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Glanspexy for floppy glans - outcomes and patient satisfaction

Skrodzka, M1; Blecher, G1; Moubasher, A1; Johnson, M1; Garaffa, G1; Ralph, D1

1: University College London Hospital, United Kingdom

Introduction: Floppy glans is a known complication of penile implant surgery. Although glanspexy represents the only solution when oral or topical application of vasoactive drugs is ineffective, very little is available in the literature regarding the outcomes and patient satisfaction from this procedure.

Methods: The notes of patients who have undergone penile prosthesis implantation over a five year period (2012-2016) have been retrospectively reviewed in order to identify the cases of true glans hypermobility who underwent glanspexy. These patients had appropriate position/size of implants and had failed medical treatment. Treatment outcomes and complications were extrapolated from patient notes and modified EDITS questionnaire. Significance was determined using an unpaired t-test.

Results: Out of 1018 patients who had previously undergone penile prosthesis implantation, 21 patients underwent glanspexy. A modified EDITS questionnaire was administered through a telephone consultation in 17 patients. Surgical outcome was extrapolated from the clinical notes in 3 patients while one patient was lost to follow up and was therefore excluded from the series. Glanspexy has been performed at the time of penile prosthesis implantation in 4 patients and in a second elective procedure in the remainder. The procedure had been carried out through a subcoronal incision, which has allowed access to the space between the spongiosum of the glans and the underlying tunica albuginea. Glanspexy has been carried out using anchoring 4-0 polydioxanone sutures in all patients. The number of sutures varied between 3 and 6. A revision glanspexy was required in one patient due to persistent hypermobility of the glans and multiple revisions in 3 cases. A Prolene mesh was used in one of the revison cases. Overall, 15 of the 20 patients (75%) were satisfied at the postoperative follow up visit and had a supported glans. The EDITS questionnaire revealed that 12 patients were satisfied with the outcome of surgery, 2 were neither satisfied nor dissatisfied and 3 were dissatisfied. One diabetic patient ,who had the glanspexy performed at the time of implant insertion needed explantation due to infection. Glans sensation was unchanged in 11 patients, reduced in 4 and improved in the remainder. Level of satisfaction was significantly lower (p= 0.0006) in comorbid patients, such as severe Peyronie’s disease, multiple penile implant exchanges, proximal urethroplasty, cystectomy, previous failed glanspexy, paraplegia and previous oncological treatment.

Conclusions: Glanspexy represents a safe and reproducible procedure for the management of hypermobile glans non-responsive to medical treatment. Satisfaction rates following this procedure can be as high as 75%.

Disclosure:

Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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