Penile prosthesis implantation and couple's satisfaction

OBJECTIVE: Implant surgery is the most acceptable curative choice for patients with erectile dysfunction and their partners, since the results are excellent with regard to the couple's pleasure and the materials used are extremely manageable. MATERIALS AND METHODS: We performed 46 prosthesis implantations in patients with erectile dysfunction: in 22 patients we implanted soft prostheses; in 20 malleable prostheses; in 1 a mono-component prosthesis, and in 3 patients a tri-component model. All patients and partners were evaluated using a questionnaire. RESULTS: We obtained a degree of satisfaction equal to 82% against 18% dissatisfaction due to a sensation of 'unnaturalness' report by the partner, with low perioperative and postoperative complications. CONCLUSION: In our opinion the degree of satisfaction of the patient is currently the only legitimate indicator to establish the effectiveness of therapy.     

Penile prosthesis implantation in a transsexual neophallus

Reconstruction surgery for a female to male transsexual usually involves mastectomy, hysterectomy and creating an aesthetically appealing neophallus. We have successfully inserted an inflatable prosthesis using the AMS CX prosthesis in a 45 year old transsexual, who had a large bulky neophallus constructed from the anterior abdominal subcutaneous fat, about 9 years ago. The single cylinder CX prosthesis was well anchored to the symphysis pubis using a dacron windsock tubing, the activation pump was placed in the dependent pouch of the right labium and the reservior in the usual perivesical space. The patient subsequently had debulking procedure using liposuction to create a more aesthetic and functional phallus. To date, the inflatable neophallus prosthesis is functioning well. (Asian J Androl 2000 Dec;2:304-306)     

Penile prosthesis implantation: past, present and future

Penile prosthesis implantation is the oldest effective treatment for erectile dysfunction. This review examines the past, present and future of penile prosthesis implantation. Advances in prosthetic design and implantation techniques have resulted today in devices that produce nearly normal flaccid and erect states, and have remarkable freedom from mechanical failure. The future of prosthetic design holds promises for even more improvements.     

阴茎假体植入术的临床应用与手术技巧(附光盘)

阴茎勃起功能障碍患者在接受药物及其他保守治疗后仍不能获得满意勃起时,阴茎假体植入术是理想的选择。阴茎假体植入后,无论患者本人还是其性伴侣都有很高的性生活满意度。近年来,国内接受阴茎假体植入术的患者越来越多。本文主要介绍阴茎假体植入术的临床应用与手术技巧。     

Penile prosthesis infections

In this retrospective review we looked at infection rates and risk factors in penile prosthesis recipients. Computer registry records of patients implanted with three-piece inflatable prostheses from April 1986 to March 1999 were reviewed. Bacteriological culture report data were obtained from the medical records. There were 491 three-piece inflatable penile prosthesis recipients with follow-up ranging from 1 to 168 months (mean 83). All patients were implanted more than 1 y ago. There were 10 infections in 491 recipients (2.0%). In 285 primary prosthesis recipients there were seven infections (2.5%). In 206 secondary prosthesis recipients there were three infections (1.5%). Seven infections occurred in 354 non-diabetics (2.0%) and three infections occurred in 137 diabetics (2.2%). None of these differences were statistically significant. Explants for infection were performed in 8 weeks or less following implantation in eight patients. In two patients explants occurred at 17 and 26 months following implantation. Cultures from the periprosthetic space grew E. coli (four), Proteus mirabilis (two), Staph. aureus (two), and bacteroides (two). Infections occurred in 2.0% of three-piece inflatable penile prosthesis recipients. There were no statistically significant differences in infection rates between first time and repeat prosthesis recipients and between diabetic and non-diabetic recipients. Eight of the 10 infections occurred 8 weeks or less following implantation.     

Penile prosthesis reimplantation

Occasionally, penile prostheses are removed following erosion, infection or malfunction and they are not replaced immediately. Patients may present later for reimplantation of a penile prosthesis after an interval free of a device. However, no information is available as to the outcome and difficulties of such a procedure. We reviewed the charts of all 305 patients undergoing implantation of a penile prosthesis at our institution and contacted all 8 who had undergone reimplantation. Bilateral prostheses were placed in 4 patients. Unilateral prostheses only could not be implanted in either side because of extensive fibrosis. Of the 8 patients 4 are able to have intercourse (1 with difficulty) and reimplantation of the prosthesis often was difficult or impossible. We conclude that reimplantation of a penile prosthesis is beneficial for some patients but they should be informed of the possibility of unsatisfactory results.     

Penile prosthesis implantation in the treatment of Peyronie's disease and erectile dysfunction

Although men afflicted with Peyronie's disease (PD) usually have a number of treatment options, those who also present with erectile dysfunction (ED) arising from unknown or iatrogenic causes are not easily treated. Surgical straightening procedures that have been used to treat PD may not restore erectile function and failure to straighten the penis with surgery may be the result of erectile inadequacy during the post-operative period. This paper discusses penile prosthesis implantation as a surgical option for patients with PD, placing emphasis on the choice of devices and surgical techniques. Several new techniques which hold the promise of high success rates and low morbidity are mentioned. International Journal of Impotence Research (2000) 12, Suppl 4, S122-S126.     

Penile prosthesis implantation: surgical implants in the era of oral medication

In patients who are not satisfied with the results of oral agents (phosphodiesterase-5 inhibitors) or in whom oral agents or other medical treatment fails to produce an adequate response, penile prosthesis implantation is an excellent treatment modality for restoring erectile function. Patient/partner acceptance, use, and satisfaction rates of penile pros-theses are better than for many other alternatives including pharmacologic injections. In-flatable penile prostheses are most frequently used and have the highest satisfaction rates. Complications of these multipiece prostheses continue to decline, and patient satisfaction rates, tolerability, and longevity continue to increase.     

Penile prosthesis implantation in the era of medical treatment for erectile dysfunction

Penile prosthesis implantation, the oldest of the modern treatments for erectile dysfunction (ED), still plays an important role despite the advent of less invasive alternatives. For some men with ED, penile prosthesis implantation is the only effective or acceptable treatment. Penile prosthesis implantation remains a viable option in the contemporary management of ED as evidenced by annual penile prosthesis implantation cases in the United States rising from 17,540 in 2000 to 22,420 in 2009. Improvements in prosthesis design and implantation techniques have resulted in significant increases in device survival and patient satisfaction.     

Penile prosthesis in Peyronie's disease

Many patients with Peyronie's disease suffer severe penile curvature, impotence, and respond poorly to conservative management. Sixteen patients with intractable Peyronie's disease had surgical incision of Peyronie's plaque and insertion of semi-rigid or inflatable penile implants. Patients had satisfactory results with elimination of curvature and resumption of coitus. Surgical procedures are indicated for impotent patients with Peyronie's disease who are unresponsive to conservative treatment.     

Penile prosthesis: psychologic factors.

A thirty-one-year-old paraplegic male requested a penile prosthesis. Psychiatric evaluations were done of both the patient and his wife. Within seventy-two hours of his arriving home with the prosthesis installed, his wife left their house to seek a divorce. The implications of this event for selecting patients for such devices are explored. Reservations are expressed about a prosthesis being inserted for patients married after the onset of impotence.     

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.     

Penile length alterations following penile prosthesis surgery

OBJECTIVE: Determine the impact of penile prosthetic surgery on penile length. METHODS: Stretched flaccid penile length was measured in men undergoing first-time penile implant surgery. Measurements were done before implantation and at 1 and 6 mo postoperatively. Patients were evaluated by the International Index of Erectile Function (IIEF) preoperatively and the IIEF and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) at 6 mo postoperatively. Patients also provided subjective assessment of penile changes at 6 mo postoperatively. Preoperative and postoperative IIEF and EDITS scores were compared as were the patients who complained of penile length loss with those who did not. RESULTS: Of the 56 patients, 50% were diabetic and 28.5% had previous radical prostatectomy; 78% of the implants were three-piece (Alpha-1, Mentor) and 22% were two-piece (Ambicor, American Medical Service). There were no statistically significant differences in penile length after the surgery compared to preoperative measurements. Forty of 56 patients (72%) reported a decrease in penile length, 10 of 50 (19%) reported no change, and 6 of 56 (9%) had a slight increase. Subjective penile length loss was more common in patients who had undergone radical prostatectomy before prosthesis implantation (32%). No statistical difference in EF domain scores occurred between patients who complained of penile length loss and those who did not; however, men complaining of length loss had lower IIEF satisfaction domain and EDITS scores. CONCLUSION: Penile prostheses do not have a negative impact on measured stretched flaccid penile length. Treatment satisfaction scores do not depend on subjective penile length loss.     

阴茎起勃器植入手术治疗阴茎硬结症合并重度S型弯曲(1例并文献复习)

目的探讨阴茎假体(起勃器)植入手术治疗阴茎硬结症合并重度阴茎弯曲效果。方法报道阴茎起勃器植入术治疗阴茎硬结症合并重度阴茎S型弯曲患者1例,结合文献复习讨论该病的临床表现、诊断及治疗。结果阴茎起勃器植入手术治疗阴茎硬结症合并重度阴茎弯曲1例,术后随访6个月,患者阴茎外观及性生活满意。结论对阴茎硬结症合并重度阴茎弯曲患者行阴茎起勃器植入术安全有效,对改善患者性功能具有重要意义。     

Penile prosthesis in the management of priapism

Priapism is the abnormal persistence of erection, painful and not sexually induced. Many cases resolve spontaneously, but if it persists for a long time there is anoxic injury and fibrosis of the corporal tissues and the sequelae is impotence. The main problem with priapism is pain and the probability of a resultant impotence. We have managed 2 patients with recurrent priapism with insertion of penile prosthesis with satisfactory results.