(232) AGGRESSIVE REHABILITATION POST-IPP EXCHANGE: WE BLEW A GASKET

Abstract Introduction In our center, the majority of men undergoing virgin IPP are engaging in sexual activity from 14-21 days post-operatively. Our standard protocol in these patients is to leave cylinders completely deflated post-operatively without compressive dressing or foley catheter. A 10Fr Jackson Pratt closed suction drain is left for 48-72 hours. At 10-14 days patients are taught to cycle their device. In November 2023, we implemented an accelerated rehab to coitus algorithm for patients undergoing simple device exchanges as well. We interrogated the effect of this protocol change in IPP exchanges over a 6-month period. Objective To interrogate an accelerated post-IPP rehab protocol in simple exchange cases. Methods This is a retrospective review of virgin IPP insertions and exchange cases that occurred between November 2023 and May 2024. Inclusion criteria were uninfected revision cases for existing device malfunction for which all components were exchanged. In the month of November, post-op protocols were identical for virgin and exchange cases, except that two closed-suction drains were used in the latter. Data on post-operative course, complications and time to sexual activity were collected. Of note, post-exchange rehabilitation protocol was modified in December 2023. Following identification of 2 complications, all exchange cases were advised to leave device completely deflated for 6 weeks. Results In this 6-month period, there were 156 virgin IPP insertions. Of these men, 85% had engaged in sexual activity from 14-21 days post-operatively. All 156 remain without complication until the end of June 2024. There were 40 device exchanges in this period, all of which were successfully exchanged via infrapubic incision to Coloplast Titan IPP irrespective of the primary surgical approach or device. 6 exchanges occurred in November 2023 when the accelerated rehabilitation protocol was instituted. Of these 6 cases, 2 (33%) developed proximal cylinder herniation through the corporotomy site within 2 weeks of initiating sexual activity. This was the first exchange for both men. Neither patient, aged 58 and 70 years, have medical conditions that would impair normal healing. For the subsequent 34 exchanges, who did not activate their IPP for 6 weeks, there were no cylinder herniations. All 34 men were able to successfully cycle their device at 6 weeks without de-novo deformity. Conclusions While an accelerated rehabilitation protocol is safe for virgin cases, we observe that a longer duration of time is required for healing following non-virgin cases. Even in the absence of systemic factors or localised infection, the corporal tunica appears to behave differently following initial intervention and requires longer for corporal integrity to re-establish. Disclosure No.