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Inicio Actas Urológicas Españolas (English Edition) Infrapubic surgical approach for penile prosthesis surgery: Indications and tech...
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Vol. 44. Issue 5.
Pages 301-308 (June 2020)
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Vol. 44. Issue 5.
Pages 301-308 (June 2020)
Review article
Infrapubic surgical approach for penile prosthesis surgery: Indications and technique
Cirugía de prótesis peneana: indicaciones y técnica infrapúbica
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N. Picola Brau, J. Torremadé
Corresponding author
Departamento de Urología, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
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Tables (3)
Table 1. Characteristics of the studies included in the systematic review.
Table 2. Evaluation of the number and type of complications of PP placement through infrapubic access and comparison with the scrotal approach.
Table 3. Comparative table. Synthesis of advantages and disadvantages of scrotal and infrapubic approaches.
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Abstract
Context

Penile prosthesis surgery is currently the most effective treatment for erectile dysfunction when medical treatment is ineffective or contraindicated. Among the surgical approaches described in the literature, the scrotal, infrapubic and subcoronal are the most common in the daily clinical practice.

Objectives

The main objectives were to describe the infrapubic surgical technique evaluating its indications and complications, as well as comparing its advantages and disadvantages with the penoscrotal approach.

Acquisition and synthesis of the evidence

A literature review from 1983 until current date was carried out in Medline (PubMed and Cochrane Library databases) following PRISMA standards. Sixteen studies were included: 4 prospective, 4 retrospective, one systematic review, one randomized trial, one original article, 5 expert opinion/surgical technique descriptive paper.

Discussion

According to the literature reviewed, although the penoscrotal approach is the most applied, the infrapubic approach showed a shorter operative time and a tendency for an earlier recovery of sexual activity after surgery. Complications are rare, having similar rates to the penoscrotal approach; no cases of glans hypoesthesia have been reported and peri-prosthetic infection rates were less than 3%. Satisfaction rates of infrapubic penile prosthesis were higher than 80%.

Conclusions

Penile prosthesis implantation requires of a profound knowledge of the different surgical approaches in order to best adapt each technique based on each individualized case. The infrapubic approach, even if it is not the most used, is as feasible and reliable as the penoscrotal approach. The infrapubic approach is effective and safe, with high level of both, patients and partners’ satisfaction.

Keywords:
Erectile dysfunction
Penile prosthesis
Infrapubic
Penoscrotal
Transcrotal
Review
Resumen
Contexto

El implante de prótesis de pene es actualmente el tratamiento más resolutivo para la disfunción eréctil tras la ineficacia o contraindicación del tratamiento farmacológico. Son muchas las vías de abordaje descritas para su implante, prevaleciendo en la actualidad la vía escrotal, la infrapúbica y la subcoronal.

Objetivos

Describir la técnica quirúrgica del abordaje infrapúbico, evaluar sus indicaciones, complicaciones y valorar sus ventajas y desventajas respecto al abordaje escrotal.

Adquisición y síntesis de la evidencia

Se realizó una búsqueda de publicaciones desde el año 1983 hasta la actualidad en bases de datos (Medline PubMed y Cochrane Library) siguiendo los criterios PRISMA. Dieciséis artículos fueron incluidos: 4 prospectivos, 4 retrospectivos, una revisión sistemática, una ensayo aleatorizado, un artículo original, 5 artículos de opinión/descripción de técnica quirúrgica.

Discusión

Según los artículos revisados, actualmente el abordaje más usado es el escrotal. Aun así, la vía infrapúbica es una técnica más rápida y con tendencia a reducir el tiempo de retorno a la actividad sexual. Las tasas de complicaciones son escasas, teniendo cifras similares al abordaje escrotal, sin haberse recogido casos de hipostesia del glande y con tasas de infección inferiores al 3%. Además, cuenta con cifras de satisfacción elevadas, superando el 80%.

Conclusiones

El implante de prótesis de pene requiere de una familiarización con los diferentes abordajes quirúrgicos para adaptar cada técnica a cada caso. La vía infrapúbica, a pesar de no ser la más empleada, es igual de válida que la vía escrotal para el implante de prótesis de pene de 3 componentes, siendo eficaz, segura y con altas tasas de satisfacción para los pacientes y sus parejas.

Palabras clave:
Disfunción eréctil
Prótesis de pene
Infrapúbica
Penoescrotal
Escrotal
Revisión

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