(803) Inflatable Penile Prosthesis Surgery: Does the Approach Matter?

Abstract Introduction The inflatable penile prosthesis (IPP) is an established treatment for erectile dysfunction in patients with an inadequate response or contraindications for pharmacotherapy. There are two main surgical approaches commonly used for IPP implantation: penoscrotal (PS) and infrapubic (IP). However, limited data are available regarding the impact of surgical approach on perioperative variables. Objectives To evaluate the significance of perioperative variables between the infrapubic and penoscrotal approaches for inflatable penile prosthesis implantation. Methods A retrospective review, in a tertiary medical center, was conducted using the departmental database. It included patients who underwent inflatable penile prosthesis implantation between March 2022 and September 2025. The perioperative data was collected and compared between the infrapubic and penoscrotal groups. The statistical analyse was performed using the JASP software. Independent-sample t tests, Mann–Whitney U tests, Chi-square tests, and Fisher’s exact tests were applied as appropriate, with statistical significance defined as p 0.05. Results Between March 2022 and September 2025, a total of 59 inflatable penile prosthesis implantations were performed in our department using either the Coloplast Titan or AMS 700 devices. The median patient age was 65.1 years. Of these, 22 were performed via the penoscrotal approach and 37 with the infrapubic approach. Six cases involving concomitant procedures (male sling or artificial urinary sphincter implantation) were excluded from the operative time and complication analyses. The operative duration was significantly longer for the penoscrotal approach (120.4 ± 39.3 minutes) compared with the infrapubic approach (94.1 ± 53.8 minutes; U = 159.0, p = 0.002), indicating a shorter operative time with the infrapubic technique. Additionally, the infrapubic approach demonstrated a greater cylinder length without rear tip extenders (17.97 ± 1.69 cm vs. 16.55 ± 1.95 cm; p = 0.008) and required fewer rear tip extenders (1.19 ± 0.40 cm vs. 1.67 ± 0.59 cm; p = 0.003). No significant differences were observed in total prosthesis length (18.81 ± 1.79 cm vs. 17.91 ± 1.82 cm; p = 0.069) or postoperative hospital stay (2.49 ± 2.28 vs. 2.41 ± 2.13 days; p = 0.789). Postoperative complications were comparable between groups, occurring in 5 of 34 patients (14.7%) in the infrapubic group and 5 of 19 patients (26.3%) in the penoscrotal group (χ2(1) = 1.073, p = 0.300), demonstrating no significant difference in complication rates between approaches. Conclusions The infrapubic approach was associated with significantly shorter operative times and longer cylinder lengths requiring fewer rear tip extenders compared with the penoscrotal approach. The total prosthesis length, postoperative hospital stay and complication rates were similar between groups. There is scientific evidence aligned with our results, suggesting that with the infrapubic technique we have a more direct corporal access, allowing for longer cylinder lengths. Surgical approach selection should therefore be individualized based on surgeon experience, the patient-specific anatomy and past medical history. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast