Presentation Authors: Mark Johnson, Marcus Hallerstrom, Giovanni Chiriaco*, Thomas Johnson, Evangelos Zacharakis, Amr Raheem, Andrew Nim Christopher, Asif Muneer, Giulio Garaffa, David Ralph, London, United Kingdom
Introduction: There is still a lack of consensus in the literature about the timing of penile (PP) prosthesis surgery following refractory ischaemic priapism (IP). The aim of this study is to compare the long-term results of early vs delayed PP insertion in this group.
Methods: A total of 126 men underwent penile prosthesis surgery for refractory IP between 1999 and 2017. Early PP insertion ( < 3 weeks from onset of priapism) was carried out in 88 men with a mean duration of 6.5 days (range 3 to 21 days) from the onset of priapism. Delayed PP insertion (>3 weeks since the onset of priapism) was carried out in 38 men with a mean duration of 6.7 months (range 0.75 to 25 months) since the onset of priapism. The results for complications, sexual ability and satisfaction were assessed at follow-up outpatient visits.
Results: In the early group, a malleable and an inflatable PP was implanted in 83 and 5 patients, respectively. After a mean follow-up of 17.8 months (range 3 to 76 months), 8% required (n = 7) required revision surgery due to infection (n = 5), curvature (n = 1) or erosion (n = 1). Patient's satisfaction rate was 94.3% and the ability to have sexual intercourse was 93.2%. In the delayed group, a malleable PP was inserted in 19 patients and an inflatable PP in the remaining 19. After a mean follow-up of 18.6 months (range 3 to 28 months), 23.7% (n = 9) patients required revision surgery due to infection (n = 6), erosion (n = 2) or mechanical failure (n = 1). Overall 86.8% (n = 32) could have sexual intercourse and patient satisfaction rates were 60.5% (n = 23). There was a significant difference (p = < 0.001) between the complication and patient satisfaction rates between the early and delayed groups.
Conclusions: Early implantation of a penile prosthesis has a significantly lower complication and higher patient satisfaction rate compared to a delayed procedure and should be the preferred option in men with refractory IP.