Impact of cavernous tissue-sparing techniques on postoperative outcomes in penile prosthesis surgery: a systematic...

Penile prosthesis implantation (PPI) is the definitive treatment for men with severe erectile dysfunction refractory to medical therapy. Conventional technique for cavernosal dilation at time of PPI often involves serial cavernosal dilation (CD), which may compromise residual erectile tissue and vascular integrity. In contrast, cavernous sparing (CS) aims to preserve cavernosal artery function, spontaneous penile tumescence, and penile girth.

This study systematically compared perioperative and postoperative outcomes between CS and CD technique at time of PPI.

A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Cochrane databases. Randomized controlled trials and prospective studies comparing CS versus CD techniques at time of PPI were included. Primary outcomes assessed were cavernosal artery preservation, residual tumescence, and postoperative penile girth. Secondary outcomes included complication rates and patient satisfaction.

Four randomized studies involving 193 patients met inclusion criteria. Cavernosal artery preservation was significantly higher in the CS group (OR = 95.92 [24.33-377.70], P < .0001). Residual tumescence occurred in 86.6%-89.13% of CS versus 6.6%-15.2% in CD group (P < .001). Penile girth gains were consistently greater in the CS, with mean increases ranging from 0.55 to 1.81 cm. Complication rates were statistically similar between the two techniques.

Cavernous tissue-sparing techniques offer superior functional outcomes without increasing complication risk. Proper surgical approach for CD at time of PPI should be selectively tailored to corpora cavernosal anatomy including intra-corporal fibrosis severity and complexity.