Penile Prosthesis in the Age of the Blue Pill

Abstract

In the event of proven erectile dysfunction (ED), specif ic treatment strategies are available in the following order : phosphodiesterase type 5 inhibitors (Cialis, Levitra, Viagra), intracavernous injections of vasoactive drugs and implanting a penile prosthesis. According to clinical experience, with all causes taken into considera tion, 25% of patients who suffer from ED do not respond to medical treatment. The penile implant is a highly effective alternative treatment where oral or injected drug therapy has proven unsuccessful or in cases where other medical treatments are contraindicated (1). According to our experience, the number of implant procedures performed increases by 15% each year and 35 prostheses will be implanted in 2009. Unfortunately, the penile implant remains a marginal therapy in Belgium despite being highly effective, having a very low complications rate and a satisfaction rating over 90%. Around 30 to 45,000 implant procedures are performed each year throughout the world with ten times more surgeries in the US than in Europe. In 2008, only 140 penile implants were performed in Belgium. There are an estimated 30 urologists who perform this proce dure and only two among this number perform more than 25 implant procedures per year. Therefore the majority of surgeons performing the procedure have less experience (three implants per year on average). This is not an ideal situation. As is the case in many European countries, it would appear that the low number of penile implants is a result of a lack of training and a shortage of information in the field, the cost of the implant, perioperative failings or complications in the case of insufficient experience. The medical legal risk is probably over-estimated but it does exist. The vast majority of implant models are inflatable. This advance, alongside the highly-informed support of doctors that are sensitive to ED patients and their partners’ quality of life, should make the process of deciding to get an implant more straight-forward. When is it time to consider a penile implant ?