257 Upsizing of penile prostheses in mechanical failure replacement

There is no data published in the literature regarding if penile prostheses (PP) revision surgery for mechanical failure would allow for a larger corporal cylinder to be placed (upsizing). Our objective is to evaluate the upsizing after PP replacement due to mechanical failure, quantify the magnitude of the same and analyse what factors influence. We have performed a multicentre retrospective observational study on PP replacement due to mechanical failure between June 1991 and October 2017. We included those patients in whom we had the type and size of both prostheses. We excluded PP replacement of less than 12 months and replacement due to infection. We analyze age, comorbidity, aetiology, size, type of prostheses and time between procedures. There were 142 replacements, meeting inclusion criteria only 85. The mean age in the first implant was 51.7 years (24-73 years). The main aetiology was vasculogenic erectile disfunction in 59 patients (69.4%), followed by pelvic surgery 15 (17.6%) (radical prostatectomy-10, radical cystectomy-4, colorectal surgery-1), Peyronie’s disease 5 (5.9%), neurologic 5 (5.9%) and priapism with one case. 23 patients (27.1%) were diabetic and the mean time to replacement was 98 months (16.5-271 months). The primary PP type was Non-inflatable PP in 27 cases (31.8%), one-piece inflatable PP in 15 (17.6%), two-piece inflatable PP in 29 (34.1%), three-piece inflatable PP in 12 (14.1%) and three-piece inflatable PP with length expansion in 2 (2.4%). The mean length of primary PP was 19.6 +/- 1.8 cm and the mean length of the secondary PP was 21.1 +/- 2.1 cm, with an average upsizing of 1.5 +/- 1.5 cm (p <0.000). In 60 cases (70.6%) upsizing was performed, in 14 (16.5%) cylinders of same length were implanted and in 11 (12.9%) smaller cylinders were implanted. Aetiology, age (p=0.36), diabetes (p=0.17) and time between procedures (p=0.12) were not correlated with higher upsizing. Only the type of primary PP was associated with higher upsizing (two-piece inflatable PP (p=0.13) and three-piece inflatable PP with length expansion (p=0.48)).