Ceruti Carlo, Sedigh Omid, Falcone Marco, Timpano Massimiliano, Preto Mirko, Sibona Mattia, Ferro Ilaria, Plamadeala Natalia, Peretti Federica, Cirigliano Lorenzo, Annunziata Emanuele, Polito Chiara, Rolle Luigi, Gontero Paolo

(140) DISTAL REPAIR OF PENILE PROSTHESIS HERNIATION WITH POLYPROPYLENE MESH REINFORCEMENT

  • Urology
  • Reproductive Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Psychiatry and Mental health
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Abstract Objectives Apical erosions are the most frequent clinical presentation of a structural failure of the tunica albuginea. In cases of limited erosion, if a thick pseudocapsule is available, it is possible to repair the failure without grafts, but in many cases it’s necessary to strengthen the apex with biomaterials. We present our technique and our experience in apicoplasty for wide distal erosions using a polypropylene mesh reinforcement. Methods Surgical Technique: Surgery is performed through a subcoronal incision. The extent of apical dissection depends on the width of the tunical failure: in many cases it is sufficient to dissect the apices from the glans, in others a wider release of the distal corpora with disassembly of the glans is necessary. A conventional Polypropylene hernia mesh has been used, tailored over the apices in order to avoid folds and compressions on the urethra and the neurovascular bundle. Clinical experience 12 patients, presented with impending erosion after implantation of inflatable implant (7 cases), malleable implant (4 cases), Apollo Expander (1 case), have been treated and followed up (median 16 months). Results We didn’t report any major (Clavien>=3) complication; among grade 2 complications we reported transitory numbness of glans (2), glans blister and/or escara with complete restitutio ad integrum (2), peno scrotal haematoma (3) No relapses of herniation nor infections were recorded and all the patients resumed satisfying penetrative sexual activity. The underlying penile implant made the mesh not palpable in 75% of patients, and no patient referred any complaint; in only 1 case the partner reported a mild dyscomfort during intercourse. Conclusions After a previous experience with the use of a porcine dermal graft we shifted to polypropylene mesh in order to increase graft resistence. The repair using a polypropylene mesh appears to be a reliable and well accepted solution to definetively treat extensive albugineal failures. Conflicts of Interest None.

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