Penoscrotal versus minimally invasive infrapubic approach for inflatable penile prosthesis placement: A single-center matched paired analysis

Introduction & Objectives Currently, approximately 80% of inflatable penile prosthesis (IPP) are placed by penoscrotal approach (PSA), although no superiority of this technique compared to the infrapubic approach has ever been demonstrated. The aim of this study was to compare perioperative results, safety and efficacy profile in patients receiving inflatable penile prosthesis(IPP) via PSA or minimally invasive infrapubic approach(MIIA) for erectile dysfunction. Materials & Methods Data were prospectively collected in our password-secured institutional database of implanted patients. A matched-pair analysis was performed including 42 patients undergoing IPP implantation via PSA(n=21) or MIIA(n=21) between 2011 and 2016. Excluded from the study were those patients with urinary incontinence, simultaneous surgery for congenital or acquired (Peyronie’s disease) recurvatum, previous urethral or penile surgery and lack of follow-up data. All patients were invited to fill in validated self-administered questionnaires to evaluate various aspects of post-prosthesis sexual life. Specifically, questionnaires included: the International Index of Erectile Function(IIEF), Erectile Dysfunction Inventory of Treatment Satisfaction(EDITS) and Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaires. Complications were allocated using the modified Clavien classification. Results Mean(SD) operative time was 128(40.6) min. in group PSA and 91(43.0) min. in group MIIA(p=0.041). Complications occurred in 3/21(14%) and 2/21(10%) patients in groups PSA and MIIA(p=0.832). Overall, no differences were observed concerning the device utilization (p=0.275). However, in group MIIA 4/21(19%) patients were able to resume sexual activity prior to 4 postoperative weeks, while in group PSA no patient was (p=0.012). Mean(SD) scores for questionnaires were similar between groups PSA and MIIA: IIEF [20.9(7.3) vs. 20.7(4.8); p=0.132], patient EDITS [76.0(25.6) vs. 74.7(20.8); p=0.256] and partner EDITS [72.5(29.1) vs. 73.1(21.4); p=0.114]. Similarly, QoLSPP showed comparable results among the groups PSA and MIIA: functional domain [3.9(1.4) vs. 4.0(1.2); p=0.390], personal [4.0(1.2) vs. 4.1(1.0); p=0.512], relational [3.7(1.5) vs. 3.9(1.2); p=0.462] and social [4.0 (1.2) vs. 3.9 (1.2); p=0.766]. Retrospective setting of the analysis and a limited number of patients could be limitation factors. Conclusions Penoscrotal and minimally invasive infrapubic approaches demonstrated to be safe and efficient techniques for IPP implantation, leading to high level of both patients and partners satisfaction. Additionally, the minimally invasive infrapubic approach showed a shorter operative time and a tendency for a faster return to sexual activity.