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JU INSIGHT Subcoronal Incision for Inflatable Penile Prosthesis Does Not Risk Glans Necrosis
By: Sung Hun Park, MD, Sewum Prosthetic Urology Center of Excellence, Seoul, South Korea; Steven K. Wilson, MD, Institute for Urologic Excellence, La Quinta, California; Lexiaochuan Wen, MD, Mayo Clinic, Rochester, Minnesota | Posted on: 25 Oct 2023
Park SH, Wilson SK, Wen L. Subcoronal incision for inflatable penile prosthesis does not risk glans necrosis. J Urol. 2023;210(4):678-687.
Study Need and Importance
The subcoronal incision for inflatable penile prosthesis (IPP) surgery provides excellent corporal exposure and has the added benefit of being well tolerated under local anesthesia. Historical reports have implicated the subcoronal incision as a major risk factor for glans vascular compromise. As a result, many implant surgeons are understandably wary of adopting this technique. Here, we report the largest series of 898 subcoronal IPP surgeries performed by a single surgeon to delineate the true incidence of glans necrosis/ischemia and characterize the commonly encountered complications associated with this unique approach for IPP placement.
What We Found
The most common complications were distal penile edema (74.7%) and incisional paresthesia (20.6%), both of which were self-limiting (see Table). Distal penile skin necrosis developed in 5 patients (0.5%), characterized by dusky tissue and incisional wound dehiscence. All 5 patients had a prior circumcision, and the specific placement of the incision relative to the prior scar was deemed as the primary cause. Among these cases, 3 healed with wet-to-dry dressing, 1 required tissue grafting, and 1 necessitated device explantation. Device infection was rare (0.2%). No reports of glans vascular compromise were observed. All first-time implants (817) were successfully completed under local anesthesia with or without adjunctive conscious sedation.
Table. Complications Specific to Subcoronal Incision Approach for Inflatable Penile Prosthesis Placement
| Complication | No. (%) |
|---|---|
| Transient distal penile edema | 673 (74.9) |
| Transient subcoronal incision paresthesia | 189 (20.6) |
| Distal penile skin necrosis | 5 (0.5) |
| Device infection | 2 (0.2) |
| Glans vascular compromise (ischemia/necrosis) | 0 (0) |
Limitations
This study is limited by its retrospective design. All surgeries were performed by an experienced surgeon who specializes in this approach, which may account for the low complication rates. The majority (96%) of patients in this series are ethnically Korean, and the data may not apply to a more diverse population.
Interpretations for Patient Care
In experienced hands, the subcoronal approach for IPP placement is safe and does not pose a risk of glans ischemia. It is most suitable for routine IPP placement and is compatible with office-based sedation techniques.
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