INTRODUCTION AND OBJECTIVES
One of the most common causes of patient dissatisfaction after penile implant (PI) surgery is subjective decrease in penile volume during sexual arousal. It has been suggested that this may be explained by decreased volume of cavernosal smooth muscle, which occurs during corporal dilation. This study compared the penile length and volume as well as patient satisfaction in men after PI who were randomized to either standard corporal dilation or dilation performed purely in the sub-tunical space.
METHODS
110 patients were randomly assigned into two groups for malleable penile prosthesis implantation. Group A (n= 48) patients undergoing sub-tunical dilation; this technique used a Metzenbaum scissor placed through a standard corporotomy and passed ventrally sub-tunically in both proximal and distal directions. Group B (n=62) patients underwent classic corporal dilation, where dilation was conducted with Hegar dilators, with dilation up to 13mm. Patients with Peyronie's disease (PD) were excluded. Postoperative assessment included completion of the sexual health inventory for men (IIEF-5) and a proprietary satisfaction questionnaire. We asked questions on shaft and glans engorgement. How close is your shaft /glans engorgement after surgery to befor surgery? Are you satisfied with your shaft/glans engorgement after surgery (1-5 SCALE).Patients were followed at 6 and 12 weeks and 6 months after PI surgery. Penile length ( from pubic bone to tip)and mid –shaft penile girth were measured at baseline and at each postoperative visit, and also recorded by the patient during sexual excitation.
RESULTS
Both groups were matched at baseline for mean age (53.41±12.36 and 54.95±11.63 years group A and B respectively), comorbidity profile and IIEF-5 score. There were significant differences in length gain (baseline vs 6 months) and postoperative girth between groups A and B (Table 1). Patient satisfaction was higher in group A. according to patient satisfaction Q and IIEF-5 scores which were matched at baseline (7.2 versus 7.3) but different after surgery: 22.5 vs 18.2, 23 vs 17.9, 22.1 vs 19.1 (both p>0.01).
CONCLUSIONS
Sub-tunical dilation at the time of PI surgery appears to translate into greater penile volume gain after surgery and higher patient satisfaction.
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