Penile implants in Japan

Abstract

ABSTRACT Introduction In Japan, APSSM's founding president Shirai developed a silicon single rod that is inserted into the outside corpora in 1971. In the 1990s penile prostheses started to be sold in Japan. However, sales stopped in 2007. Since then, it has been up to doctors to order them individually. Objective we performed 141penile prothesis surgeries between 1992 and 2019.9. Age is 25-81 years average 62 ± 8 years old. the causes of ED are Diabetes 57 cases, arteriosclerosis (hypertension) 24 cases, failure of prosthesis surgery 17 cases, intrapelvic surgery (prostate ca, bladder Ca, rectal Ca) 16 cases, brain disease (bleeding, infarction, Parkinson, meningitis) 12 cases, Renal failure 7 cases, Peyronie ’s disease 5 cases, priapism 2 cases, wrong masturbation habit 1 case. Diabetes was the most common cause. Diagnosis is vasculogenic and neurogenic 88 cases, vasculogenic 54 cases, vasculogenic and curvature 3 cases, neurogenic 6 cases. Methods Anesthesia method is local anesthesia (penile block) 128 cases, general anesthesia 13 cases. Penile prostheses were AMS 700CXM 6 cases, Titan OTR narrow base (Coloplast) 2 case, hydroflex 1 case, AMS Dura II 26 cases, AMS 600 17 cases, Genesis (Coloplast) 84 cases, Koken (Japan) 5 cases. We have used AMS since 1992, The sale of penile protheses in Japan was halted in 2007. Since 2008, Our University doctors have been ordering Coloplast prostheses Implanted penile prosthesis size is 11-19.5cm length average 15.9cm, median 16cm. The diameter is Dura II 1cm (26 cases), AMS 600 0.95cm (15 cases) 1.15cm (2 cases), Genesis 1.1cm (28 cases), Genesis 0.95cm (56 cases). Day surgeries are popular therefore 94% of patients prefer a non-inflatable prosthesis. We devised a single-implant procedure and performed surgery for the following indications:1. Narrow cavernosum because of congenital abnomarity or re-operations. 2. Small penis. 3. Uncontrolled diabetes. 4. ED caused by corporal veno-occlusive dysfunction (CVOD) in a young man. 5. Patient preference for a warm erect penis (with a PDE5 inhibitor). Single implant surgery has a high satisfaction rate of 98% with no complications, but there are still many enlargement operations and use of PDE5 inhibitors. Results Intercourse was possible 137 cases (97.0%) and impossible 4 cases (3.0%). Ejaculation was possible 100cases (77%), impossible 32 cases (24%) (prostate or rectal surgery, retrograde ejaculation due to DM). Complication rate is 7.8%, exposure of one side prosthesis to urethra 2.8%, exposure of one side prosthesis to skin 0.7%, Exposure of tube (AMS700CXM) 0.7%, persistent pain 2.1%, infection 1.4%. Satisfaction rate is 95.0% Conclusions The penile prosthesis is still considered to be the surgical gold standard for treatment of ED. All other available treatments for ED should be compared with the results of penile prosthesis surgery. In Japan, 95% of day surgeries use non-inflatable prostheses. Disclosure Work supported by industry: no.