Login to Access Video or Poster Abstract: MP25-07
Sources of Funding: None

Introduction

The prevalence of moderate to severe erectile dysfunction (ED) in the general population is 25%. This is compounded by exposure to pelvic radiation with some series estimating ED to be 22% to 84%, with higher numbers seen in patients who have undergone prior pelvic surgery such as for prostate cancer. Inflatable penile prosthesis (IPP) offers patients a definitive treatment option in patients refractory to medical therapy. We present our contemporary experience in placing a three-piece IPP for medication-refractory ED in patients with a history of pelvic radiation. _x000D_

Methods

From 2010-2016, using an IRB-approved database we completed a retrospective review of 450 patients who underwent primary placement of an IPP (AMS 700CXM, American Medical Systems Inc, Minnetonka, MN, USA) Of those patients, 46 patients had been exposed to pelvic radiation, either external beam or brachytherapy. Some of these patients also had radical prostatectomy (12) or other pelvic surgery performed either primarily or in a salvage setting. A three-piece IPP was implanted via an infrapubic (96%) or penoscrotal approach (4%) and the reservoir placed in the space of Retzius (35%) or in the retroperitoneum via a separate incision (65%) depending on their previous surgical history. 20 patients had artificial urinary sphincters (AUS) placed during a different setting. Patient demographics and postoperative outcomes including prosthetic infection were examined._x000D_

Results

No intraoperative complications were observed in patients with exposure to pelvic radiation who underwent placement of an IPP. After a mean follow-up of 753 days (35 - 2,454 days), there were no IPP infections observed. One patient had an erosion of their AUS which required explantation. A total of 6 patients (13.0%) required revisional surgery, with 3 pump revisions, 1 reservoir revision, and 2 cylinder replacements (aneurysm or upsizing). When compared to all patients who underwent IPP placement during that same study period we found no increased risk of infection in these patients.

Conclusions

Despite improvements in the delivery of radiation to the pelvis, erectile dysfunction is still a major cause of patient dissatisfaction. The IPP offers patients a definitive treatment option and excellent patient and partner satisfaction. In the hands of experienced surgeons, there is no increased risk of complications associated with placing these devices in this patient population.

Funding

None