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Device Autoinflation

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Also Known As

Spontaneous prosthesis inflation, IPP autoinflation, unwanted prosthesis inflation, prosthesis self-inflation, spontaneous device tumescence, unintended prosthesis activation

Definition

Device autoinflation refers to the spontaneous inflation of a penile prosthesis without patient activation.¹ This phenomenon occurs when an inflatable penile prosthesis (IPP) does not deflate completely or does not stay deflated after proper deflation by the patient.² It is characterized by unwanted tumescence of the penis with a hardness scale of ≥4/10, despite no manual activation of the pump mechanism by the patient.³ Device autoinflation is considered an uncommon but bothersome mechanical complication of penile prosthetic surgery that can significantly impact patient satisfaction and may necessitate revision surgery in cases of severe bother.

Clinical Context

Device autoinflation is primarily observed in patients who have undergone implantation of an inflatable penile prosthesis (IPP) for the treatment of erectile dysfunction (ED).¹ The literature cites an incidence rate of approximately 3-5% over the past decade, with historical reports suggesting rates as high as 11%.²⁻³

Patient selection factors that may increase the risk of autoinflation include prior pelvic surgery, particularly radical prostatectomy, which can obliterate the space of Retzius where the reservoir is typically placed. This anatomical alteration may lead to insufficient space creation at the time of reservoir placement, contributing to autoinflation risk.

The most common causes of device autoinflation include:

  • Mechanical factors such as failure of the lockout valve³
  • Over-filling of the reservoir during device implantation
  • Insufficient space creation for the reservoir
  • Capsule formation around the reservoir causing compression
  • Rarely, arteriocavernosal fistula formation during prosthesis insertion that mimics autoinflation¹

Clinical management options include:

  • Observation for mild cases
  • Device revision surgery to address mechanical issues
  • Reservoir repositioning or replacement
  • In rare cases of arteriocavernosal fistula, minimally invasive percutaneous angioembolization¹
  • Novel approaches such as robot-assisted laparoscopic reservoir capsulotomy and mobilization

Patient bother from autoinflation ranges from mild to severe, with symptoms including embarrassment from unwanted erections, pain, and discomfort.²⁻³ In cases of high bother, reoperation rates of approximately 2% have been reported.² Successful management can lead to resolution of symptoms and restoration of normal device function.

Scientific Citation

[1] Lee WG, Satchi M, Skrodzka M, et al. A Rare Cause of Autoinflation after Penile Prosthesis Insertion: Case Series and Systematic Review. J Sex Med. 2022;19(5):879-886. DOI: https://doi.org/10.1016/j.jsxm.2022.01.262

[2] Miranda E, Ortega Y, Deveci S, et al. Device Autoinflation Following Penile Implant Surgery. J Sex Med. 2017;14(1 Suppl):S46. DOI: https://doi.org/10.1016/j.jsxm.2016.11.103

[3] Rodriguez KM, Kohn TP, Davis AB, Hakky TS. Penile implants: a look into the future. Transl Androl Urol. 2017;6(Suppl 5):S860-S866. DOI: https://doi.org/10.21037/tau.2017.05.28

[4] Narayan VM, Bodie J, Anderson JK. Robot-assisted reservoir capsulotomy and mobilization to treat auto-inflation of an inflatable penile prosthesis. AUA University. 2016. Available at: https://auau.auanet.org/content/v10-09-robot-assisted-reservoir-capsulotomy-and-mobilization-treat-auto-inflation-inflatable

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