Introduction. In patients with erectile dysfunction (ED), inflatable penile prosthesis (IPP) surgery is regarded as the gold standard treatment in medically refractory cases or where its conservative treatment options are contraindicated. Despite improvements in surgical technique and implanted materials, IPP surgery retains a substantial complication rate. The aim of the study was to record and grade the postoperative complications of IPP implantation according to a modified Clavien system. Methods. A total of 60 three-piece IPP implantations were performed between 2007 and 2013 by a single surgeon. The primary outcome was to stratify the early (first 30 days) complications into five categories using the modified Clavien-Dindo classification system. A secondary aim was to record the long-term adverse events and to identify possible factors related to complication occurrence. Results. Overall, there were 21 (35%) postoperative complications in 17 of 60 men (28.3%), with 15 adverse events occurring early after surgery. In terms of late complications, there were six (10%) major complications managed by either revision surgery or removal of the prosthesis. Conclusion. This study utilizes a validated morbidity scale thus overcoming problems of previous studies reporting IPP surgery complications. The modified Clavien classification system easily aids in assessing and comparing accurately patients’ postoperative complications, thus improving management and prevention. 1. Introduction Erectile dysfunction (ED) is highly prevalent in certain groups of population. Penile prosthesis implantation is the gold standard in treatment of ED when medical therapy either fails or is contraindicated or unwanted by the patient. Over the last 30 years, several penile implants have been developed to improve the penile rigidity in conjunction with a better cosmetic result [1]. Moreover, surgical techniques and antibiotic coverage of the newer implants have improved safety and both patient and partner satisfaction. In spite of these improvements, however, operative complications remain that can be severe and include increasing morbidity and hospitalization cost. There is a need for an objective postoperative complications reporting system to improve the quality of health service and to facilitate cost reduction and patient satisfaction by reducing postoperative morbidity. The Clavien-Dindo classification distinguishes surgery complications based on the type of therapy needed to correct the complication, thus distinguishing postoperative complications that may appear similar
References
[1]
A. Minervini, D. J. Ralph, and J. P. Pryor, “Outcome of penile prosthesis implantation for treating erectile dysfunction: Experience with 504 procedures,” BJU International, vol. 97, no. 1, pp. 129–133, 2006.
[2]
D. Dindo, N. Demartines, and P.-A. Clavien, “Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey,” Annals of Surgery, vol. 240, no. 2, pp. 205–213, 2004.
[3]
C. Mamoulakis, A. Skolarikos, M. Schulze et al., “Results from an international multicentre double-blind randomized controlled trial on the perioperative efficacy and safety of bipolar vs monopolar transurethral resection of the prostate,” BJU International, vol. 109, no. 2, pp. 240–248, 2012.
[4]
A. Rajpurkar and C. B. Dhabuwala, “Comparison of satisfaction rates and erectile function in patients treated with sildenafil, intracavernous prostaglandin E1 and penile implant surgery for erectile dysfunction in urology practice,” The Journal of Urology, vol. 170, no. 1, pp. 159–163, 2003.
[5]
I. Vakalopoulos, S. Kampantais, S. Ioannidis et al., “High patient satisfaction after inflatable penile prostheses implantation correlates with female partner satisfaction,” Journal of Sexual Medicine, vol. 10, no. 11, pp. 2774–2781, 2013.
[6]
H. Sadeghi-Nejad, “Penile prosthesis surgery: a review of prosthetic devices and associated complications,” Journal of Sexual Medicine, vol. 4, no. 2, pp. 296–309, 2007.
[7]
G. D. Henry, S. K. Wilson, J. R. Delk II, et al., “Revision washout decreases penile prosthesis infection in revision surgery: a multicenter study,” The Journal of Urology, vol. 173, no. 1, pp. 89–92, 2005.
[8]
C. C. Carson III, J. J. Mulcahy, and M. R. Harsch, “Long-term infection outcomes after original antibiotic impregnated inflatable penile prosthesis implants: up to 7.7 years of followup,” The Journal of Urology, vol. 185, no. 2, pp. 614–618, 2011.
[9]
J. E. Reifsnyder, R. Ramasamy, C. K. Ng, et al., “Laparoscopic and open partial nephrectomy: complication comparison using the Clavien system,” Journal of the Society of Laparoendoscopic Surgeons, vol. 16, no. 1, pp. 38–44, 2012.
[10]
P. A. Clavien, J. R. Sanabria, and S. M. Strasberg, “Proposed classification of complications of surgery with examples of utility in cholecystectomy,” Surgery, vol. 111, no. 5, pp. 518–526, 1992.
[11]
A. Masson-Lecomte, K. Bensalah, E. Seringe et al., “A prospective comparison of surgical and pathological outcomes obtained after robot-assisted or pure laparoscopic partial nephrectomy in moderate to complex renal tumours: results from a French multicentre collaborative study,” BJU International, vol. 111, no. 2, pp. 256–263, 2013.
[12]
J. Beilan, R. Strakosha, D. A. Palacios, and C. J. Rosser, “The postoperative morbidity index: a quantitative weighing of postoperative complications applied to urological procedures,” BMC Urology, vol. 14, article 1, 2014.
[13]
E. Chung, C. T. Van, I. Wilson, and R. A. Cartmill, “Penile prosthesis implantation for the treatment for male erectile dysfunction: clinical outcomes and lessons learnt after 955 procedures,” World Journal of Urology, vol. 31, no. 3, pp. 591–595, 2013.
[14]
L. Lindeborg, M. Fode, L. Fahrenkrug, and J. Sonksen, “Satisfaction and complications with the Titan(R) one-touch release penile implant,” Scandinavian Journal of Urology, vol. 48, no. 1, pp. 105–109, 2013.
