Infrapubic Approach for Inflatable Penile Prosthesis: Perioperative and Long-Term Outcomes

116 men followed 6+ years after infrapubic penile implant: 27% developed glans numbness, 9.5% needed reoperation

Journal: The French Journal of Urology | Published: 2026-02-05 | Type: Multicenter Retrospective Study | PMID: 41653989 Authors: El Akri M et al. (University of Rennes, France; Clinique de La Porte de L'Orient, Lorient, France) Funding/COI: Funding not reported; authors declare no competing interests

Summary

A French two-center retrospective review of 116 men who received inflatable penile prostheses via the infrapubic approach reports low infection and explantation rates over a median 81.5-month follow-up. The headline concern: 26.7% of patients reported glans hypoesthesia — a rate the authors themselves flag as requiring prospective investigation. High-volume surgeons were associated with significantly lower reoperation risk.

Claims

• Device infection rate: 3.4% (4/116; 1 early, 3 late)
• Late reoperation rate: 9.5% (11/116; reasons include crossover, implant lengthening, dysfunction)
• Late device explantation rate: 3.4% (4/116)
• Median Patient Global Improvement Index score: 2/7 ("better") at end of follow-up
• Glans hypoesthesia reported in 26.7% of patients (31/116)
• High-volume surgeons associated with reduced reoperation risk (HR=0.28, P=0.034 by univariate Cox regression)
• Median follow-up: 81.5 months (IQR: 35–119)

Study Quality

This is a Level 4 retrospective case series — two centers, no control group, no randomization, no head-to-head comparison with the penoscrotal approach the introduction promises to address. Kaplan-Meier device survival analysis is appropriate for the design. The 81.5-month median follow-up is a genuine strength, but the wide IQR (35–119 months) reflects substantial variability in how long individual patients were actually tracked.

The univariate Cox regression finding on surgeon volume is hypothesis-generating at best. No multivariate adjustment was reported, leaving confounders — patient complexity, selection effects, practice changes across a 12-year enrollment window spanning multiple device generations — entirely uncontrolled.

Red Flags

• Level 4 evidence: retrospective, no comparator arm, cannot establish causality for any finding
• The study's stated objective was to evaluate infrapubic outcomes, implicitly against alternatives — no such comparison was made
• "High-volume surgeon" is not defined anywhere in the abstract
• 12-year enrollment window (2010–2022) introduces device generation changes and evolving surgical technique as uncontrolled variables
• Funding source not reported
• 26.7% glans hypoesthesia rate cannot be attributed to the infrapubic approach without a penoscrotal comparison group

Strengths

• Median follow-up of 81.5 months is above average for IPP literature
• Multicenter design adds modest generalizability beyond a single surgeon's series
• Kaplan-Meier device survival methodology is appropriate
• Candid reporting of glans hypoesthesia rather than burying it
• Infection and explantation rates are consistent with published benchmarks for IPP surgery

Verdict

Useful long-term descriptive data from a two-center French series, but this paper cannot answer its own central question: whether the infrapubic approach differs meaningfully from the penoscrotal approach. The 26.7% glans hypoesthesia rate is the most clinically significant number here, and the authors deserve credit for reporting it clearly — but without a control arm, it's impossible to determine if this is an approach-specific effect or the baseline for any IPP implantation. The surgeon-volume finding is intriguing and directionally consistent with broader surgical literature, but a univariate HR in 116 patients doesn't carry much weight. Treat this as descriptive benchmarking data for a single technique, not evidence for or against choosing it.