Köhler, Tobias

Abstract Background Glanular hypermobility (GH) or supersonic transporter (SST) deformity are occasionally encountered during penile prosthesis (PP) implantation, yet management strategies are underreported with minimal data available on surgical outcomes. Aim To describe a modified technique for glanulopexy to correct GH/SST in men undergoing PP placement and assess outcomes associated with this technique. Methods Glanulopexy was performed in men with GH/SST identified at the time of or following PP placement. A modification to previously described techniques was performed, whereby a suture is passed into the glans and secured to the tissue overlying the corpora through small incisions on the lateral aspects of the distal penile shaft. Outcomes Correction of the anatomic deformity (GH/SST), device infection, and changes in penile sensation were evaluated during post-operative follow-up. Results From 2014–2017, a total of 12 patients underwent modified glanulopexy for GH/SST. Nine (75%) were performed at the time of PP, while the remaining 3 were performed in a delayed fashion. At a median follow-up of 12 months (range 1–33 months), all patients with the device in situ demonstrated appropriate glanular positioning, and no patients reported changes in penile sensation. A single patient required device removal secondary to infection. Clinical Translation Glanulopexy with permanent suture successfully corrects severe GH or SST in men with inflatable PP without reduced penile sensation. Conclusions Strengths of the current study include the description of a simple, safe, and reproducible technique for GH/SST that adds minimal operative time and can be performed under local anesthesia when necessary. To our knowledge, this represents one of the largest reported series of glanulopexy outcomes reported in the literature. Limitations include that this is a single-surgeon series, there is limited follow-up, and lack of a comparison group. Further study with external validation is warranted to establish the optimal role for the procedure.

Abstract Background After radical prostatectomy (RP), erectile dysfunction, often necessitating the need for inflatable penile prosthesis (IPP) insertion, and urinary incontinence and climacturia can ensue. Aim To assess the efficacy and safety of the mini-jupette, a mesh used to approximate the medial aspects of the 2 corporotomies at the time of IPP insertion, for the management of climacturia and urine leakage in patients with minimal incontinence. Methods We conducted a pilot multicenter study of patients with post-RP erectile dysfunction and climacturia and/or mild urinary incontinence (≤2 pads/day [ppd]) undergoing IPP insertion with concomitant placement of a mini-jupette graft. Outcomes Pre- and postoperative erectile function, continence and climacturia, and overall surgical outcomes were assessed. Results 38 patients underwent the mini-jupette procedure. The mean age of the population was 65.3 years (SD = 7.7). 30 had post-RP climacturia and 32 patients had post-RP incontinence (mean = 1.3 ppd, SD = 0.8). 31 patients received Coloplast Titan, 4 received AMS 700 LGX, and 3 received AMS 700 CX IPPs. Mean corporotomy size was 2.9 cm (SD = 1.0). Mean graft measurements were 3.2 cm (SD = 0.9) for width, 3.3 cm (SD = 1.3) for length, and 11.0 cm2 (SD = 5.1) for surface area. At a mean follow-up of 5.1 months (SD = 6.9), there were 5 postoperative complications (13.2%) of which 4 required explantation. Climacturia and incontinence were subjectively improved in 92.8% and 85.7%, respectively. Mean ppd decreased by 1.3 postoperatively. Clinical Implications The Andrianne mini-jupette is a feasible adjunct to IPP placement that can be used for subsets of patients with post-RP climacturia and/or minimal incontinence. Strengths and Limitations Strengths of this study include the novel nature of this intervention, the multi-institutional nature of the study, and the promising results demonstrated. Limitations include the retrospective nature of the study and the heterogeneity of the techniques and grafts used by different surgeons involved. Conclusion Longer follow-up and larger patient cohorts are needed to confirm the long-term safety and benefits of this intervention.