(065) Intraoperative Comparison of Bioflex With Hydrophilic Coating Versus Silicon / Mesh With Antibiotic Coating Cylinders in Inflatable Penile Prosthesis Replacement Surgery: Significant Difference in O.R. Time, Need for Advance Reconstruction and EBL

Abstract Introduction Surgical replacement of an Inflatable Penile Prosthesis (IPP) carries a much higher risk of complications, especially infection, compared to the primary implantation. A fibrous tissue capsule forms around each implant component. Bioflex hydrophilic-coated cylinders (BHCC) usually “slide out” easily when removed during replacement surgery due to their unibody construction and lubricious coating. Whereas with the silicone antibiotic-coated cylinders (SACC), the outer layer can split open, exposing the mesh underneath to tissue ingrowth altering the tissue planes and the scarring can exist for the entire length of the corpora. Additionally, the input tubing has a Gortex sheath that causes tissue ingrowth locking-in the base of the cylinders making removal more difficult. This can make an already complicated case into some of the most difficult cases in prosthetic urology. The tissue ingrowth into the mesh can require a large wide block resection of the corpora cavernosa (CC) and the need for resultant reconstruction of the corpora to replace the new device. We hypothesize that BHCC will have significantly lower operating room (OR) time, need for advanced reconstruction and estimated blood loss (EBL) than silicone/mesh cylinders with antibiotic coating than SACC. Objective Intraoperative comparison of BHCC to SACC OR time, need for advanced reconstruction and estimated blood loss. Methods A retrospective extensive chart review of a single surgeon working in the same location over the last 20+ years was performed. Over 500 replacement/revision/secondary surgeries have been done by the single surgeon over that time in that location. IRB for a retrospective chart review was obtained. Data was gathered by a HIPAA-trained research staff and put into an Excel spreadsheet. Patient demographics and past medical history were included. Moreover, the penile implant surgical history was obtained: date of the original surgery, date(s) of any subsequent penile implant surgeries, duration of each and any penile implant, type of penile implant for each surgery, cylinder utilized and length, rear tip extenders usage, reservoir type/size and fluid volume filled into the reservoir, location of the reservoir, intraoperative complications, postoperative complications, OR time, estimated blood loss (EBL) and any concurrent surgeries done– special attention to any advanced surgical moves [ex. corporal reconstruction, cylinder aneurysm repair, urethral injury] done during the surgery and postoperative device survival and follow-up. Results In comparing the data for intraoperative IPP replacement surgeries there was a statistically significant difference (p<0.05) between BHCC and SACC in terms of operating room time, cases needing advanced reconstruction, and estimated blood loss (EBL). The biggest factor accounting for these differences was tissue ingrowth into the Gortex sheath and/or the exposed mesh and the resultant tissue ingrowth. Conclusions It appears BHCCs have significantly less OR time, need for advanced reconstruction, and EBL than SACCs in IPP replacement surgeries. The most common reason is tissue in-growth into the Gore-Tex boots and into the exposed mesh when the outer layer of silicone cylinder is split open (cylinder rupture). Disclosure Yes, this is sponsored by industry/sponsor: Coloplast Corporation Clarification: Industry funding only - investigator initiated and executed study Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Signati, Boston Scientific, Pfizer, ConvaTec, FocalOne, BlueWind, Irrisept