(340) A CASE OF GLANS NECROSIS STATUS POST PLACEMENT OF AN INFLATABLE PENILE IMPLANTATION IN A 35-YO PATIENT WITH TYPE I MUSCULAR DYSTROPHY

Abstract Introduction We present the case report a 35-year-old patient with type-I muscular dystrophy (DM1) and no known pre-operative or intra-operative risk factors who experienced acute glans necrosis following insertion of an inflatable penile prosthesis (IPP). Objective Our aim was to review what factors may have contributed to acute glans necrosis in a patient with type I muscular dystrophy and to document our outcome to add to the limited literature on this topic. Methods We reviewed the PUBMED literature for current recommendations regarding acute glans necrosis management, present our own case presentation, and discuss why DM1 may pose a risk for this post-operative complication. Results This 35-year-old male with a history notable for genetically-confirmed DM1 and first-degree heart block, obstructive sleep apnea and testicular detorsion at age 12 without known sequelae. He had no significant medical or surgical history. The patient was followed over a course of five years and found to have gradually worsening erectile dysfunction poorly responsive to medical therapy. The patient elected to undergo placement of an inflatable penile prosthesis. There were no intra-operative complications or adjunctive surgical procedures performed. Foley was removed at end of case and a drain was left in place. Implant was inflated to 70% and a non-occlusive Kerlex wrap was applied. Post-operatively, the patient was monitored in ICU due to risk of apnea. On three-hour post-operative check, he was found to have a concerning exam with dusky appearance of glans. The implant was fully deflated, and he was started on aspirin 81 mg, Sildenafil, topical nitropaste to glans, and supplemental oxygen. The exam continued to worsen, and he underwent uncomplicated explantation 12 hours post-initial implantation with immediate signs of glans recovery. The known risk factors for glans necrosis post-IPP placement include atherosclerosis, diabetes, smoking, pelvic irradiation, concomitant circumcision, and use of vasoconstrictive agents [1]. A confounder we explore is muscular dystrophy type I (DM1). DM1 is a multisystem disease that affects gene splicing and expression [2], with individually documented evidence showing involvement of the cardiac, vascular, and coagulation systems amongst others. DM1 is associated with cardiomyopathy and fatal arrythmias [3]. Furthermore, certain muscular dystrophies, especially DM1, have increased venous thromboembolism risk [4]. Early reports showed hypersensitive platelet response in myotonic patients [5, 6], but literature is conflicting with some showing normal response [7]. DM1 is linked to multiple ophthalmic vascular pathologies. [8-10]. As a complex multi-system disorder affecting gene function, DM1 may pose a risk for glandular necrosis. In hindsight, early device removal was likely optimal, as expectant management risks significant tissue loss [1], whereas timely explantation has been documented to allow for full tissue recovery. [11, 12]. Conclusions This case report describes acute glans ischemia post-IPP placement in a patient with type I muscular dystrophy and identifies a new potential risk factor for this complication. It adds to the dearth of data for the treatment of this complication and reinforces that prompt removal of IPP can lead to good tissue recovery. Disclosure No.