Abstract
Glans hypermobility (GH) is a well-described clinical entity that can have significant implications for cosmesis and function, resulting in sexual dissatisfaction, penile pain, and early device erosion, with an estimated incidence of 0.04% to 10%. We developed a novel grading scale to assess GH severity intraoperatively during primary inflatable penile prosthesis (IPP) placement and describe a modified glanspexy technique to correct GH when encountered during IPP placement. 530 patients who underwent primary IPP placements from two high-volume prosthetic surgeons between February 2018 – November 2019 were retrospectively reviewed in order to identify the incidence of GH. Of these, 139 (26.2%) had hypermobility. Employing our new scaling system, grade 1, 2, and 3 GH was seen in 86 (16.2%), 29 (5.5%), and 24 (4.5%) cases, respectively. Increased implant size correlated with a decreased likelihood of GH incidence. Each increase in implant size by 1 cm decreased the incidence of detecting GH by 11.0% (OR = 0.89; p = 0.015). 11 patients underwent primary GH repair using our described technique. At one-year follow-up, one patient required repeat glanspexy for recurrent bothersome GH and a second patient developed a suture granuloma at the glanspexy incision requiring unilateral cylinder explant. Our modified glanspexy technique can be used to correct GH in any direction and is a useful tool for the prosthetic surgeon’s armamentarium.
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TK contributed to the conceptual design of the study, manuscript review, and writing. MZ and AM were responsible for writing and reviewing the manuscript. ND and RM were responsible for data collection. SH contributed to the study’s conceptual design and in manuscript review. SSJ, MB, and PP also contributed to the conceptual design and participated in the manuscript review.
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Köhler, T., Mian, A., Ziegelmann, M. et al. Glans hypermobility scale (GHS): A simple grading scale and description of a modified glanspexy technique. Int J Impot Res (2024). https://doi.org/10.1038/s41443-024-00843-4
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DOI: https://doi.org/10.1038/s41443-024-00843-4