Extrinsic Compression of Inflatable Penile Prosthesis Secondary to Prone Positioning for COVID-19 Pneumonia: A Case Series of Two Patients

INTRODUCTION: Complications of extrinsic compression on an inflatable penile prosthesis (IPP) due to prone positioning for COVID-19 pneumonia have not been described. Patients with an IPP present a unique challenge for managing compression injuries secondary to proning due to the dependent position of the penis and ability of the device to restrict blood flow to the distal penis when externally compressed for long periods of time. We present two patients with previous IPP placement who experienced glans and penile ischemia secondary to extrinsic compression of the penis from proning, who were monitored conservatively and avoided urgent explantation. OBJECTIVE: To describe two patients with IPPs who were intubated and proned for COVID-19 pneumonia who experienced IPP-related complications due to pressure injury, one of whom survived for follow-up. METHODS: Two male patients, ages 68 and 74 years, who developed penile injury following proning for COVID-19 pneumonia. The first patient presented with skin breakdown of the ventral aspect of the penis and scrotum without exposed implant. The second patient presented with a pale and dusky glans. RESULTS: The first patient was managed by scrotal elevation with bacitracin application to the wound twice daily. There was no surgical intervention or debridement of the penile and scrotal wounds. The patient was then followed on an outpatient basis without need for explantation at 4-months from initial consultation (Figure 1). He underwent a CT of the abdomen and pelvis as well as a CT Urogram as an outpatient that confirmed appropriate positioning of all components of the device without evidence of underlying infection. On exam, the penile prosthesis was well-positioned and cycled normally, with a freely mobile pump within the scrotum. The second patient expired during hospitalization from COVID-19 respiratory failure, but was monitored for six days without glans necrosis (Figure 2) once external pressure was removed. CONCLUSIONS: Patients with IPPs who require prone positioning are a unique population that are at risk for extrinsic compression injury of the penis. In contrast to ischemia related to instrinsic compression, such as with the sliding technique, which results in glans necrosis and necessitates urgent explantation, conservative treatment and serial examination in the setting of external compression from prone intubation was a viable and safe option to immediate explantation in these patients. Prevention, in the form of proper padding and minimization of external compression, remains paramount as we obtain more long term data from this unique patient population. DISCLOSURE: No