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PubMedDate not supplied

Experience with the Jonas penile prosthesis in the treatment of impotence.

The penile prosthesis has become established as a mode of therapy for organic and chronic psychogenic impotence. The Jonas type of penile prosthesis has been implanted into 10 patients and has achieved both functional success and excellent acceptance by the partner. Mechanical and pathological complications have a very low incidence. This penile prosthesis should be made available to carefully selected impotent patients who are deemed psychologically suitable candidates and in whom medical treatment has failed or is not indicated. It represents an important advance in the treatment of the male with erectile impotence.

Adult↗

PubMed2005

Antibiotic coating reduces penile prosthesis infection.

AIM: To evaluate the efficacy of a new antibiotic-coated (rifampicin+monocycline) penile prosthesis in prevention of bacterial adhesion and reduction of penile prosthesis infection. METHODS: In a retrospective analysis of medical records of men who had undergone implantation of American Medical Systems (AMS) inflatable penile prostheses between July 1990 and November 2003, we compared patients with AMS antibiotic-coated prostheses and patients with AMS nonantibiotic-coated prostheses. A total of 152 men aged from 27 to 79 years with erectile dysfunction underwent implantation of the AMS inflatable penile prosthesis. Fifty-eight patients received the antibiotic-coated prosthesis between July 2001 and November 2003, and 94 patients received the nonantibiotic-coated prosthesis between July 1990 and June 2001. RESULTS: In most cases infection was present; it was detected 1-2 days or up to 3-6 months after implantation. Complications including infection, which required surgical intervention, were observed in 15 patients of the nonantibiotic-coated prosthesis group (three reoperations for infection), and noninfection-related failure in five patients of the antibiotic-coated prosthesis group. In the nonantibiotic-coated prosthesis group of patients, time to infection ranged from 1 day to 6 months (mean 3.5 months). The antibiotic-coated prosthesis group of patients immediately after surgery and during the short- and intermediate-term follow-up had no infection of the penile prosthesis. CONCLUSIONS: We suggest that the antibiotic locally delivered from the prosthesis coating might be an effective supplement for prevention of prosthesis-related infection in penile prosthesis surgery.

Adult↗

PubMed1998

Treatment outcome after radical prostatectomy is not adversely affected by a pre-existing penile prosthesis.

OBJECTIVES: To report on the safety of radical retropubic prostatectomy (RRP) in patients with a penile prosthesis presenting with clinically localized prostate cancer. METHODS: From January 1990 to December 1997, 8 consecutive men with a penile prosthesis underwent RRP for clinically localized prostate cancer. Retrospective data regarding patient population, operating time, estimated blood loss, length of hospital stay, and clinical outcome were evaluated. RESULTS: Mean patient age was 65.4 years (range 57 to 70) at the time of RRP, with a mean preoperative serum prostate-specific antigen level of 11.5 ng/mL. Mean duration of RRP surgery was 183.9 minutes, and the mean estimated blood loss was 1281.8 mL. No complication requiring penile prosthesis removal occurred. In 1 case, the reservoir tubing was punctured during closure of the abdominal fascia wall. This was immediately recognized and fixed. All patients had a functioning penile prosthesis after RRP. CONCLUSIONS: RRP can be safely and expeditiously performed in patients with a pre-existing penile prosthesis. The risk of prosthesis malfunction after RRP is very low. Patients with a penile prosthesis and prostate cancer should not be denied the option of undergoing RRP.

Aged↗

PubMed2001

Penile prosthesis implantation and infection for Sexual Medicine Society of North America.

Penile prosthetics have developed over the past three decades into an effective treatment for erectile dysfunction with high reliability and patient satisfaction rates. The morbidity of these devices is principally limited to mechanical malfunction and the most feared complication of prostheses infection. Most penile prosthesis infections are caused by gram positive skin contaminations such as Staphylococci. The signs and symptoms of these infections may be difficult to identify in early stages, but late infections may lead to tissue loss and poor prognosis for prosthesis replacement. Treatment of penile prosthesis infections is best carried out with a salvage technique including aggressive lavage and prosthesis replacement. The success of this technique is salvage of prosthesis and return to function in more than 80% of cases. While penile prosthesis infection continues to be a dreaded complication, early diagnosis and aggressive surgical treatment may salvage the majority of these implants.

Humans↗

PubMed1998

Immediate salvage procedure for infected penile prosthesis.

PURPOSE: The most devastating complication after the insertion of a penile prosthesis is the development of infection. The standard approach involves removing the entire device, treating intensively with antibiotics and attempting to reinsert a prosthesis at a later date, often with a suboptimal result. Based on the encouraging results of others, during the last 24 months we have used in 2 separate private urological practices a salvage procedure for treatment of infected inflatable penile prostheses. MATERIALS AND METHODS: The protocol used in 7 men with an infected inflatable penile prosthesis included removal of all device components, a 7-step vigorous intraoperative irrigation with 4 different solutions, including vancomycin, immediate reimplantation of a new inflatable penile prosthesis and postoperative outpatient antibiotics with oral ciprofloxacin or intravenous vancomycin or cefazolin. RESULTS: Of the 7 men 6 have experienced excellent results with no infection, minimal morbidity and preservation of penile length. The only failure occurred in a poorly controlled diabetic who required multiple revisions and may have had latent infection for months before it became apparent. CONCLUSIONS: We believe that an immediate salvage procedure for an infected inflatable penile prosthesis is an effective treatment for this difficult complication.

Adult↗

PubMed1989

Negative pressure devices in the explanted penile prosthesis population.

Of 402 penile prosthesis implanted at our institution between 1980 and 1987, 20 required explantation due to infection, erosion, pain or tissue necrosis. Of these 20 patients 14 were available for a prospective trial using a negative pressure device in an attempt to restore potency. Among these 14 patients 11 used the device at home for a minimum of 30 days after an acceptable office demonstration. Three patients did not desire the negative pressure device after an office visit test. Of the 11 home users 10 (91 per cent) reported at least satisfactory erections and successful intercourse. Interestingly, 5 of 6 patients in whom explantation was due to infection were able to use the negative pressure device successfully. Over-all, 10 of the 14 explant patients (71 per cent) engaged in regular successful intercourse using the device. The negative-pressure device can be a useful therapy for erectile impotence even in the sometimes challenging explant population. Despite previous corporeal infection and presumed fibrosis, negative pressure devices can provide patients with a functional erection-like state.

Consumer Behavior↗

PubMed1992

[Implantation of self-contained non-inflatable penile prosthesis in patients with organic impotence].

Between April, 1988 and August, 1990, the OmniPhase penile prosthesis, a non-inflatable self-contained penile prosthesis, was implanted in 34 patients, aged from 37 years to 79 years, averaging 54.2 years. The etiologies of the impotence were radical surgery for bladder cancer or rectal cancer in 17 patients, diabetes mellitus in 7 patients, vascular abnormality in 3 patients, spinal injury in 2 patients, penile disorders in 2 patients and others in 3 patients. Penile prosthesis was implanted by subcoronal incision under spinal or general anesthesia. Clinical results were evaluated 12 weeks after surgery. Thirty-two patients (94.1%) could have intercourse postoperatively. Eighteen patients (52.9%) were completely satisfied and 14 patients (41.2%) were satisfied, whereas one patient (2.9%) had no improvement and another patient (2.9%) deteriorated. There was no serious complication. However, prosthesis was explanted because of skin erosion in one patient. Pain, which lasted for more than 10 days, was seen in 3 patients (8.8%), penile edema in 11 patients (32.4%), and acute epididymitis in one patient. The obtained results showed that implantation of OmniPhase penile prosthesis is a safe and useful procedure for treatment of organic impotence.

Adult↗

PubMed1976

[Surgical treatment of erectile impotence using the AMS penile prosthesis].

First experiences with an AMS penile prosthesis which can hydraulically fill and empty is reported. Advantage of this prosthesis: Physiologic imitation of erection and handling this method. The best cosmetic solution of all previous types of penile prosthesis. Disadvantage: A relatively complicated system and thus liable to defects. However, repairing is, in any case, easily done. After 3 years of use, experience is showing that this method turned out to be a cosmetically and functionally satisfying operative procedure.

Erectile Dysfunction↗

PubMed1988

42 months of experience with the Mentor inflatable penile prosthesis.

The Mentor inflatable penile prosthesis is a hydraulic device that was introduced in May 1983 for the treatment of erectile dysfunction. Since its introduction further technical modifications and improvements have been made on the product. From the onset the reliability, function and cosmetic effect of this physiological device have been excellent. The modifications have served to improve the ease of operation and to increase further the reliability as demonstrated by our progressive decrease in the incidence of mechanical failures. From May 1983 to November 1986 we implanted 137 Mentor inflatable penile prostheses. Our over-all mechanical failure rate was 7.3 per cent. As a result of the modifications, however, the mechanical failure rate decreased to 3.1 per cent during the last 38 months of that period when 129 (94 per cent) of the prostheses were implanted, and during the last 24 months of that period when 86 (63 per cent) of the prostheses were implanted the mechanical failure rate was only 1.2 per cent.

Adolescent↗

PubMed1985

Single cylinder penile prosthesis.

The single cylinder penile prosthesis is a viable procedure. It has many advantages. Its success depends on the careful selection, counseling, and follow-up of the patients and their partners.

Aged↗

PubMed1986

Operative approach for secondary placement of penile prosthesis.

Secondary placement of penile prosthesis was done in 8 patients following removal of the primarily placed prosthesis for extrusion and infection. Exposure of the corpora cavernosum along its entire length facilitated placement of semirigid prosthesis in each of these patients. The postoperative result was functional in all cases with a normal size in girth and parallel alignment of the distal tip of the prosthesis. In each case the secondarily placed prosthesis was shorter than the primarily placed prosthesis, and the amount of decrease in length appeared to be dependent on the severity of the complication that led to the removal of the primarily placed prosthesis.

Erectile Dysfunction↗

PubMed2006

Corporeal excavation: new technique for penile prosthesis implantation in men with severe corporeal fibrosis.

INTRODUCTION: Penile prosthesis implantation in men who have fibrotic corpora as the result of ischemic priapism or previous removal of an infected penile prosthesis poses a significant challenge to the implanting surgeon. We describe a new technique, corporeal excavation, to meet this challenge. TECHNICAL CONSIDERATIONS: The operative approach is through an inverted T penoscrotal incision that affords exposure of nearly the entire corpus cavernosum on each side. Extended corporotomies are made on the ventral aspect of each corpus cavernosum, and a plane of dissection between the fibrotic corporeal tissue and the inner surface of the tunica albuginea is established, resulting in core removal of nearly all fibrotic intracorporeal tissue. Cylinders are laid into the empty corporeal bed, and the tunica albuginea is closed primarily. Nine patients were identified who had undergone this procedure. The operative notes and medical records were reviewed, and telephone interviews were done for follow-up when patients had not been recently seen in the clinic. CONCLUSIONS: Successful outcomes were achieved in all 9 patients. Corporeal excavation permits penile prosthesis implantation in men with severe intracorporeal fibrosis usually resulting from priapism or previous removal of infected penile prostheses.

Device Removal↗

PubMed1995

Management of nondilatable cavernous fibrosis with the use of a downsized inflatable penile prosthesis.

The basic underlying cause of inability to implant a penile prosthesis is cavernous fibrosis resulting in unsatisfactory cavernous dilation. During the last 3 years, 20 patients with severe cavernous fibrosis underwent penile prosthetic implantation with a downsized inflatable penile prosthesis, obviating the need for additional cavernous reconstruction. After a mean followup of 20 months 19 of the 20 patients had a functional device with only 1 requiring explantation for infection. We believe that this downsized penile prosthesis is a valuable addition to the urological armamentarium when considering reimplantation or implantation in a patient with intracavernous fibrosis and scarring.

Adult↗

PubMed2004

[Development and clinical application of the Chinese-made inflatable penile prosthesis].

OBJECTIVE: To study the effect and safety of the Chinese-made inflatable penile prosthesis in the treatment of erectile dysfunction (ED). METHODS: According to the anatomy and physiology of Chinese men, an inflatable penile prosthesis was developed in China, consisting of an innovated pump, a reservoir, and a pair of penile cylinders, which were connected by tubes to form a complete system. It was authorized to be used clinically by State Food and Drug Administration (SFDA). Forty-five cases of organic ED were selected for penile prosthesis implantation. Penoscrotal approach was used to implant the cylinders into the corpus cavernosum, the pump into the scrotum and the reservoir into the prevesical space. RESULTS: Surgical problems and mechanical failures were not found in the subjects. Post-operative complications occurred in 3 cases (6.6%), but did not affect the intercourse. Satisfactory intercourses were achieved 10-12 months later and the intercourse duration averaged about (20 +/- 6) min. CONCLUSION: The Chinese-developed inflatable penile prosthesis was safe and effective for patients with ED, with low rate of mechanical failures. Its long term effect has yet to be further studied.

Adult↗

PubMed2003

Factors influencing the outcomes of penile prosthesis surgery at a teaching institution.

OBJECTIVES: To evaluate the long-term outcomes of penile prosthesis surgery at a teaching institution. METHODS: Patients who had penile prosthesis surgery from 1988 to 1999 at a private teaching hospital and the Dallas Veterans Affairs Medical Center were identified and charts abstracted for age at first prosthesis, ethnicity, etiology of impotence, comorbid medical disease, previous treatments, surgeon, type of prosthesis, perioperative complications, social history, and outcome. Patient outcomes were determined either from recent clinical documentation within the prior year or by telephone survey of patients. Frequent implanters were defined as those surgeons who performed more than 10 procedures during the study period. Kaplan-Meier curves were used to evaluate survival for patients and prostheses; statistical significance was assessed by the log-rank test. RESULTS: A total of 152 patients were identified, 81 patients at the Veterans Affairs Medical Center and 71 patients at the private hospital. A total of 180 procedures were performed by 15 attending surgeons, 4 of whom performed most (n = 132) of these procedures. No statistically significant difference was noted in patient age between the two hospitals. No statistically significant differences were found in survival of the penile prostheses on the basis of a history of smoking, diabetes, hypertension, or coronary artery disease. First prostheses had statistically significant better survival compared with secondary prostheses (5-year rate 71% versus 42%; 10-year rate 60% versus 35%, P = 0.0002). The overall infection rate at final follow-up was 9.9% and 18.8% for primary and secondary prostheses, respectively (P = 0.03). The 5-year survival outcomes with first prostheses for frequent implanters were superior to those of infrequent implanters (70% versus 63%, P = 0.034). Malleable prostheses had fewer complications than three-piece inflatable prostheses (10-year survival rate 87% versus 50%, P = 0.0081). CONCLUSIONS: Superior penile prosthesis outcomes were achieved with first penile prostheses when implanted by higher volume implanters. Meticulous technique and experience are important in all penile prosthesis surgery; however, outcome analysis emphasizes that the differences in outcomes are most apparent with first prostheses, which represent the best opportunity for the patient to achieve good results.

Adult↗

PubMed2000

Glandular-tunical stabilization to repair SST deformity of the inflatable penile prosthesis.

Among the complications of penile prosthetic surgery, the SST deformity is uncommon. Nonetheless, this functional and cosmetic complication affects patient and partner. We describe a modified corrective technique of glandular stabilization and repositioning specifically designed for the inflatable penile prosthesis. The pericoronal glandular fascia is secured to the tunica albuginea by protecting the underlying inflatable cylinder and avoiding tunical plication. This technique minimizes the risk of cylinder perforation and penile sensory loss and foreshortening.

Erectile Dysfunction↗

PubMed1994

Ten years of experience with various penile prosthesis in Korean.

Currently there are more than 10 types of penile prosthesis available, ranging from the very simple to the very sophisticated. We review our experiences with various penile prosthesis, with particular regard to the complication rate. From Dec. 1983 to Jul. 1993, we implanted 295 penile prosthesis of eight different types. The average age of patients was 44 years. Every patient was evaluated with various multidisplinary diagnostic approaches. The etiologies of impotence were vasculogenic 29%, diabetogenic 22%, spinal cord injury 16%, pelvic bone injury 11%, etc. The types of implanted prosthesis were AMS malleable 143, Jonas 42, Dynaflex 36, Hydroflex 8, Uni-Flate 1000 2, AMS 700 CXM 58, Ultrex 3, Mentor alpha-1 3 and the mean follow-up period was 34 months. The diameters of implanted prosthesis were from 9.5 mm to 13 mm, mostly 9.5 mm (52.9%). The length of implanted prosthesis were from 10 cm to 20 cm, mostly 16 approximately 18 cm (68.8%). Cases with uneven diameters or lengths were 20 (6.8%). The int aoperative complications were 1 corporeal rupture and 1 bladder rupture, and the postoperative complications were 2 prosthesis infections, 2 mechanical failures, and 1 prosthesis infection with mechanical failure. In those 4 patients reimplantations were successful. More than 99% (290/291) patients still have functioning prosthesis. Every prosthesis has their advantages and disadvantages. Factors to be analysed in the selection of proper prosthesis should include patients economic status, education, personality, social activity, hand dexterity, and penile size.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2000

10 years of experience with penile prosthesis implantation in Taiwanese patients.

PURPOSE: We evaluated the long-term results of penile prosthesis implantation during the last 10 years. Special considerations were examined concerning Asian corporeal diameter, device survival and sociocultural factors influencing patient-partner satisfaction. MATERIALS AND METHODS: We followed 331 patients who underwent penile prosthesis implantation from December 1985 to May 1996. Surgical data, postoperative complications and information from a survey on satisfaction are reported. RESULTS: The most prevalent corporeal diameter in our patients was 11.0 to 11.5 cm. Postoperatively wound infection was the most serious surgical complication. The 5-year device survival was similar in the malleable and inflatable types except for a poorer outcome with the self-contained inflatable Hydroflex penile prosthesis. Overall patient satisfaction with surgery was 86.6%. CONCLUSIONS: Penile prosthesis implantation still has its place as definitive therapy in some patients with uncorrectable erectile dysfunction. In Taiwanese society more consideration of prosthesis selection, surgical preparation and patient-partner counseling is the basis for further success in the future.

Actuarial Analysis↗