The use of penile prostheses in the treatment of impotence

Risk and benefits of penile length preservation techniques during penile prosthesis implantation: a systematic review by the young academic urologists sexual and reproductive health working group

Background

Penile shortening, frequently resulting from end-stage Peyronie's disease (PD), has a negative impact on patients' sexual activity and overall quality of life, especially when accompanied by Erectile dysfunction (ED). Various surgical techniques have been described to manage concomitant ED and penile shortening through penile prosthesis (PP) implantation.

Objectives

To evaluate the benefits and risks of different penile length preservation techniques during PP implantation.

Design

A systematic review of the available literature on the use of penile length preservation maneuvers in conjunction with PP implantation was conducted.

Data sources and methods

For this systematic review, three databases (Medline, Embase and Cochrane) and clinical trial.gov were queried for relevant publications from 1 January 1990 to 1 September 2022. The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

Results

The qualitative analysis included 15 relevant articles involving 1186 adult patients who underwent penile length preservation techniques during PP implantation. Penile lengthening of 1-7 cm was reported. Overall, postoperative complications were described in up to 21.7% of cases. Only five studies reported functional outcomes, showing a significant improvement in postoperative period based on the administered questionnaire (e.g. IIEF - International Index of Erectile Function, EDITS - Erectile Dysfunction Inventory of Treatment Satisfaction).

Conclusion

Penile length preservation procedures appear to offer a viable option for managing acquired penile shortening, particularly in cases of PD. However, they are associated with a significant risk of complications. Proper patient selection, thorough discussion of risks and benefits, and referral to high-volume centers are mandatory to achieve optimal outcomes and minimizing complications.

Trial registration

PROSPERO database registration CRD42022360758.

Survival From Revision Surgery for New Rigicon Infla10 Three-piece Inflatable Penile Prosthesis Is Comparable to Preceding Devices

OBJECTIVE

To report the incidence of the reoperation surgeries of nearly all the Rigicon Infla10 implants performed since device introduction in 1/2019. Inflatable penile prosthesis has some of the highest survival from revision surgery of any medical device implanted in humans [1]. We expand on previous Rigicon Infla10 research, adding more patients and increasing follow-up duration [2].

MATERIALS AND METHODS

535 patients had Rigicon Infla10 devices implanted from 1/2019 to 8/2022. 103 surgeons from 26 centers in 15 countries participated in the study. Patient information forms were analyzed from virtually all implantations. Explantation or revision surgery for mechanical failure, infection, other medical reasons, and patient dissatisfaction were cataloged. SPSS 25.0 (IBM) was used for the statistical analysis of Kaplan Meier survival statistics.

RESULTS

Mean follow-up was 24.2months (7-43months). Mean patient age was 56years. Reoperation was necessary for 3.5% of subjects. Revision for mechanical failure occurred in 2.24% (12/535). The rate of explant for patient dissatisfaction was 0.56% (3/535). Revision for component out of place was 0.37% (2/535) with an infection rate and unsuccessful Peyronie's correction being 0.19% (1/535). Survival from requiring another corrective surgery at 1, 2, and 3years was 96.4%, 95.0%, and 94.0%, respectively. These initial survival rates compare favorably to devices currently available, which have been repeatedly enhanced to improve reliability.

CONCLUSION

In its first 2-3years of availability, The Rigicon Infla10 inflatable penile prosthesis shows freedom from revision comparable to existing enhanced devices that have been on the market for decades.

Comparison of penile prosthesis types' complications: A retrospective analysis of single center

OBJECTIVES

The aim of this study was to compare clinical outcomes and complication rates associated with semirigid (malleable) and inflatable penile prostheses (PPs) and investigate the factors that influence these complications.

MATERIAL AND METHODS

The records of 131 patients who had undergone penile prosthesis implantation (PPI) in our clinic due to erectile dysfunction (ED) between January 2010 and March 2019 were retrospectively reviewed. The initial surgery included 116 primary implants and 15 men had two revision operations. Patients were assigned to two groups as semirigid (malleable) PPI (group 1) and inflatable PPI (group 2) patients, and obtained data were compared across these two groups.

RESULTS

Group 1 included 93 patients, while Group 2 included 38 patients. Postoperative complication rates of Group 1 were 8.6% (n = 8), and Group 2 were 21% (n = 8), and the comparison of postoperative complication rates revealed a statistically significant difference between the two groups (p = 0.025). The majority of these complications (50%) was constituted by mechanical failure associated with inflatable PPs. When patients were further segregated as those with and without diabetes type 2 (DM) and those who had and had not undergone radical pelvic surgery (RPS), the comparison of complication rates across these subgroups did not yield any significant difference.

CONCLUSIONS

We determined in this study that semirigid (malleable) PPs were associated with lower complication rates compared to the inflatable group, particularly with regard to mechanic failure, and that DM and history of RPS did not make a difference in complication rates in patients planned to undergo PPI.

Outcome of penile prosthesis implantation: are malleable prostheses an appropriate treatment option in patients with erectile dysfunction caused by prior radical surgery?

The aim of our study was to evaluate the outcome of penile prosthesis implantation in patients with various comorbidities as a cause of erectile dysfunction (ED). The data of 181 patients who underwent surgery between 1998 and 2012 in two centers were evaluated. The mean age of the patients was 52.2 years (range: 31-71 years). The study group contained 162 patients (89.5%) with malleable prostheses and 19 (10.5%) with inflatable implants. All patients were re-evaluated 1 month later to assess prosthesis function and complications, and further re-examinations were performed if needed. Satisfaction was defined as having satisfactory intercourse and happiness with the device in general. The follow-up period was at least 12 months for each patient. The postoperative complication rate was 32% (n = 58). The number of complications with inflatable and malleable prostheses was 7 (3.9%) and 51 (28.1%), respectively. Overall, 21 prostheses (11.6%) had to be removed because of various complications and patient dissatisfaction. Patients with prior radical surgery had higher extraction rates (ƛ = 14.606, P < 0.05, Chi-square test). The main reasons for removal were erosion (n = 11; 6.1%) and infection (n = 3; 2.1%). With respect to satisfaction during intercourse, we found that 104 (57.5%) patients described themselves as very satisfied with the prosthesis, while 21 (11.6%) were unsatisfied. The high explantation rate in patients with prior surgery was remarkable in our study. Our results revealed that a malleable prosthesis should not be the preferred type of implant for patients with prior surgery.

Neutrophil to Lymphocyte Ratio as a predictor of early penile prosthesis implant infection

PURPOSE

To investigate the predictive value of preoperative serum neutrophil-to-lymphocyte ratio (NLR) on the development of postoperative infections in patients undergoing penile prosthesis implantation (PPI).

METHODS

We retrospectively analyzed the data of 361 patients who underwent PPI over a 4-year period with at least 1-year follow-up. Demographics, blood results, and postoperative 1-year complications were recorded. Recommended cutoff values of NLR for early postoperative infectious complications were determined using receiver operating characteristic analysis.

RESULTS

A total of 153 patients with the mean age of 56.4 ± 8 years were included in the study. Mean follow-up time was 56.7 ± 30.4 months (12-108 months). Early postoperative infectious complications were occured in 18 patients (11.8%). These infections were prosthesis infection in 8 patients (5.2%), wound infection in 6 patients (3.9%), and urinary tract infection in 4 patients (2.6%). All these complications were occured within the first year of the surgery. Mean NLR was statistically higher in patients with postoperative complications when compared with uncomplicated cases (7.2 ± 3.9 vs. 2.2 ± 1.4, p < 0.001, respectively) Using a cut point of 6.2, preoperative NLR predicted postoperative complications with a sensitivity of 67% and specificity of 99%.

CONCLUSIONS

This study is the first to investigate the relationship between NLR and early postoperative infection as a complication of PPI. The results demonstrated that the NLR value could be a potential laboratory parameter for predicting early postoperative infectious complications in patients undergoing PPI.

Surgical outcomes and complications of Tube® (Promedon) malleable penile prostheses in diabetic versus non-diabetic patients with erectile dysfunction

OBJECTIVE

To evaluate surgical outcome, complications, and patients satisfaction with the Tube® (Promedon, Cordoba, Argentina) malleable penile prosthesis in diabetic and non-diabetic patients with refractory erectile dysfunction (ED).

PATIENTS AND METHODS

The records of 128 eligible patients who received Tube malleable penile prostheses at our institute between September 2008 and October 2015 were reviewed.

RESULTS

Of the 128 patients, who received Tube penile prostheses at our institute, 53 were diabetics and 75 were non-diabetics. Both groups of patients were comparable for mean age, education level, marital status, hospital stay, time to commencing sexual intercourse, and median follow-up. Complications included: inter-corporeal septal perforation (2.3%), glanular urethral injury (1.5%), acute urinary retention (3.9%), superficial wound infection (7%), penile discomfort (9.4%), and penile prostheses infection (5.5%). Moreover, 3.9% developed atrophy of the cavernosal tissue, 5.5% experienced bad cosmesis, 6.3% experienced ejaculatory disorders, and 2.3% developed bladder calculi. In all, 13 prostheses (9.4%) were removed, seven of them due to infection, three on the patients' demand and three due to mechanical failure. The satisfaction rates with the prostheses were 77.3% and 79.4% in the diabetic and non-diabetic patients, respectively; with an overall satisfaction rate of 78.5%. There was no significant difference in the complication rate or prostheses infection between diabetic and non-diabetic patients.

CONCLUSION

Tube malleable penile prostheses are associated with low complication and high satisfaction rates. There was no significant difference in the complication rate or prostheses infection between diabetic and non-diabetic patients. A prospective comparative study with a large number of patients is recommended.

Penile prostheses

Penile prosthesis implantation is recognized as a valid option to obtain an artificial erection satisfactory for sexual intercourse in those patients in which a pharmacological approach is contraindicated or ineffective. Penile prostheses are subbject to continuous development and they are achieving ever better mechanical reliability and safety. The devices are divided into two general types: semirigid (malleable and mechanical) and inflatables. The AMS® (American Medical Systems) and Coloplast Ltd® produce the majority of inflatable and semirigid devices.Malleable and mechanical prostheses have the disadvantage that the penis is always erect although it can be orientated in different ways, while the advantages are ease of use and the need for a simpler surgical procedure compared with inflatable prostheses. Three-component prostheses are more sophisticated than semirigid devices. The advantages of these devices are that the prosthesis feels softer than semirigid or two-piece devices when deflated, with a better cosmetic result, and it ensures a more natural erection than others kinds of prosthesis. The disadvantages are the possibility of malfunction and the need for a more complicated surgical technique. Implantation of a penile prosthesis can be performed in a short surgical time under locoregional anaesthesia, and for this reason hospitalization is usually brief and the patient can be discharged 2 days after the operation if complications are not evident. Patient and partner satisfaction reflect the quality and the effectiveness of this treatment. Even though the results are positive in the vast majority of patients, the possibility of several complications makes penile prosthesis implantation a delicate kind of surgery. Complications can happen when the operation is carried out, in the peri-operative and in the postoperative period, and include infections, erosions of the prosthesis and mechanical failure in case of inflatable prosthesis. Penile prostheses available on the market have improved the success of this kind of surgery, thanks to the introduction of new materials and designs.

Preservation of cavernosal erectile function after soft penile prosthesis implant in Peyronie's disease: long-term followup

The aim of this retrospective study is to evaluate the long-term followup of soft penile SSDA prosthesis, without plaque surgery in the treatment of Peyronie's disease. This study included 12 men with Peyronie's disease who underwent placement of a penile prosthesis. All patients were followed for at least 6 years. Prosthesis straightened the penile shaft in all cases, restoring patient sexual satisfaction. No operative or postoperative complications occurred, and no reoperations were needed. All patients have undergone further examination with basal and dynamic eco color Doppler. The findings are encouraging as the penis preserves the ability to enhance the tumescence and penile girth. We can conclude that SSDA penile prosthesis is safe and effective in Peyronie's disease.

Penile implantation in Europe: successes and complications with 253 implants in Italy and Germany

INTRODUCTION

Results for prosthesis implantation from everyday clinical practice within Europe are few. This report provides data on the most commonly used penile prostheses (the American Medical Systems [AMS] series).

AIM

The study aimed to assess, retrospectively, complications and patient satisfaction with AMS penile implants in 253 consecutive patients with erectile dysfunction from three European centers.

METHODS

Pre, intra- and postoperative data were obtained from chart review, with a mean follow-up of 60 months; 200 patients were available for evaluation. Patient satisfaction data were collected using the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire.

MAIN OUTCOME MEASURE

Complications and patient satisfaction were assessed. Patient satisfaction was evaluated using a standardized assessment tool (the modified EDITS questionnaire).

RESULTS

Major postoperative complications occurred in 40 (20%) patients, including 9 (22.5%) prosthesis infections, 18 (45%) mechanical failures, and 13 (32.5%) erosions. Patient satisfaction with the AMS 700CX, AMS Ambicor, and AMS 600-650 was 97%, 81%, and 75%, respectively; dissatisfaction was 0%, 5%, and 6%, respectively. Partner satisfaction with the AMS 700CX, AMS Ambicor, and AMS 600-650 was 91%, 91%, and 75%, respectively; dissatisfaction was 0%, 5%, and 6%, respectively. Erections were more natural (harder) than before with the AMS 700CX, AMS Ambicor, and AMS 600-650 in 91%, 85%, and 88%, respectively; hardness was the same as before in 9%, 15%, and 13%, respectively; no erections were less hard than before.

CONCLUSIONS

Postoperative complications differed from those reported in the literature, while patient satisfaction rates were roughly similar. The reporting of specific data for different implant types, plus the use of standardized assessment tools for patient satisfaction is significant as in the future, it will allow comparison of data between centers performing penile prosthesis implants using these devices.

Preoperative psychosocial evaluation of penile prosthesis candidates

Penile prosthesis surgery is a recommended treatment option for a subset of patients who present with erectile dysfunction (ED). Although treatment outcome research indicates that patients are generally satisfied with this intervention, it remains an invasive procedure with risk for complications. A review of the literature reveals general agreement for the importance of a thorough preoperative evaluation to determine appropriateness for a penile implant; however, there are no known descriptions of such an evaluation in the literature. This article provides an introduction to the domains that are most relevant to assess in a patient who is considering penile implant surgery: sexual history (including organic and psychogenic causes of ED), success and utilization of other treatment interventions, relationship functioning, and patient expectations for and knowledge of the procedure. The advantages to this approach are presented, particularly in enhancing patient satisfaction with treatment outcomes.

Experience with Tube (Promedon) malleable penile implant

INTRODUCTION

The main advantages of semirigid penile prosthesis are simple implantation, ease of use, very low risk of mechanical failure and more financial suitability for patients in developing countries.

AIM

To evaluate reliability and safety of Tube(R) (Promedon, Cordoba, Argentina) penile prosthesis in the surgical treatment of erectile dysfunction.

PATIENTS AND METHODS

This retrospective case series was conducted on 83 patients who underwent Tube penile implant surgeries between 2001 and 2006. The choice of Promedon penile implant was determined by the patient himself. Strict infection control measures were applied. Patients were followed up for stability of vital signs and discharged within 72 h.

RESULTS

Successful sexual intercourse was possible for 75 (90.4%) of cases. Common postoperative complaintswere: prosthesis too short in 27 cases (32.5%), not happy with the appearance of the penis in 8 cases (9.6%), non-specific pain which subsided spontaneously in 20 cases (24%), in which no further intervention was done apart from reassurance. 79 (95.2%) patients were on regular follow-up for the first year and the rest dropped out. None of the patients experienced prosthetic infection postoperatively. Crural cross-perforation (4%) was managed intraoperatively. Hematomas (1.6%) were managed conservatively. Retarded ejaculation (10%) and penile hypothesia (0.8%) resolved spontaneously within 6 months in all cases.

CONCLUSION

The Promedon malleable penile prosthesis is reliable and safe in the surgical treatment of erectile dysfunction.

Symptomatic treatment of multiple sclerosis. Multiple Sclerosis Therapy Consensus Group (MSTCG) of the German Multiple Sclerosis Society

Besides immunomodulation and immunosuppression, the specific treatment of symptoms is an essential component of the overall management of multiple sclerosis (MS). Symptomatic treatment is aimed at the elimination or reduction of symptoms impairing the functional abilities and quality of life of the affected patients. Moreover, with symptomatic treatment the development of a secondary physical impairment due to an existing one may be avoided. Many therapeutic techniques as well as different drugs are used for the treatment of MS symptoms, but only a few of them have been investigated, especially in MS patients, and are approved by the national health authorities. Despite an overwhelming number of publications, only a few evidence-based studies exist and consensus reports are very rare, too. Therefore, it seemed necessary to develop a consensus statement on symptomatic treatment of MS comprising existing evidence-based literature as well as therapeutic experience of neurologists who have dealt with these problems over a long time. This consensus paper contains proposals for the treatment of the most common MS symptoms: disorders of motor function and coordination, of cranial nerve function, of autonomic, cognitive, and psychological functions as well as MS-related pain syndromes and epileptic seizures.

Cutaneous temperature measurements in men with penile prostheses: a comparison study

To evaluate and compare the cutaneous temperature of the penis in normal men, those with erectile dysfunction (ED), those with semirigid penile prostheses (SRPPs), and those with inflatable penile prostheses (IPPs), and those before and after trimix injection to create a penile erection. A total of 68 patients were evaluated. Five patient groups were identified, including men with normal erectile function, with ED, with SRPPs, with IPPs, and following intracavernosal injection of trimix solution. Cutaneous glans temperature increased significantly by more than 2.2 degrees C in the trimix-injected group compared with all other groups (P<0.001). Using cutaneous temperature measurements of the penis, patients with SRPPs had significantly lower cutaneous glans temperatures than normals (P<0.02), those in the ED group (P<0.04), and those in the IPP-deflated group (P<0.01). The mean temperature difference was 1.44+/-0.40 degrees C. Using cutaneous temperature measurements of the penis, men with SRPPs have a colder glans as compared with men with normal erectile function, ED, IPPs, and those who have received an injection of trimix. Men with normal erectile function, ED, and IPPs did not have significant cutaneous temperature differences.

Outcome of penile prosthesis implantation for treating erectile dysfunction: experience with 504 procedures

OBJECTIVE

To evaluate the outcome of penile prosthesis surgery for different types of prosthesis.

PATIENTS AND METHODS

The notes of 447 men who had 504 penile prosthesis implanted between August 1975 and December 2000 were evaluated. Of the prostheses inserted, 393 were malleable, 81 were three-piece inflatable and 30 were self-contained hydraulic prostheses. The mean (range) age of the men was 52 (21-78) years; 404 men had primary implants and 43 had revision surgery after operations at other institutions. The mean follow-up was 50 (1-297) months.

RESULTS

Of the 447 men, 22 were lost to follow-up immediately after surgery. The most serious postoperative complications were infection (8%) and erosion (5%), which was more common in diabetic patients (10%) and after pelvic trauma with a urethral injury (21%). Of 482 prostheses, 21 failed mechanically (4%) and revision surgery was needed for 5% of the prostheses inserted (24/482). Overall, 89% (377/425) of men could have sexual intercourse and 344 (81%) were satisfied with the results.

CONCLUSIONS

Of the men implanted with a penile prosthesis, 81% were satisfied with the outcome and an even higher proportion were satisfied with the inflatable prostheses. Dissatisfaction was mainly due to complications that resulted in removal of the prosthesis.

Clinical experience with the Mentor Alpha-1 inflatable penile prosthesis: report on 65 patients

OBJECTIVE

To evaluate the complications and prosthesis survival associated with implantation of the Mentor Alpha-1 inflatable penile prosthesis (IPP) for the treatment of erectile dysfunction (ED).

MATERIAL AND METHODS

Between August 1995 and March 2003, 65 patients underwent implantation of a Mentor Alpha-1 IPP at the Urological Departments of Skejby or Aalborg University Hospitals. Patient data were obtained retrospectively from medical files.

RESULTS

The follow-up period ranged from 1 to 96 months (median 48.5 months). Twenty-one patients (32%) experienced complications that required revision. The majority of complications consisted of mechanical problems, but infection was also a large contributor to the complication rate. Seven patients (11%) had the prosthesis permanently removed due to infection. Kaplan-Meier estimates of the 5-year prosthesis survival rates with and without successful revisions due to complications were 88% and 63%, respectively.

CONCLUSIONS

The Mentor Alpha-1 IPP is an efficient treatment for ED in situations where less invasive therapy has failed. The risk of infection or mechanical failure must not be ignored. Patients should be informed of this risk before agreeing to implantation surgery.

Penile prosthesis extrusion due to gonococcal infection

Gonococcal infection of a penile prosthesis is a rare presentation of a common disease. Here we report two cases of penile prosthesis extrusion due to gonococcal infection.

Erectile dysfunction: etiology and treatment in young and old patients

This study shows that endocrine and vascular etiologies of erectile dysfunction are more common in the older age group, whereas depression and marital discord are more common in the younger age group. There is considerable overlap between various factors pointing to the multifactorial nature of erectile dysfunction. Review of the treatment option chosen reveals that the invasive modalities were least common as compared with the popular vacuum tumescence device (although cumbersome) and testosterone replacement. Persons with low testosterone have an improved efficacy of sildenafil when hypogonadism is treated. Sildenafil with its ease of administration and high efficacy seems to be the logical first choice for most of the patients. If contraindications exist or treatment failures occur, other treatment options should be offered to patients.

Erectile dysfunction

Erectile dysfunction (ED) is a highly prevalent and often undertreated condition. It may be a symptom of underlying, chronic illness and can have a negative impact on quality of life, psychosocial health, and relationships. The aging of the population, as well as the introduction of new treatment options, such as sildenafil, has led to increased public awareness of this disorder. New oral therapeutic agents are on the horizon. This article provides an overview of the physiology of erection, the pathophysiology of ED, and modern patient evaluation. Management options, including traditional therapeutic approaches as well as the new generation of oral agents, are also presented.

Deep venous thrombosis due to compression of external iliac vein by the penile prosthesis reservoir

Penile implant surgery has a high rate of success and a very high patient satisfaction rate. Compression of the external iliac vein by the reservoir of the penile implant is an extremely rare occurrence. We describe a case of deep vein thrombosis due to compression of the external iliac vein, which required replacement of the penile implant reservoir.

Long-term outcomes of inflatable penile implants: reliability, patient satisfaction and complication management

Despite the revolutionary introduction of oral erectogenic agents for the treatment of erectile dysfunction, there will always be patients who do not respond to conservative therapy. Penile prosthetic surgery remains an important option for these patients. Mechanical reliability and patient satisfaction have improved significantly throughout the years. This review focuses on the most recent and important updates regarding product enhancements, patient satisfaction studies, and management of intra- and postoperative problems.

Comparison of in-patient and out-patient penile prosthesis surgery

Between December 1996 and December 1998, 79 inflatable penile implant insertions have been performed at our institution by a single surgeon. The objective of this analysis was to compare our in-patient and out-patient experience with penile prosthesis insertion with respect to ease of performance and complication profiles. Data was collected in a prospective manner for both groups (in-patient, n = 33 and out-patient, n = 46). The two groups were compared with respect to intra-operative blood loss, operative time, time lost from work, narcotic use and complication rates. Both groups of patients experienced similar operative blood loss, essentially identical operative times, time lost from work and narcotic use. Most importantly, overall complication rates were 6% for the in-patient group and 4% for the out-patient group. Inflatable penile implant surgery is feasible in an ambulatory surgical setting. There is no difference in complication rates, loss of time from work, or intra-operative and post-operative course. Furthermore, there is a significant saving at our institution by performing the procedure in an out-patient fashion. In-patient prosthetic surgery is reserved for secondary procedures following a prior implant infection or primary implants in men with significant co-morbidities that require in-patient postoperative monitoring.

Use of sildenafil in penile implant patients

OBJECTIVE

To determine whether Sildenafil use in the patients with penile implants provided additional sexual satisfaction.

MATERIAL AND METHODS

12 patients who had had insertion of inflatable penile implants were given oral Sildenafil in the period following implantation. They were assessed for sexual satisfaction before and after oral Sildenafil use. The assessment was done using questions 7, 8, 13 and 14 of the International Index of Erectile Function (IIEF) questionnaire. These four questions of the IIEF questionnaire address the domain of satisfaction in male sexual behavior. Each person answered these questions using a scale of 1 (almost never or never) to 5 (almost always or always). The main answer to each question after Sildenafil was compared to the mean answer before.

RESULTS

There was a significant increase in the mean answer score to each of these questions.

CONCLUSION

Supplemental Sildenafil can increase the sexual satisfaction of patients with inflatable penile implants.