Presentation Authors: Joseph M Caputo*, Christopher I Sayegh, Shyam Sukumar, Denise Asafu-Adjei, Doron S Stember, Peter J Stahl, New York, NY
Introduction: The risks of secondary penile prosthesis (PP) surgery (revision, replacement or explant) include catastrophic complications such as visceral organ injury, vascular injury, and failure to remove a PP component. Preoperative imaging is a potentially useful strategy to mitigate risk and facilitate surgical planning. Our objective was to evaluate the potential clinical utility of CT imaging prior to secondary PP surgery.
Methods: CPT codes and retrospective chart review was used to identify 84 men who underwent CT at our center after primary PP surgery from 2003-2018 (including men who underwent primary surgery at our center and men who had primary surgery outside). CTs were reviewed by a fellowship-trained prosthetic urologist for PP component locations, distances from the reservoir to the nearest iliac vessel, and presence of rear tip extenders (RTEs) in the proximal crura (using CT bone window). Findings were compared with available op notes.
Results: Atypical reservoir locations were found in 8/84 (9.5%) men. 5 reservoirs were intraperitoneal, 2 were subcutaneous, and 1 was in the thigh adjacent to the femoral vessels. Primary PP surgery op notes were available for 76 men. Reservoir locations were discordant from the op note in 15/76 (20%), including 8 reservoirs on the opposite side and 7 in a different anatomic compartment. Median distance from the reservoir to the nearest iliac vessel was 0.23 cm (IQR= 0-0.87). The reservoir was in direct contact with an iliac vessel in 28/84 (33%) men, and in direct contact with the bladder in 47/84 (56%) men. The proximal crura of the penis were evaluable on 69/84 CTs, which allowed for identification of 6/69 (9%) suspected proximal perforations and 4/19 (21%) patients in whom RTEs were identified on CT but were not included in the op report.
Conclusions: Unexpected and potentially perilous PP component locations are common. Pelvic CT prior to secondary PP surgery can help an implanter plan surgical approach, anticipate adjunctive surgical maneuvers (i.e. RTE sling), and definitively determine if RTEs are present. CT can also identify high risk cases in which planned involvement or availability of other specialists may be prudent (e.g. for laparoscopic retrieval of an IP reservoir, see Figure).