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PubMed2001

Penile prosthesis in the organ transplant recipient.

OBJECTIVES: To determine whether pelvic organ transplant recipients are at a higher risk of developing complications after placement of a penile prosthesis relative to those receiving a penile prosthesis who did not undergo pelvic organ transplantation. METHODS: Two hundred eleven men underwent placement of a penile prosthesis by a single urologist at our institution between July 1994 and March 2000. Of these, 46 patients had undergone pelvic organ transplantation before placement of the penile prosthesis. The average time from transplantation was 43 months. The average follow-up after prosthesis placement was 23 months. These patients were monitored for various complications, including infection, malfunction, autoinflation, and injury to the prosthesis. They were compared with a cohort of men who had had a prosthesis placed but had not received pelvic organ transplantation. RESULTS: The overall complication rate was significantly higher in the transplant patients (22%) than in the nontransplant patients (7.9%) receiving prostheses (P <0.01). Infection was seen in 2 transplant patients (4.3%) and in 7 nontransplant patients (4.2%) (P <1). Malfunction occurred in 4 of the transplant patients (8.7%) and 6 of the nontransplant patients (3.6%) (P <0.2). In those patients with a prosthesis malfunction, 9 of 10 involved a three-piece prosthesis. All four malfunctions in the transplant group occurred in three-piece prostheses. The difference in the rate of malfunction was statistically significant (P <0.001) when comparing the three-piece prosthesis in the transplant and nontransplant patients (P <0.001). Surgical injury to the retroperitoneal reservoir occurred in 4 transplant patients (8.7%) (all with three-piece prostheses) and in none of the nontransplant patients (P <0.001). CONCLUSIONS: The risk of infection after insertion of penile prostheses in patients with pelvic organ transplantation was similar to that in nontransplant patients. The risk of malfunction and injury to the prosthesis (three-piece) was higher in transplant patients. The overall complication rate was significantly higher in patients after transplantation and can be attributed to the reservoir complications related to three-piece prostheses. In patients with a prosthesis that did not have a retroperitoneal reservoir, no significant difference in the overall complication rate was observed. Pelvic organ transplant recipients in whom traditional conservative therapy for erectile dysfunction fails should be considered candidates for penile prosthesis placement. However, three-piece prostheses should be avoided, as these patients are best served with prostheses that do not require a retroperitoneal reservoir.

Adult↗

PubMed1991

Outpatient 3-piece inflatable penile prosthesis.

The 3-piece inflatable penile prosthesis was implanted in 74 consecutive organically impotent outpatients during the last 4 years. The classical infrapubic surgical approach required minor alterations to adapt to the outpatient setting. This cost-reducing technique is safe medically and cogent financially.

Adult↗

PubMed2001

Reservoir herniation as a complication of three-piece penile prosthesis insertion.

OBJECTIVES: To obtain data concerning the incidence and management of reservoir herniation in inflatable penile prosthesis surgery in a clinical investigation. Reservoir herniation after scrotal placement of inflatable penile prosthesis is an unusual complication, and a review of the published medical reports reveals only anecdotal reports and no definitive articles. METHODS: A multi-item self-addressed questionnaire was mailed to the members of the Society for the Study of Impotence questioning the occurrence of reservoir migration from the prevesical space to the inguinal canal or scrotum. In addition, the database of one of us was reviewed to determine the incidence of reservoir migration in a large series of 1206 three-piece penile prostheses. RESULTS: The response rate was 38%. A minority of respondents (28%) were familiar with the problem. Of those who had experienced this complication, the occurrence was very rare and usually appeared in the immediate postoperative period, often in association with vigorous coughing spells or vomiting. The responders also indicated that imperfect surgical technique might have been implicated in some cases. Management usually consisted of reservoir replacement or repositioning through an inguinal incision with repair of the defect. Alternatively, several surgeons used the existing scrotal incision if the patient presented in the immediate postoperative period. The incidence of reservoir herniation was 0.7%. CONCLUSIONS: Reservoir herniation is a rare complication of inflatable penile prosthesis surgery that occurs almost exclusively in penoscrotally placed prostheses. Familiarity with various approaches to the management of this complication is clinically useful to urologists performing penile prosthesis surgery.

Foreign-Body Migration↗

PubMed1984

Mentor inflatable penile prosthesis. Preliminary clinical results in 30 patients.

The Mentor inflatable penile prosthesis was designed to decrease the incidence of mechanical failures associated with the Scott inflatable penile prosthesis. The penile cylinders of the Mentor prosthesis are manufactured from Bioflex polyurethane, a new polymer which is more durable and less elastic than silicone. The Mentor prosthesis also has a connector system which employs plastic clamps rather than suture ties to fix tubings to connectors. The new prosthesis has been implanted in 30 patients with organic impotency. These patients have been followed for an average of 7.7 (5-12) months. All patients achieved a satisfactory cosmetic and functional result from the procedure.

Aged↗

PubMed2007

Outcomes and satisfaction rates for the redesigned 2-piece penile prosthesis.

PURPOSE: We evaluated long-term viability, quality of life and satisfaction with the redesigned 2 piece Ambicor inflatable penile prosthesis. This device underwent revision of the rear tip extender and reinforcement of the pump tubing connection to decrease fluid leak failure in 1998. MATERIALS AND METHODS: In this retrospective analysis we evaluated 146 men with erectile dysfunction at 2 centers who underwent device implantation between June 1999 and October 2004 with the redesigned prosthesis. Patient information forms were completed, including patient history, surgical information and revision data. Patients were mailed a modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire, a modified Erectile Dysfunction Inventory of Treatment Satisfaction Partner survey and a questionnaire regarding pertinent inflatable penile prosthesis questions. RESULTS: A total of 146 men with a mean age of 58.7 years (range 25 to 78) were evaluated after inflatable penile prosthesis placement. Time from implant to followup was 3 to 73 months (mean 38). Only 1 device (0.7%) was removed due to infection. One implant (0.7%) was replaced due to fluid loss and 1 (0.7%) was revised due to improper sizing. Kaplan-Meier life table analysis indicated that the percent of patients free from reoperation was 99.2% at 12 months, 99.2% at 36 months and 91% at 48 months or greater. Of the 101 subjects completing the survey the average patient used the prosthesis 5 times monthly and 88.9% reported continued use. Of the patients 91% said that it was easy to use and 95% had little to no trouble learning to use it, while 84% stated that the inflatable penile prosthesis provided good to excellent rigidity for coitus. Overall patient and partner satisfaction was 85% and 76%, respectively. Of the patients 86% said that they would recommend the prosthesis to friends or if need be undergo the procedure again. CONCLUSIONS: The redesigned Ambicor 2-piece penile prosthesis appears to be safe and effective. It is associated with a low rate of revision as well as high patient and partner satisfaction.

Adult↗

PubMed1987

Erosion of an inflatable penile prosthesis reservoir into an ileal conduit.

We report an unusual complication of an inflatable penile prosthesis. The penile prosthesis reservoir had been placed intra-abdominally and it eroded into an ileal conduit. The reservoir was removed endoscopically but the patient ultimately required creation of a new ileal conduit. Placement of reservoirs intraperitoneally risks erosion into the bowel.

Adult↗

PubMed1995

Penile prosthesis insertion with corporeal reconstruction with synthetic vascular graft material.

Difficulty with penile prosthesis insertion may be encountered in patients with severe cavernous scarring or tunica albuginea deficiencies. Eleven patients who underwent penile prosthesis implantation required simultaneous corporeal reconstruction due to prior prosthesis infection and/or erosion in 6, priapism in 2 and Peyronie's disease in 1. One patient underwent prior neophallus construction with a tubularized abdominal wall flap for gender reassignment and 1 had congenitally deficient corporeal bodies. In 4 patients previous additional attempts at prosthesis replacement were unsuccessful. The reconstruction techniques included exposure of the corpora usually through a ventral midline incision and repair with synthetic vascular graft material. Accessory sub-coronal incisions were used when the disease was localized to the distal corpora. Six patients required reconstruction of more than half of the corporeal lengths bilaterally and in 5 smaller portions were repaired. Two patients received a semirigid and 9 an inflatable implant. Mean followup was 46 months (range 5 to 81). One patient required early reexploration for separation of the graft from the tunica and 2 required late surgical revision for distal tip divergence. Healing has been excellent and prosthesis function satisfactory in all patients. Infection, erosion and mechanical failure have not occurred. Penile prosthesis insertion with corporeal reconstruction using synthetic graft material is possible in these cases with acceptable morbidity rates and satisfactory erectile function.

Abdominal Muscles↗

PubMed2001

Mechanical reliability and safety of, and patient satisfaction with the Ambicor inflatable penile prosthesis: results of a 2 center study.

PURPOSE: We reviewed the experience with the 2-piece Ambicor penile prosthesis (American Medical Systems, Minnetonka, Minnesota) at 2 medical centers to investigate its mechanical reliability and complication rates as well as patient and partner satisfaction with the device. MATERIALS AND METHODS: From 1995 through 1999, 131 men underwent implantation of an Ambicor penile prosthesis at 2 medical centers. We performed a 3-part study consisting of a retrospective clinical record review, mailed patient and partner questionnaire, and mailed modified patient and partner Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire. Mean followup was 43.4 months (range 12 to 73). RESULTS: All 131 men had a history consistent with an organic etiology of erectile dysfunction, including vascular disease in 62%, radical retropubic prostatectomy in 17%, Peyronie's disease in 15%, neophallus construction in 4% and radical pelvic surgery in 2%. Mean patient age was 56.8 years (range 22 to 76) at implantation. Overall there were complications in 10 cases (7.6%), including infection, hematoma and mechanical failure in 6 (4.6%), 1 (0.7%) and 3 (2.3%), respectively. A total of 112 men (85%) and 91 partners completed the questionnaire. All patient respondents still had an Ambicor prosthesis implanted and 96.4% had erection suitable for coitus. Overall patient and partner satisfaction was 96.4% and 91.2%, respectively. Of the respondents 92.9% of patients and 90.1% of partners would recommend the device to others. Of the 85 men (65%) and 46 partners who completed the modified Erectile Dysfunction Inventory of Treatment Satisfaction survey 90.6% and 82.6%, respectively, were satisfied or very satisfied overall with the penile prosthesis. CONCLUSIONS: The Ambicor penile prosthesis is associated with a low complication rate and reliable mechanical function. High satisfaction was reported by patients and partners.

Adult↗

PubMed1998

Penile prosthesis implantation in the treatment of Peyronie's disease.

PURPOSE: This study was undertaken to evaluate the results and complications of penile prosthesis implantation in patients with erectile dysfunction caused by Peyronie's disease. MATERIALS AND METHODS: Men undergoing surgical intervention for erectile dysfunction caused by Peyronie's disease at the University of North Carolina School of Medicine were reviewed. Patients included 30 men aged 29-64 (mean = 49.6) with a duration of Peyronie's disease from 12-72 months (mean = 31.4 months). All men had palpable Peyronie's plague, significant penile curvature and plaque formation. All patients underwent implantation of AMS 700CX penile prostheses from 1993 to 1997. RESULTS: Penile straightening was carried out using modeling in 28 (93%) while plaque incision was necessary in 2 men (7%). All patients had a resultant straight penis with functional penile implant. There were no patients who suffered penile prosthesis infection and no mechanical malfunctions were observed during the follow-up. CONCLUSIONS: Penile prosthesis implantation with modeling is a safe, simple, effective technique for straightening penile curvature in patients undergoing implantation of penile prosthesis for Peyronie's disease. Penile prosthesis implantation is a safe, effective, low morbidity method for restoring potency in men with male erectile dysfunction and Peyronie's disease.

Adult↗

PubMed1991

Cost-benefit analysis of pharmacologic erection program (PEP) versus penile prosthesis.

We compared the current dollar inclusive costs of the two most commonly implanted penile prostheses with our pharmacologic erection program (PEP). The inclusive cost of implantation for the inflatable penile prosthesis (IPP) is $9,000 and for the malleable penile prosthesis (MPP) $3,150. The inclusive cost of PEP at maximal dose and maximal frequency of use over a five-year period is $3,450. Penile prosthesis was found to be more cost-effective for the long-term treatment of younger impotent men, whereas in the elderly group the use of PEP over a limited time span may be equally or more cost-effective.

Cost-Benefit Analysis↗

PubMed1984

Success with penile prosthesis from patient's viewpoint.

This study is designed to explore the patient's point of view on success with penile prosthesis. Detailed questionnaires were sent to 57 penile prosthesis recipients, 38 of whom responded. Overall, 89 per cent claimed improved sexual satisfaction, and 76 per cent noted improved self-image with their prostheses. Seventy-six per cent claimed their partners approved of the prosthetic device. Prosthetic appearance was satisfactory to 87 per cent. Five patients, knowing what they now know, would not have had the prosthetic implantation. A significant factor in 4 of the 5 patients was lack of partner approval. We conclude penile prosthesis implantation is successful in returning satisfactory sexual intercourse to impotent men and their partners. Partners of those desiring penile prosthesis should be included in the preoperative evaluation process.

Consumer Behavior↗

PubMed2003

[Treatment of the paraplegic patient with erectile dysfunction by implantation of China-made three-piece inflatable penile prosthesis].

OBJECTIVE: To evaluate the effect of the treatment on paraplegic patients with erectile dysfunction (ED) by implantation of China-made three-piece inflatable penile prosthesis. METHODS: Eighteen paraplegic patients with ED refractory to non-operative treatment were implanted with three-piece inflatable penile prosthesis through an incision at the border of penis and scrotum. The rate of maintained coitus and the satisfactory coitus of spouse were obtained by inquiring and letter visiting. RESULTS: Operations were successfully performed upon all 18 patients. Follow-ups after operations ranged from 3 months to 36 months, mean follow-up being 18 months. Fluid exudation from penile prosthesis and localized infection occurred in one patient and mechanic complication occurred in two. Maintained coitus rate was 17/18. Ejaculation reflection occurred in three patients. CONCLUSIONS: Treatment of paraplegic patient with ED refractory to non-operative treatment by implantation of China-made three-piece inflatable penile prosthesis has good concealment and rehabilitative effect, with similar mechanical troubles to imported products. With excellent covertness, implantation of three-piece inflatable penile prosthesis is well accepted by ED patients.

Adult↗

PubMed2004

The impact of sildenafil citrate on sexual satisfaction profiles in men with a penile prosthesis in situ.

OBJECTIVE: To assess the efficacy of sildenafil in increasing penile glans tumescence and improving patient satisfaction in men with a penile prosthesis, as this remains a major treatment for erectile dysfunction but a common complaint is the lack of glans engorgement. PATIENTS AND METHODS: To determine whether sildenafil combined with a penile prosthesis improves satisfaction, patients used an implant alone for at least 1 month, after which they completed the International Index of Erectile Function (IIEF) questionnaire. The same patients were then given sildenafil citrate and completed the IIEF questionnaire after using the sildenafil/implant combination. RESULTS: Patients who responded to sildenafil with glans engorgement reported significantly greater satisfaction scores than with an implant alone. CONCLUSION: We currently offer sildenafil citrate after implantation to all men who have a penile prosthesis placed.

Adult↗

PubMed2003

[Treatment of erectile dysfunction by implantation of domestic made three-piece inflatable penile prosthesis, a retrospective study of 29 cases].

OBJECTIVE: To evaluate the effect of implantation of domestic made three-piece inflatable penile prosthesis on erectile dysfunction (ED). METHODS: Domestic made three-piece inflatable penile prosthesis were implanted through an incision at the border of penis and scrotum on 29 patients with ED refractory to non-operative treatment, among which 23 being with neurogenic ED, including 18 paraplegia cases and 5 cases of traumatic injury of nervi erigentes; 4 cases with ED caused by arteriovenous fistula; I case with ED caused by fibrosis of corpus cavernosum, and 1 case with ED caused by Klinefelter's syndrome. Follow-up was conducted for 3 - 36 months to survey the clinical effect. RESULTS: Operation was successfully performed upon all 29 patients. Follow-up after operation lasted 3 - 36 months, 18 months on average. Fluid exudation of penile prosthesis and localized infection occurred in 1 patient and mechanic complication occurred in 2 patients. Maintained sexual intercourse rate was 28/29. 3 ED patients with primary arteriovenous fistula made their spouses pregnant after treatment. CONCLUSION: With excellent covertness and at low cost, implantation of domestic made three-piece inflatable penile prosthesis is effective and well accepted by ED patients.

Adult↗

PubMed1989

Small-bowel obstruction by an inflatable penile prosthesis reservoir.

Early experience with the inflatable penile prosthesis has been plagued with high failure rates. With improvements in design and surgical technique, the relative incidence of mechanical failures has decreased from 69.9% of all complications to 38.2%, increasing the relative importance of pathologic failures (from 27.3% to 56.4%). The overall complication rate has decreased from an initial 32.5% to 9.0% in recent series. A unique case of small-bowel obstruction caused by intraluminal migration of the reservoir of an inflatable penile prosthesis is described. It was successfully managed by resection of the affected bowel loop and extraperitoneal reimplantation of the reservoir. Although general surgeons are not involved in the placement of these devices, it is important for us to be aware of the possibility of erosion and migration of the component parts, which may result in potentially lethal gastrointestinal and other complications that we may be called on to assess.

Adult↗

PubMed2002

The management of low-flow priapism with the immediate insertion of a penile prosthesis.

OBJECTIVE: To evaluate the outcome of patients undergoing the immediate insertion of a penile prosthesis as a treatment for acute low-flow priapism. PATIENTS AND METHODS: Eight patients presenting with low-flow priapism with a mean duration of 91 h (range 32-192) were prospectively evaluated. All had failed conservative management with the instillation of alpha-adrenergic agents, and four had already undergone shunt procedures elsewhere. Immediate management consisted of the insertion of a malleable prosthesis in six patients and an inflatable prosthesis in two. One of the malleable prostheses was subsequently changed to an inflatable device. RESULTS: There were no early complications, with all patients being satisfied with the end result, and seven having sexual intercourse. One patient developed a penile deformity after surgery, cause by fibrosis around one inflatable cylinder. All patients have maintained their penile length. CONCLUSIONS: Prolonged low-flow priapism results in a variable degree of cavernosal fibrosis and a subsequent loss of penile length. The delayed insertion of a penile prosthesis can be difficult, with high complication rates. The immediate insertion of a penile prosthesis in patients with prolonged low-flow priapism is simple and maintains penile length. This should always be offered to the patient at initial presentation, as the complication rate is low and the subsequent outcome excellent.

Adult↗

PubMed1997

Immediate sexual rehabilitation by simultaneous placement of penile prosthesis in patients undergoing radical prostatectomy: initial results in 50 patients.

OBJECTIVES: To evaluate the results of simultaneous placement of a penile prosthesis with radical prostatectomy. METHODS: From June 1993 to June 1996, 50 men underwent a combination procedure of non-nerve sparing radical retropubic prostatectomy and placement of a penile prosthesis. We performed a retrospective chart review of these patients, examining patient age, preoperative prostate-specific antigen level, Gleason score, operative time, estimated blood loss, analgesic use, length of hospital stay, time until intercourse, and complications. This group was compared with a group of 72 men undergoing radical prostatectomy alone during the same time interval. RESULTS: No significant differences were noted in preoperative patient variables. The mean operative time for prosthesis insertion was 82 minutes, and the mean time to sexual intercourse was 12.7 weeks. No prosthesis infections have occurred, with a mean follow-up of 1.7 years. Four men (8%) have required revision of their inflatable penile prosthesis. There were no significant differences between the combination procedure and radical prostatectomy alone with regard to estimated blood loss, length of hospital stay, or analgesic use. CONCLUSIONS: Simultaneous placement of a penile prosthesis during radical prostatectomy provides early return to sexual function, with no apparent increase in morbidity. Further study will be required to determine the impact of combination surgery on psychosocial adjustment and quality of life.

Humans↗

PubMed2001

[Disappointing long-term experiences of patients with penile prosthesis].

OBJECTIVE: To describe the long-term experience with the implantation of a penile prosthesis as a last resort treatment for erectile dysfunction. DESIGN: Retrospective and descriptive. METHOD: During the period 1986-1996, 124 men received a penile prosthesis. Basic information was obtained from medical files. Seventy-six men could be traced and were sent a questionnaire. Sixty patients and 44 partners participated in the study. RESULTS: The median time since the implantation was 81.3 months (range: 13-139). The chance of reoperation was 35%. Seventeen percent of the patients and 25% of the spouses regretted the decision to have the implantation. Thirty-one percent no longer used the prosthesis and 15% had never used it. Twenty percent of the patients and 31% of the partners noticed an improvement in their sexual relationship whereas 26% and 23% respectively noticed a decline. Twenty percent of the patients sometimes failed to penetrate despite the prosthesis. Nevertheless, 66% would advise implantation to someone else. Almost 50% of the men reported spontaneous tumescence during sexual arousal. CONCLUSION: After the implantation of a penile prosthesis, the reoperation rate was high, and many patients and their partners were dissatisfied with their sexual relationship despite regaining a functional erection. Implantation requires thorough sexological counselling both before and after the operation.

Adult↗