The good, the bad, and the ugly about surgical approaches for inflatable penile prosthesis implantation

Abstract

The penoscrotal (PS), infrapubic (IP), and subcoronal (SC) incisions are used for inserting an inflatable penile prosthesis (IPP). Each surgical approach has its advantages and disadvantages and experts continue to debate which technique has the best outcomes. We performed a critical review of the published English-language studies up to April 2020 investigating the PS, IP, or SC approach for IPP placement. The PS approach is the most frequently used incision. The available data do not suggest a difference between PS and IP approach in size of the implanted prostheses, achieved penile length, patient satisfaction, infection rate, and risk of urethral injury. The risk of dorsal nerve injury, even if low, seems to be greater for IP approach. IP technique is associated with shorter operative time and earlier use of IPP compared with PS approach. Despite limited available data it is reasonable to assume that SC approach, compared with other approaches, has longer operative time and similar infection rate. The time to device activation with SC technique could be similar to the IP approach, but there is only minimal data that can confirm this hypothesis.

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Fig. 1: History: Scott’s original suprapubic approach.
Fig. 2: Evolution from metal Scott to Wilson disposable “Scott retractor”.
Fig. 3: History: first description of infrapubic approach.
Fig. 4: History: perineal approach.
Fig. 5: Penoscrotal approach.
Fig. 6: Infrapubic approach.
Fig. 7: Subcoronal approach.
Fig. 8: Skin loss following subcoronal incision.

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Correspondence to Javier Romero Otero.

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Conflict of interest

SKW is consultant for AMT, Coloplast, International Medical Devices, and Lecturer for Boston Scientific. JRO is proctor and expert advisor for Coloplast, and proctor for Boston Scientific. CM has no conflict of interest to declare.

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Otero, J.R., Manfredi, C. & Wilson, S.K. The good, the bad, and the ugly about surgical approaches for inflatable penile prosthesis implantation. Int J Impot Res (2020). https://doi.org/10.1038/s41443-020-0319-4

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