(335) VENTRAL CORPORAL REINFORCEMENT USING PERICARDIUM ALLOGRAFT (TUTOPLAST®) IN PATIENT UNDERGOING URETHRECTOMY PROCEDURE WITH INFLATABLE PENILE PROSTHESIS IN PLACE

Abstract Introduction Radical cystectomy (RC) is the standard treatment for non-metastatic muscle-invasive or high-grade/intravesical therapy refractory bladder cancer. Erectile dysfunction (ED) is a common consequence of RC, with inflatable penile prosthesis (IPP) placement considered as the gold standard for refractory cases. Urethral recurrence post-RC necessitates urethrectomy, which poses challenges for patients with existing IPP. Objective The thinning of the ventral tunica albuginea during urethrectomy may increase the risk of corporal disruption and IPP cylinder aneurysm, affecting long-term device functionality. This case introduces a novel surgical technique using Tutoplast graft, a human-derived pericardium allograft, for corporal reinforcement during urethrectomy in the presence of in situ IPP. Methods 74-year-old male, with history of robotic-assisted RC for bladder cancer in 2015 and IPP placement for refractory ED in 2017, presented for recurrent blood per urethra in 2023. Imaging revealed masses on the penile urethra and bulbar urethra. The patient underwent total urethrectomy and was noted intra-operatively to have significant thinning of the ventral tunica albuginea. To prevent device aneurysm or mechanical failure, Tutoplast graft was used to reinforce the thinned tunica albuginea. Tutoplast was secured to the lateral, superior, and inferior aspects of both corpora. Patient was followed up to 6 months post-operatively. Results Final pathology of the urethra showed high-grade papillary urothelial carcinoma with invasion of the corpus spongiosum. The patient recovered well post-operatively, with normal IPP functionality up to the 6 months follow-up period. This case introduces Tutoplast graft as a simple and cost-effective technique to support the ventral tunica albuginea and protect the IPP cylinders during urethrectomy. While Tutoplast has been used in other settings, its application in preventing IPP malfunction post-urethrectomy is a unique contribution. Conclusions Corporal reinforcement using Tutoplast graft during urethrectomy in patients with existing IPP is a promising and innovative technique. It presents a viable solution to mitigate the risks of corporal disruption and IPP cylinder aneurysms during urethrectomy. The positive outcome demonstrated in this case report warrants further studies with larger patient populations and longer follow-up periods to assess the long-term outcomes and potential risks associated with this procedure. Disclosure No.