PENILE PROSTHESIS IMPLANTATION

doi:10.1016/S0094-0143(05)70144-0

Urologic Clinics of North America

Volume 28, Issue 2, 1 May 2001, Pages 355-362

https://doi.org/10.1016/S0094-0143(05)70144-0 Get rights and content

Urologists did not develop a significant interest in the treatment of erectile dysfunction until the introduction of the inflatable penile prosthesis in 1973.²⁷ For the next 10 years, the treatment of erectile dysfunction was fairly straightforward, that is, sex therapy for potentially reversible erectile dysfunction and penile prosthesis implantation for almost every other form. Currently, a variety of treatment options are available for erectile dysfunction, including systemic therapy, sex therapy, vacuum erection devices, intraurethral medication, penile injection therapy, penile revascularization, and penile prosthesis implantation. Topics discussed in this article include the role of penile prosthesis implantation in the treatment of erectile dysfunction, the selection of candidates for prosthesis implantation, the types of devices available and their indications, and the methods of implantation and the results.

Section snippets

CONTEMPORARY ROLE OF PENILE PROSTHESIS IMPLANTATION

Almost all men with erectile dysfunction prefer treatment with a systemic medication. With the introduction in 1998 of effective systemic therapy in the form of sildenafil citrate,¹⁰ oral medication rapidly has become the first line of therapy for erectile dysfunction. When systemic therapy fails or is contraindicated, second-line treatments are considered, including sex therapy, vacuum erection device therapy, intraurethral medications, and penile injection therapy. Men with erectile

Rod Prostheses

Rod prostheses are paired solid devices implanted in the corpora cavernosa that produce constant penile rigidity. Advantages of these devices include their ease of implantation and relative freedom from mechanical failure. Disadvantages include a constantly rigid penis that resembles neither normal erection nor flaccidity, difficulties with concealment, and an increased risk for device erosion.

American Medical Systems (AMS, Minnetonka, MN) manufactures a malleable penile prosthesis, the AMS

The Infrapubic Approach

In the infrapubic approach, a small vertical or transverse incision is made below the pubis just above the penis. The main advantage of this approach is that it permits reservoir placement under direct vision. Disadvantages include limited corporeal exposure, an inability to anchor the pump in the scrotum, and possible damage to the dorsal nerves of the penis. Dorsal nerve injury seldom occurs during first-time device implantation; however, during revision or device removal, nerve injury may

Device Reliability

In 1998 Dubocq and co-workers⁶ reported the results in 283 three-piece inflatable implant procedures and 83 two-piece inflatable implant procedures using the AMS and Mentor devices. Mean follow-up was 66 months. At a cut-off of 63 months, the probability of device survival free of mechanical failure was as follows: Mentor Alpha I, 0.957; AMS Ultrex, 0.842; AMS 700CX, 0.839; Mentor GFS, 0.783; and Mentor Mark II, 0.750.

In 1998 Govier and co-workers¹² reported the results in 169 three-piece

References (34)

J.R. Bishop et al.
Use of glycosylated hemoglobin to identify diabetics at high risk for penile periprosthetic infections
J Urol
(1992)
M.D. Brant et al.
The prosthesis salvage operation: Immediate replacement of the infected penile prosthesis [see comments]
J Urol
(1996)
CarboneD.J. et al.
Management of severe corporeal fibrosis with implantation of prosthesis via a transverse scrotal approach
J Urol
(1998)
C.C. Carson et al.
Late hematogenous infection of penile prostheses
J Urol
(1988)
J.A. Daitch et al.
Long-term mechanical reliability of AMS 700 series inflatable penile prostheses: Comparison of CX/CXM and Ultrex cylinders
J Urol
(1997)
F. Dubocq et al.
Long-term mechanical reliability of multicomponent inflatable penile prosthesis: Comparison of device survival
Urology
(1998)
R.L. Fein
The G.F.S. Mark II inflatable penile prosthesis
J Urol
(1992)
B.B. Garber
Mentor Alpha I inflatable penile prosthesis: Patient satisfaction and device reliability
Urology
(1994)
B.B. Garber et al.
Does surgical approach affect the incidence of inflatable penile prosthesis infection?
Urology
(1998)
I. Goldstein et al.
Safety and efficacy outcome of mentor alpha-1 inflatable penile prosthesis implantation for impotence treatment
J Urol
(1997)

F.E. Govier et al.

Mechanical reliability, surgical complications, and patient and partner satisfaction of the modern three-piece inflatable penile prosthesis

Urology

(1998)

F.B. Holloway et al.

Intermediate term assessment of the reliability, function and patient satisfaction with the AMS700 Ultrex penile prosthesis [see comments]

J Urol

(1997)

J.P. Jarow

Risk factors for penile prosthetic infection

J Urol

(1996)

KearseW.S. et al.

Report of a multicenter clinical evaluation of the Dura-II penile prosthesis

J Urol

(1996)

R.H. McLaren et al.

Patient and partner satisfaction with the AMS 700 penile prosthesis

J Urol

(1992)

D.K. Montague

Penile prosthesis corporotomy closure: A new technique

J Urol

(1993)

D.K. Montague

Periprosthetic infections

J Urol

(1987)

Cited by (49)

Electrophysiological evaluation of alterations in penile sensation due to penile prosthesis implantation in patients with erectile dysfunction
2023, Asian Journal of Urology
Citation Excerpt :
However, the mean values of preoperative NCV and postoperative values NCV were compared and there was no significant difference observed (Table 2). PPI surgery is an effective treatment option for patients with ED who fail to respond to pharmacological agents [6,7]. Despite being an effective treatment option with a high patient satisfaction rate, PPI surgery only accounts for approximately 1% of the opted treatment methods due to its invasive nature [7,8].
The present study was aimed to determine the effect of penile prosthesis implantation (PPI) surgery on penile sensation by evaluating the penile electromyography (EMG) variables.
The research was designed as a prospective study. Thirty patients who were diagnosed with organic erectile dysfunction and had underwent PPI surgery between January 2017 and January 2018 in the Urology Clinic of Antalya Training and Research Hospital were included in this study. Penile sensory EMG was performed on each patient 1 day prior to the surgery by the Physical Therapy and Rehabilitation clinic. Additionally, the control EMG study was also performed in the 3rd and 6th postoperative months.
We included 27 patients in this study who attended regular follow-ups and had complete EMG results. Out of the 27 patients, 23 (85.2%) patients had received malleable (ProMedon) penile prosthesis, one (3.7%) patient had received a two-piece inflatable (Ambicor) penile prosthesis, and three (11.1%) patients had received a three-piece inflatable (AMS 700 CXR) penile prosthesis. The mean nerve conduction value (NCV) of the patients was 29.85 (standard derivation: 22.54; range: 0–78.4) m/s during the preoperative period, whereas it was 27.64 (standard derivation: 24.72; range: 0–83.3) m/s in the 3rd postoperative month and 24.80 (standard derivation: 22.31; range: 0–88.4) m/s in the 6th postoperative month. There was no significant difference between preoperative NCV and 3rd postoperative month NCV (p=0.607). Similarly, no significant difference was observed between preoperative NCV and 6th postoperative month NCV (p=0.276). Additionally, the change between NCV values at postoperative 3rd and 6th months was not statistically significant (p=0.553).
Significant loss of penile sensation does not occur in patients who undergo PPI surgery.
Guidelines for erectile dysfunction. Colombian Urological Society
2015, Urologia Colombiana
Management of Perforation Injuries During and Following Penile Prosthesis Surgery
2015, Journal of Sexual Medicine
Citation Excerpt :
Other possible causes of extrusion include oversizing the cylinders and overly vigorous distal dilation, especially with small caliber dilators [5]. Although semi-rigid rods have been associated with erosion because of the constant pressure they exert [6], comparative series have not found that rods have a higher complication rate compared with inflatable penile prostheses (IPP) [7, 8]. Rates of extrusion and erosion have been reported at 1.2–8.0% [7, 8].
Distal extrusion of penile prosthesis cylinders is a challenging problem that is associated with pain and imminent erosion through penile skin. Distal extrusion and other perforation injuries, including crural and urethral, are other manifestations of tunica albuginea injuries that result in poor clinical outcomes and patient satisfaction.
A description of Dr. John Mulcahy's landmark article for management of lateral extrusion is presented along with discussion of techniques for managing other types of perforation injuries associated with penile implants.
Dr. Mulcahy's original article is reviewed and critiqued. Surgical methods to manage perforation injuries are discussed.
The main outcome measures used were the review of original article, subsequent articles, and commentary by Dr. Mulcahy.
Knowledge of techniques for management intraoperative and postoperative complications related to tunical perforation is necessary for implant surgeons.
Perforation injuries are challenging noninfectious complications of penile prosthesis surgery. Familiarity with techniques to manage these problems is essential for ensuring good outcomes and patient satisfaction. Stember DS, Kohler TS, Morey AF. Management of perforation injuries during and following penile prosthesis surgery. J Sex Med 2015;12(suppl 7):456–461.
Application of laser speckle blood perfusion imaging in the evaluation of erectile function in rats
2022, Andrologia
Health care reality of urological endoprosthetics in Germany from 2006 to 2016
2021, Urologe
Evaluation and management of erectile dysfunction
2020, Design and Implementation of the Modern Men's Health Center: A Multidisciplinary Approach

View all citing articles on Scopus

: Address reprint requests to Drogo K. Montague, MD, Urological Insitute, A/100, Cleveland Clinic Foundation 9500 Euclid Avenue, Cleveland, OH 44195

View full text