Infrapubic approach for inflatable penile prosthesis: Perioperative and long-term outcomes

Erectile dysfunction (ED) impacts nearly 150 million men worldwide. Inflatable penile prosthesis (IPP) placement is considered after oral pharmacological treatments and intracavernous injections. This surgery is often performed through a penoscrotal approach. However, infra-pubic approach seems to allow faster activation of the prosthesis, with similar complication and satisfaction rates. The objective of this study was to evaluate the perioperative and long-term outcomes following inflatable penile prosthesis implantation using the infrapubic approach.

The medical records of all patients who underwent inflatable penile prosthesis (IPP) placement via the infrapubic approach between 2010 and 2022 at two centers were retrospectively reviewed. Preoperative data and intraoperative data were collected. Postoperative complications occurring within 30 days after implantation were also recorded. Device survival without explantation or reoperation was assessed from the date of implantation to the last follow-up visit, using the Kaplan-Meier method. Sexual function and satisfaction were assessed at the end of the follow-up period.

One hundred and sixteen patients were included in the study. The median age was 63 years (IQR: 55.5-68.0). The median follow-up time was 81.5 months (IQR: 35-119). We observed a 3.4% (4 patients) device infection rate, with one early and three late infections. Eleven patients (9.5%) required late reoperation: two patients for crossover, two patients for implant lengthening, one patient for implant dysfunction, and two patients for unknown reasons. Four patients (3.4%) required late device explantation: two for late infections, one for chronic pain and one for unknown reasons. The median Patient Global Improvement Index score at the end of follow-up was 2/7 (better) (IQR: 1-3). Thirty-one patients (26.7%) reported glans hypoesthesia. In univariate Cox regression analysis, procedures performed by high-volume surgeons were associated with a significantly reduced risk of reoperation (HR=0.28, P=0.034).

The infrapubic approach is a reliable and reproducible technique. Comparative prospective studies could help clarify its causal link to glans hypoesthesia and guide surgeons in selecting the most appropriate surgical approach.

Level 4.