Penile necrosis requiring total phallic reconstruction following insertion of penile prosthesis
BAUS ePoster online library. Lee W. 11/10/20; 304206; P6-1
Mr. Wai Gin Lee
Mr. Wai Gin Lee
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Abstract
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Penile necrosis requiring total phallic reconstruction following insertion of penile prosthesis

Lee W1, Assiri H1, Reid T1, Christopher N1, Ralph D1
1University College London Hospitals NHS Foundation Trust, United Kingdom

Background:
The most catastrophic complication of penile implant surgery results in either total/partial loss of the penis or severe fibrosis with loss of penile tissue to such an extent that phalloplasty is required to regain urinary and sexual function. This series assesses the risk factors involved in this group of patients and their outcomes following reconstruction.

Methods:
All patients following phalloplasty for penile necrosis were identified from a comprehensive prospective database. Potential risk factors for penile necrosis were identified and the type and outcomes of reconstruction summarised. Functional outcomes were assessed by questionnaire.

Results:
Fifteen patients (mean age 53.9 +/- 13.9 years) required phalloplasty following penile necrosis (53% by radial forearm free flap) with no flap loss. Reasons for erectile dysfunction were diabetes (40%), Peyronie's disease and pelvic trauma (20% each). All patients had identifiable risk factors - most commonly found was diabetes (60%), followed by smoking (53%), adjunctive procedures like sliding technique or grafting (40%), revision surgery (27%) and infection with delayed explantation (27%). Following phalloplasty, all responders had sensation (and could orgasm if tried) and 86% were able to void standing. The questionnaire response rate was 67%.

Conclusions:
Penile necrosis following IPP insertion is rare and occurs in the presence of risk factors, particularly diabetes and smoking. IPP surgery should be considered carefully in this population of patients especially for revision surgery or where adjunctive procedures are planned. Infection requires immediate explant of the device. Phalloplasty has good surgical and functional outcomes should reconstruction be required.
Penile necrosis requiring total phallic reconstruction following insertion of penile prosthesis

Lee W1, Assiri H1, Reid T1, Christopher N1, Ralph D1
1University College London Hospitals NHS Foundation Trust, United Kingdom

Background:
The most catastrophic complication of penile implant surgery results in either total/partial loss of the penis or severe fibrosis with loss of penile tissue to such an extent that phalloplasty is required to regain urinary and sexual function. This series assesses the risk factors involved in this group of patients and their outcomes following reconstruction.

Methods:
All patients following phalloplasty for penile necrosis were identified from a comprehensive prospective database. Potential risk factors for penile necrosis were identified and the type and outcomes of reconstruction summarised. Functional outcomes were assessed by questionnaire.

Results:
Fifteen patients (mean age 53.9 +/- 13.9 years) required phalloplasty following penile necrosis (53% by radial forearm free flap) with no flap loss. Reasons for erectile dysfunction were diabetes (40%), Peyronie's disease and pelvic trauma (20% each). All patients had identifiable risk factors - most commonly found was diabetes (60%), followed by smoking (53%), adjunctive procedures like sliding technique or grafting (40%), revision surgery (27%) and infection with delayed explantation (27%). Following phalloplasty, all responders had sensation (and could orgasm if tried) and 86% were able to void standing. The questionnaire response rate was 67%.

Conclusions:
Penile necrosis following IPP insertion is rare and occurs in the presence of risk factors, particularly diabetes and smoking. IPP surgery should be considered carefully in this population of patients especially for revision surgery or where adjunctive procedures are planned. Infection requires immediate explant of the device. Phalloplasty has good surgical and functional outcomes should reconstruction be required.
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