformity. However, true hypermobility of the glans penis is found in at least 25.1% of patients despite technique. This incidence is essential data to report to patients when counseling them preoperatively and setting proper expectations for IPP placement. Considering the low incidence of patients requiring glanulopexy, intraoperative glanulopexy at the time of IPP placement may not be advised.