Ventral, subcoronal, and penoscrotal penile approach for semirigid rod penile prostheses

Abstract

Autologous cartilage and bone grafts that are used for internal splinting as prosthetic materials have been performed historically, but long-term results have been poor [1]. Advances in treatment enabled the use of synthetic materials (acrylic rods), as described by Goodwin and Scott in 1952 [3]. Semirigid rod penile prostheses were introduced in the early 1970s, relatively close to the advent of hydraulic prostheses. Initially, semirigid rod implants readily were accepted because of the relative simplicity of insertion and use. Although semirigid rod and hydraulic implants have a high rate of satisfaction, the inflatable or hydraulic prostheses now make up more than 90% of the market. Inflatable prostheses are more desirable in terms of increased rigidity and flaccidity. Nonetheless, semirigid rod penile prostheses are still applicable and have potential advantages, including: • Low rate of mechanical failure • Adequacy of erections • Ease of insertion • Extensive applicability to pelvic surgery patients • Little manual dexterity needed for operation • Less anxiety, compared with the anxiety of cycling a hydraulic device • Lower financial costs and operating time • Aid in placement of external condom catheter in spinal cord Disadvantages include a greater risk for pressure necrosis from the rods compared with the risk with inflatable devices, especially in patients with absent or decreased penile sensation. This problem results from the lack of flaccidity, a disadvantage that makes inflatable devices are more marketable. Another disadvantage is the increased difficulty in peforming endoscopy. Semirigid rod prostheses are available as malleable or mechanical types (Table 1). The mechanical prosthesis from Timm Medical Technologies (Eden Prairie, MN) primarily is composed of polyethylene segments and an outer layer of silicone. The malleable prostheses, available from American Medical Systems (Minnetonka, MN) and Mentor (Santa Barbara, CA), are designed as a core of bendable wire with a silicone sheath.