Abstract: PD22-01
Sources of Funding: none

Introduction

Glans necrosis following penile implant is a very rare complication. The literature has a paucity of information with only 5 single case reports. Glans necrosis is devastating to both patient and physician. The blood supply of the glans penis is twofold: dorsal penile arteries and corpus spongiosum muscle. Glans necrosis initially presents with a dusky, sometimes blistered glans on first post op day. The dilemma of immediate implant removal or continued observation perplexed each surgeon.

Methods

The patients were collected from the experience of large volume implanters in 7 countries. We report 19 cases following prosthesis implantation (8 rods, 11 inflatable) examining etiology and treatment outcomes with the hope of both prevention & optimum treatment suggestion. From this patient population we compiled risk factors and adjunctive surgical maneuvers that might compromise vascularity of the Glans Penis. 7 of the patients had pre-operative Doppler showing arterial patency of the dorsal arteries. Risk factors detected were:_x000D_ Severe arteriosclerotic cardiovascular disease (ASCVD) (84%) _x000D_ Diabetes (84%)_x000D_ Smoking (72%)_x000D_ Previous removal of implant usually for infection (68%)_x000D_ Radiation Therapy (56%)_x000D_ 79% of patients had 60% of these comorbidities. 53% of patients had 80% risk factors_x000D_ Surgical maneuvers found in the population during prosthesis placement were_x000D_ Subcoronal incision for coincident circumcision or penile degloving (89%)_x000D_ Penile wrap with elastic bandage (74%)_x000D_ Coincident distal urethral injury &/or repair (28%)_x000D_ Sliding procedure for penile lengthening (28%)

Results

15 (79%) patients had expectant management i.e., implant preservation & observation. All sustained significant loss of glans; most required relocation of urethral meatus. 4 (21%) patients were managed with immediate prosthesis removal and hyperbaric oxygen. All healed without sequelae._x000D_

Conclusions

Prospective implant patients with many of the risk factors -- diabetes, smoking, radiation therapy, previous implant removal, & severe ASCVD -- should not undergo coincident subcoronal incision for circumcision, distal urethral repair, or penile lengthening. Occlusive elastic penile bandage should be avoided. Upon development of signs of glans ischemia, immediate implant removal is mandatory for prevention of glans necrosis.

Funding

none