Steven K Wilson1, Cesar Mora-Estaves1, Paulo Egydio2, David Ralph3, Mohamad Habous4, Christopher Love5, Ahmad Shamsodini6, Robert Valenzuela7, Faysal A Yafi8. 1. Institute for Urologic Excellence, La Quinta, CA. 2. Penile Curvature Center, São Paulo, Brazil. 3. University College London Hospital, London, UK. 4. Elaj Medical Centers, Riyadh, Saudi Arabia. 5. Men's Health Melbourne, Melbourne, Australia. 6. Weil Cornell Medical University, Doha, Qatar. 7. Washington Heights Urology, New York, NY. 8. University of California Irvine, Irvine, CA. Electronic address: Fyafi@uci.edu.
Abstract
OBJECTIVE: To examine possible etiology and treatment outcomes in 21 patients with glans necrosis following penile prosthesis implantation. METHODS: Glans necrosis typically presented with a dusky glans on the first postoperative day following prosthesis implantation. RESULTS: The blood supply to the glans penis consists of the dorsal arteries and the terminal branches of the spongiosal arteries. Using the cohort in our study, we compiled preoperative comorbidities and adjunctive surgical maneuvers that might compromise glans vascularity, leading to glans necrosis. Preoperative risk factors were arteriosclerotic cardiovascular disease (90%), diabetes mellitus (81%), smoking (81%), previous prosthesis explantation (57%), and previous radiation therapy (48%). The most prevalent intraoperative and postoperative factor was subcoronal incision for reasons as simple as coincident circumcision or as complex as for penile degloving (86%). Other factors detected were penile wrapping with an occlusive elastic bandage (62%), use of a sliding technique for penile lengthening (33%), and coincident distal urethral injury repair (29%). Seventeen patients (81%) managed expectantly with preservation of implanted prosthesis sustained significant glandular loss. Four patients managed with immediate prosthesis removal healed without sequelae. CONCLUSION: Patients with preoperative risk factors undergoing penile prosthesis implantation should avoid high-risk adjunctive surgical maneuvers. Upon development of signs of glans necrosis postoperatively, in the setting of these high-risk factors, immediate implant removal may prevent subsequent glans necrosis.
OBJECTIVE: To examine possible etiology and treatment outcomes in 21 patients with glans necrosis following penile prosthesis implantation. METHODS:Glans necrosis typically presented with a dusky glans on the first postoperative day following prosthesis implantation. RESULTS: The blood supply to the glans penis consists of the dorsal arteries and the terminal branches of the spongiosal arteries. Using the cohort in our study, we compiled preoperative comorbidities and adjunctive surgical maneuvers that might compromise glans vascularity, leading to glans necrosis. Preoperative risk factors were arteriosclerotic cardiovascular disease (90%), diabetes mellitus (81%), smoking (81%), previous prosthesis explantation (57%), and previous radiation therapy (48%). The most prevalent intraoperative and postoperative factor was subcoronal incision for reasons as simple as coincident circumcision or as complex as for penile degloving (86%). Other factors detected were penile wrapping with an occlusive elastic bandage (62%), use of a sliding technique for penile lengthening (33%), and coincident distal urethral injury repair (29%). Seventeen patients (81%) managed expectantly with preservation of implanted prosthesis sustained significant glandular loss. Four patients managed with immediate prosthesis removal healed without sequelae. CONCLUSION:Patients with preoperative risk factors undergoing penile prosthesis implantation should avoid high-risk adjunctive surgical maneuvers. Upon development of signs of glans necrosis postoperatively, in the setting of these high-risk factors, immediate implant removal may prevent subsequent glans necrosis.