Bonakdarhashemi, M

Abstract Introduction Inflatable penile prosthesis (IPP) implantation is a common and effective surgical treatment for erectile dysfunction. However, the presence of comorbidities and the use of anti-thrombotic therapy (AT) can complicate surgical decision-making. Due to the correlation between erectile dysfunction and cardiovascular disease, the preoperative comorbidities of surgical patients are important to examine. Objective The goal of this study was to assess the outcomes of IPP implantation in men on active AT therapy compared to a non-AT therapy cohort. Methods A retrospective analysis from 2015 to 2023 was conducted using data from three high-volume implant centers. The study focused on men who underwent three-piece IPP placement. Demographics, comorbidities, secondary procedures, drain information, and complications were recorded. The three centers each have different techniques and approaches to the surgery. Center 1 utilizes a penoscrotal approach, never places a drain, and places the reservoir in an ectopic location. Center 2 utilizes an infra-pubic approach, places a drain which remains in place for 3 days, and utilizes various reservoir locations depending on patient profile. Lastly, center 3 utilizes a penoscrotal approach, places a drain with removal when output is less than 50 mL over 8 hours, and places the reservoir in an ectopic location. Outcomes were analyzed using multivariate and univariate analysis. Results A total of 210 patients on active AT therapy and 128 non-AT patients were included. The AT and non-AT groups showed significant differences in baseline comorbidities, with the AT group exhibiting higher rates of cardiovascular disease, hypertension, and thrombosis (p<0.05). Among patients on anti-thrombotic therapy, 27.6% required revision surgeries and had increased rates of ectopic reservoir placement compared to the non-AT group (p<0.001). Despite these differences, there were no statistically significant variations in overall complication rates between the two groups. Drain output was notably higher in the AT cohort on postoperative days 1 (mean 110.5 cc vs 60 cc, p<0.001) and 2 (mean 78 cc vs 20 cc, p<0.001); however, hematoma rates remained comparable between both groups (p=0.667). Importantly, neither the type of anti-thrombotic therapy nor the surgical approach used appeared to influence postoperative outcomes. Eleven patients (5.2%) experienced complications in the AT arm and 5 patients (3.9%) experienced complications in the non-AT arm (p=0.793). Conclusions IPP implantation is feasible and safe in men on active anti-thrombotic therapy when performed in high-volume centers with appropriate perioperative management. Further studies with larger cohorts and longer follow-up are needed to refine protocols and determine long-term outcomes for these high-risk patients. Disclosure No

Abstract Introduction Penile prosthesis (PP) implantation is associated with high patient satisfaction and improved sexual quality of life in medically refractory erectile dysfunction (ED). While reported patient satisfaction with this surgery is high, there are a variety of factors that can influence patient satisfaction after PP surgery. Objective We aimed to identify factors responsible for patient dissatisfaction after PP surgery. Methods We initiated a registry of patients undergoing surgery for placement of a PP. After consent, Perioperative study assessments and follow-ups were conducted. After surgery, patients were directed to fulfill a survey at 6 months and 12 months. Patients who completed both surveys were included in the analysis. Results A total of 304 patients had a PP placement, of these 101completed at least the first survey. Patients reported using their PP a median of 4 (2-8) times per month at 6 months, and 5 (2-9) at 12 months (p = 0.651). Main reasons of lack of use of the PP can be seen in Fig. 1A. The most frequent reported reason was lack of interest from partner (20.3% at 6-months, 18.8% at 12-months). Patient reported reasons for dissatisfaction are seen in Fig. 1B. Examples include penile pain (19% at 6-months, 11% at 12-months), difficulty with orgasm (39% at 6-months, 37% at 12-months), unsatisfactory penile cosmesis (28% at 6-months, and 25% at 12-months), problems inflating of the prosthesis (14.9% at 6-months, and 21.5% at 12-months), and problems deflating of the prosthesis (33.7% at 6-months, and 31.6% at 12-months). Despite these concerns, most patients found PP easy to use (83.2% at 6-months, and 82.1% at 12-months) and a reported a very or somewhat natural sensation with their erections (66.4% at 6-months, and 62.8% at 12-months) Fig. 1C. Conclusions There was a higher than anticipated rate of penile pain, difficulty achieving climax, and unsatisfactory cosmesis that warrant further investigation. Despite this, the majority of patients found their PP easy to use and a reported natural sensation when having erections. Disclosure Yes, this is sponsored by industry/sponsor: Coloplast. Clarification: Industry funding only - investigator initiated and executed study.