The Geriatric Patient with Penile Prosthesis

Abstract

To the Editor:–The use of penile prosthesis in the treatment of erection impotence has steadily increased since its introduction in 1973. Details about different models of prostheses, surgical techniques, and complications have been presented elsewhere.1, 2 However, the clinical aspects of implanted penile prostheses have remained confined to those specialists who are treating this problem. The majority of medical staff may never have the opportunity to see penile implanted patients or the related complications. Among penile prostheses carriers, more than 50% are men aged 60 years or more. Ten percent of them are in the 70 to 80-year age group.2, 3 With the increasing number of elderly patients, geriatricians have to bear this possibility in mind. Failure to recognize penile prosthesis may have undesirable consequences. Factors that contribute to such failure are cognitive disfunction, confusion due to acute disease, or reluctance of the patients family to discuss the prosthesis. An 80 year old patient was admitted to a general hospital because of acute cardiac failure. His treatment in the acute phase included urethral catheterization for urine monitoring. The catheter was removed a few days later. The presence of penile implant was unnoticed. Later on he was transferred to our long-term care unit. Shortly afterwards, he developed urinary retention, and again, a urethral catheter was introduced. Despite close clinical attention the presence of the penile prosthesis was undetected. The urologist ordered to investigate the cause of urinary retention immediately detected the penile implant. Inquiry among the medical staff (including geriatricians, internists and registered nurses) revealed that although they were informed about the subject, they had never before encountered a penile prosthesis carrier. Urethral catheterization of elderly patients with penile prostheses must be done carefully, with close follow-up thereafter. In the presence of a urethral catheter, urinary infections are more frequent.4 Urinary tract infections are major risk factors for penile implant infections, as are diabetes mellitus, neurogenic bladder, and general debilitation.2, 3 Elderly patients having permanent erection or unusual induration on penis palpation may have a penile prosthesis implant. Recognizing it in time may prevent infection, penile pressure sores, and medico-legal complications.