Penile Prosthesis Implantation Research Articles

Comment on: Penile prosthesis implantation is safe and effective in Peyronie's Disease patients with and without erectile dysfunction.

Comment on: Penile prosthesis implantation is safe and effective in Peyronie's Disease patients with and without erectile dysfunction.

Response to comment on: penile prosthesis implantation is safe and effective in Peyronie's disease patients with and without erectile dysfunction.

Response to comment on: penile prosthesis implantation is safe and effective in Peyronie's disease patients with and without erectile dysfunction.

Double distal corporal anchoring stitch for lateral penile implant cylinder extrusion.

The ventral and distal aspects of the corpora cavernosa are the thinnest, increasing the likelihood of cylinder extrusion or crossover complications pertaining to inflatable penile prosthesis procedures. A double distal corporal anchoring double stitch can be used to robustly secure impending lateral extrusions and crossovers of implant cylinders. It is a novel, effective corrective measure for the uncommon complication of migrated cylinders in inflatable penile prosthesis placement. To describe the surgical indications and technique for the double distal corporal anchoring fixation stitch for lateral penile implant cylinder extrusion. We discuss a double-stitch technique that is performed following corporoplasty and capsulotomy. A lateral incision is made subcoronally on the affected side to identify the crossover or lateral extrusion. The cylinder is repositioned properly within the native corpora to prevent further cylinder migration. Two 2-0 Ethibond sutures are threaded through the distal cylinder eyelet, and each suture is delivered through the glans with a Keith needle and tied off. An incision is made in the glans, and 1 arm of each suture is tied with the other to create a bridge between the sutures that can be positioned deep within the skin of the glans. Over the past 4 years, 66 patients with lateral cylinder extrusion underwent the double distal corporal anchoring fixation stitch procedure, with overall improved satisfaction (97%). Only 2 patients had surgical complications. One patient experienced repeated lateral extrusion of the penile implant cylinders 6 weeks following the double-anchoring stitches procedure. The second patient developed a painful suture granuloma that necessitated excision, which resolved this issue, and the penile implant cylinder remained in the proper position over a year later. This technique ensures the secure fixation of the affected cylinders in the surgical capsule by creating a bridge between 2 sutures holding each repositioned cylinder in place, and the ensuing fibrotic reaction helps to fixate the extruded cylinder within the midglandular tissue. This surgical technique describes the double distal corporal anchoring stitch for lateral penile implant cylinder extrusion. Further studies are warranted to validate long-term outcomes and satisfaction. The double distal corporal anchoring fixation stitch is a safe and efficacious method to secure cylinders in the proper surgical capsule during revision procedures to correct distal crossovers or laterally extruded penile prosthesis implants.

Comparing 0.05% chlorhexidine gluconate monotherapy to conventional antibiotic irrigation in de-novo penile prosthesis implantation: a two-center prospective randomized controlled non-inferiority study (preliminary results).

Infection remains a significant concern following penile prosthesis (PP) implantation surgery. Published guidelines have indicated the use of pre-operative intravenous (IV) antibiotics but have not provided specific recommendations regarding intra-operative irrigation. For long in our practice, we have been using a combination of antibiotics for irrigation (rifampin 600 mg/L of sterile water, gentamicin 80 mg/L of sterile water). Recently, 0.05% chlorhexidine gluconate (CHG) (Irrisept®) (Irrimax Corp, Lawrenceville, GA, USA), has shown promise as an alternative irrigant, with potential advantages in terms of cost, ease of administration and reduced antibiotic resistance risk. The study aims to assess the non-inferiority of CHG antiseptic irrigation compared to conventional combined antibiotic irrigation in preventing postoperative infections for men undergoing de-novo PP implantation. This is a two-center Institutional Review Board (IRB) approved prospective randomized controlled non inferiority trial, involving men undergoing de-novo PP implantation with a predetermined non-inferiority margin of 4%. Patients were randomly assigned into one of two groups: the CHG irrigation or the group receiving conventional antibiotic irrigation. All patients received IV antibiotics preoperatively and were sent home on oral antibiotics for 2 weeks post-operatively. The primary endpoint of this trial was to evaluate the incidence of PP infections. Secondary objectives encompassed the assessment of simplicity of use and cost-effectiveness. A hundred patients were enrolled in our study so far (50 in each arm). Only one case of PP infection necessitating explanation was reported in each arm. Moreover, the use of CHG irrigation offered the potential advantages of ease of administration and less cost as compared to antibiotic irrigation solutions. Preliminary data from this non-inferiority study demonstrate that CHG irrigation is non-inferior to conventional antibiotic irrigation in preventing postoperative infection following PP implantation. These findings support the consideration of CHG irrigation as a viable alternative during PP implantation, offering both clinical effectiveness and potential cost savings as well as reducing the risk of antibiotic resistance. ClinicalTrials.gov NCT06489431.

Improved Health Care Utilization Among Men With Depression Undergoing Inflatable Penile Prosthesis in a U.S. Commercial Population.

We evaluated depression-related health care resource utilization and antidepressant prescription medication utilization among commercially insured men in the United States who underwent inflatable penile prosthesis (IPP) implantation between January 1, 2007 and December 31, 2020, and who received a depression diagnosis in the year preceding the IPP procedure. A total of 11,177 patients received an IPP during the index period, 808 of whom were diagnosed with depression. A statistically significant reduction in overall depression-related health care visits occurred from pre- to post-IPP, decreasing from 4.9 to 3.8, p < .001. In addition, there was a significant reduction in depression-related inpatient visits (0.07 vs. 0.03, p = .02) and office visits (4.25 vs. 3.29, p < .001) from pre- to post-IPP. Of the 678 men who received an antidepressant medication within 1 year prior to their IPP date, 15% stopped antidepressant medication use entirely post-IPP. Among patients with continued antidepressant medication use post-IPP (n = 574), there was a significant decrease in the number of prescriptions (7.55 vs. 8.09, p < .0001) and refills (7.52 vs. 8.11, p = .0015), with a higher likelihood of discontinuation (17.6% vs. 10.5%, p < .0001) and a lower proportion of days covered (0.79 vs. 0.83, p = .0004) post-IPP compared with pre-IPP. In conclusion, IPP was associated with reduced depression-related health care utilization and antidepressant medication use among recipients. This suggests potential mental health benefits for IPP recipients beyond restoration of erectile function. Comprehensive insurance coverage for IPP, especially for men with depression, may be beneficial to both patients and insurers.

PE034 Experience exploration in simultaneous penile prosthesis implantation during robotassisted radical prostatectomy

PE034 Experience exploration in simultaneous penile prosthesis implantation during robotassisted radical prostatectomy

Contemporary management of ischemic priapism: A 12-year population-based analysis from a large US database.

Priapism is a urological condition characterized by a persistent erection. The management varies based on its subclassifications. Despite established clinical guidelines for ischemic priapism, there is a lack of large-scale research focused on patient characteristics and management strategies. To analyze the contemporary management of ischemic priapism in the US, exploring patient demographics and clinical characteristics, as well as predictors of erectile dysfunction (ED) and penile prosthesis implantation (PPI). We performed a retrospective analysis of the PearlDiver Mariner database, reviewing records from 2010-2021. Adult males diagnosed with ischemic priapism were included. Data analysis covered demographic, clinical variables, and management strategies. Predictors of de novo ED and PPI were evaluated using multivariable logistic regression analysis. Of 36,120 patients, most (93%) received only medical management, and a minority underwent surgical interventions (penile shunt surgery [PSS], PPI or both). Medical management was typically effective, as 67.08% of the patients in this group experienced only one episode of priapism. However, de novo ED occurred in 16.57% of these patients. The majority of patients undergoing PPI had an inflatable prosthesis (81%). Older age (odds ratio, OR 1.02), the presence of metabolic diseases (OR 1.39), neurogenic disorders (OR 1.72), solid pelvic malignancies (OR 1.09), and multiple episodes of priapism were identified as significant predictors of de novo ED (all p<0.05). Similarly, age (OR 1.03), the presence of metabolic diseases (OR 1.23), solid pelvic malignancies (OR 1.99), and multiple episodes of priapism were associated with higher likelihood of PPI (all p<0.05). Most cases of ischemic priapism are managed with the medical therapy. Less than 3% of patients with ischemic priapism receive PPI, and when this occurs an inflatable prosthesis is favored. Age, specific comorbidities, and multiple episodes of priapism appear to be significant predictors of ED and PPI.

Imaging techniques for diagnosing and managing Peyronie disease.

Erectile dysfunction (ED) affects up to 50% of men to some degree and has a variety of physiologic and psychologic causes, but many patients do not seek specialist treatment. One cause of ED is Peyronie disease (PD) defined by the presence of fibrotic plaques in the tunica albuginea which cause painful penile contractures. While diagnosing PD relies on clinical history and a focused history and physical exam, adding imaging studies can identify nonpalpable plaques and any underlying vasculogenic ED to tailor the extent of surgical treatment and determine when implantable penile prostheses are beneficial. After briefly reviewing penile anatomy, erectile function, and the clinical features of PD, this paper describes the imaging findings of vasculogenic ED on Doppler ultrasound (US), followed by the imaging appearance of PD on US, computed tomography (CT), and magnetic resonance imaging (MRI) to increase recognition of this disease and show how imaging can be used as a problem-solving tool for treatment planning and evaluating post-surgical complications, especially malfunctioning implanted devices. By increasing the understanding of how imaging can be used for patients with PD with or without vasculogenic ED before and after treatment, radiologists and urologists can collaborate on patient management.

Changing trends in penile prosthesis implantation in China and an overview of postoperative outcomes from a single center

BackgroundSurgical penile prosthesis implantation (PPI) procedures have only recently been introduced to mainland China, with the overall number of such procedures having been conducted to date remaining relatively low. Accordingly, relatively little remains known with respect to the annual trends in PPI. Accordingly, this study was developed with the goal of clarifying these trends across different hospitals in mainland China, while also providing a single-center overview of post-PPI patient outcomes.ResultsTo identify males in mainland China who had undergone PPI, a retrospective review of data from January 2019 – October 2023 was conducted. This approach revealed an increase in the total PPI caseload from 120 in 2019 to 413 within the first 10 months of 2023. Over this same interval, the number of surgeons performing PPI rose from 33 to 74. A retrospective review of the 112 patients who had undergone PPI at Shanghai General Hospital from 2019–2023 revealed that these patients had a median age of 39 [27–63] years, and PPI treatment led to a significant increase in median International Index of Erectile Function-5 (IIEF-5) scores from a baseline value of 10.23 ± 1.26 to a post-treatment value of 22.6 ± 2.73. The underlying causes of erectile dysfunction for these patients included vasculogenic factors (58/112; 51.8%), diabetes mellitus (21/112; 18.8%), and injuries to the spinal cord or pelvis (14/112; 12.5%). The overall rates of satisfaction with the PPI reported by patients and their partners were 93.0% and 90.4%, respectively, and the 3-year PPI survival rate for this cohort was 87%.ConclusionThese data highlight a rising trend in the number of PPI being performed in China, with these steadily increasing rates since 2019 emphasizing the increasingly high levels of acceptance of this procedure by patients and clinicians as a means of treating erectile dysfunction. However, the expertise is restricted to a small number of surgeons. Even so, it is a safe and efficacious approach to managing severe erectile dysfunction for patients in China, and when performed by experienced surgeons based on standardized protocols, low complication rates can be achieved while providing patients and their sexual partners with high levels of satisfaction.

Complication and Explantation Rates of Penile Prostheses in Transmasculine Patients: A Meta-analysis

ObjectiveTo synthesize current literature on penile prosthesis implantation post-gender affirming phalloplasty to correlate implant types and complication rates. MethodsA meta-analysis of penile prosthesis in transmasculine patients was initiated in December 2022. Inclusion criteria encompassed randomized clinical trials, cohort studies, and cross-sectional studies reporting on penile prosthesis complications post-gender-affirming phalloplasty. Exclusion criteria were review articles, meta-analyses, studies that exclusively reported on cisgender patients or surgeries other than penile prosthesis implantation. An initial search of five databases yielded a total of 1593 articles. Upon screening, 15 full-text articles were eligible for inclusion. 9 studies were included in the analysis. ResultsThe overall complication rate for the inflatable prosthesis group was 38% (95% CI: 21, 59) and for the malleable prosthesis group was 37% (95% CI: 18, 62). The most probable complications in the inflatable group were infection (14.5%), dysfunction (12.9%), dislocation (5.7%), and leakage (5.4%). The most probable complications in the malleable group were dislocation (14.9%), infection (11.2%), dysfunction (9.1%), and extrusion (7.6%). There was no significant difference in the probability of any complications between the malleable and inflatable prosthesis groups.The best estimate of explantation rates for any reason for the inflatable group was 19% (95% CI: 9, 38) and for the malleable group 13% (95% CI: 4, 33). There was no significant difference in the probability of any reason for explantation between the malleable and inflatable prosthesis groups.

An Analysis of the Procedure Volume and Geographic Distribution of US Urologists Performing Outpatient-Based Inflatable Penile Prosthesis Implantation

Introduction: This study described the procedure volume and geographic distribution of US urologists performing outpatient-based inflatable penile prosthesis (IPP) implantation. Methods: This retrospective administrative claims analysis from Definitive Healthcare identified urologists performing outpatient IPP implantation (Current Procedural Terminology 54405) on commercially insured or Medicare patients in 2021 in hospital outpatient settings. Procedural volumes for each implanter were calculated, and geographical analyses used their primary affiliated hospitals to identify the states in which the procedures were performed. Results: In 2021, 2049 urologists conducted 21,835 outpatient-based IPP procedures on a representative sample of commercially insured and Medicare patients, averaging 10.7 procedures per implanter annually. Procedural volumes were right-skewed: 8.6% of urologists performed 33.7% of procedures. Most urologists (91.4%) performed &lt;20 cases. The highest volume implanters who performed more than 100 cases accounted for 6.3% of procedure volumes. Geographical analysis showed Florida (11.2%), California (7.8%), Texas (7.5%), New York (5.9%), Michigan (4.2%), Ohio (3.9%), and Georgia (3.9%) had the highest numbers of outpatient implanters, consistent with the top 7 states by IPP implantation volume (Florida [11.4%], Texas [9.4%], New York [6.5%], California [6.3%], Ohio [5.8%], Georgia [4.2%], and Michigan [3.4%]). Conclusions: Most urologists performing outpatient IPP (91.4%) performed &lt;20 procedures per year in 2021. Less than 10% performed approximately one-third of the procedures. These findings highlight essential considerations for fostering development in the field of urology, particularly for emerging implanters aiming to expand patient outreach. The implications aim to establish a balanced and accessible landscape, benefiting both practitioners and the patients they serve.

Is it safe to implant a penile prosthesis in a solid organ transplant recipient? A systematic review.

Solid organ transplant recipients exhibit an elevated incidence of erectile dysfunction, attributed to comorbidities and specific factors associated with organ failure. While treatment mirrors the general population's, response rates are lower, and there is a heightened concern about implanting a penile prosthesis in immunocompromised patients due to the potential occurrence of severe complications. The aim of this study was to assess the safety of penile prostheses in this population. Among fourteen included studies, ten were case reports or series of cases, and four were non randomized case-control studies with non-transplanted patients as controls. Complications affected 34 patients (11.15%), with mechanical device failures in 18 cases (5.9%) and infections in 13 cases (4.26%). Most infections required hospitalization, antibiotic treatment, and prosthesis removal, with two cases of life-threatening Fournier's gangrene. Case-control studies revealed no differences in overall reoperation rates between transplant recipients and controls. However, pelvic organ transplant recipients undergoing three-piece prosthesis implantation showed higher complications rates related to reservoir issues. Despite limited evidence, case-control studies demonstrated a generally low/moderate risk of bias within each specific domain, although overall bias was moderate/severe. As a result, clinicians may mitigate concerns regarding penile prosthesis implantation in solid organ transplant recipients.

Long-term penile prosthesis couple's satisfaction: A systematic review and meta-analysis.

Data supporting successful and satisfactory penile prosthesis (PP) implantation outcomes are mainly based on subjective, rather than objective, analysis. To systematically review and objectively analyze, all available data related to patient and partner PP satisfaction. An extensive search was performed, including the following key-words: ("penile prosthesis" and "satisfaction"). The search, which accrued data from January 1, 1969, up to July 31, 2023, was restricted to English-language articles including human participants. Out of 663 retrieved articles, 83 were considered including, 12,132 subjects with a mean age and mean follow-up of 58.6 [range 20; 77.1] years and 47.6 [range 6; 374] months, respectively. Overall, a high patient satisfaction rate was observed 83[80; 86]%. The satisfaction rate increased in subjects with three-piece PP and in those with a higher rate of cardiovascular or neurological diseases and was independent of the patient's age. Partner's satisfaction rate was lower when compared to that observed in men and it increased according to the use of inflatable devices and the presence of patient Peyronie's disease. The long-term complication rate was limited ranging from 3% for erosion to 4.6% when mechanical failure was considered. Patient and partner satisfaction is excellent and increases with time. The number of complications is limited and is strongly associated with the presence of diabetes mellitus. We found a high couple satisfaction score that was higher when reported by males compared to females. Patient satisfaction increased with time, and it was independent of age.

Advancements in ectopic reservoir placement for inflatable penile prostheses.

Traditional reservoir placement (RP) into the space of Retzius during three-piece inflatable penile prosthesis implantation has been associated with serious bladder, iliac vessel, and bowel complications, encouraging the development of "ectopic" RP methods. In this study we sought to document an up-to-date, comprehensive analysis of ectopic RP techniques regarding both patient satisfaction and clinical complications. A PubMed, Ovid MEDLINE, and Cochrane Library literature search of English language articles from 1966 to 2023 with keywords "inflatable," "penile prosthesis," "reservoir," and "placement" gave 179 publications, 70 of which were included in a comprehensive chronology and investigation after review. Overall, 12 retrospective studies detailing 9 ectopic RP techniques were compared for discussion. Sufficient data for comparison were found for 9 ectopic RP methods: posterior/anterior to transversalis fascia (PTF/ATF); high submuscular (HSM); HSM "Five-Step" technique (HSM-FST); lateral retroperitoneal (LR); sub-external oblique (SEO); direct vision, transfascial (DVT); low submuscular with transfascial fixation (LSM w/ TFF); and midline submuscular reservoir (MSMR). Although rare, serious complications have occurred with the use of ectopic RP techniques: 2 bladder perforations on implantation with PTF RP, a delayed bowel obstruction with HSM RP, and a colonic injury in a patient with a history of colon surgery with LR RP. Generally, herniation is the most relevant clinical complication in ectopic RP. At the time of this review there was no reported herniation with LR, SEO, LSM w/ TFF, or MSMR, likely due to fixation steps and/or reinforced spaces. Regarding patient satisfaction, HSM, HSM-FST, and LSM w/ TFF had similarly high rates of patient satisfaction while other techniques had no patient satisfaction data available. Importantly, reservoir palpability/visibility relates directly to patient satisfaction. Levels of palpability and/or visibility were reported in patients who underwent PTF/ATF, HSM, HSM-FST, SEO, and LSM w/ TFF, whereas no palpability was reported in patients who underwent LR, DVT, and MSMR. Proper comparison of ectopic methods is not possible without standardized patient surveys, consistent complication reporting, and larger sample sizes, indicating the need for a large, prospective, multisurgeon trial.

Efficiency of Early Penile Rehabilitation on Erectile Function Recovery after Open Radical Prostatectomy

Prostate cancer (PC) is one of the most commonly diagnosed malignancies worldwide and the second leading cause of mortality among men (1). Nowadays, radical prostatectomy is considered the primary therapeutic modality for treating patients with localized PC (stage pT2), providing a five-year survival rate of nearly 100% (2). Sexual dysfunction in men associated with PC treatment encompasses three distinct entities: erectile dysfunction (ED) and penile shortening; ejaculatory and orgasmic dysfunction; and psychosexual dysfunction, which pertains to sexual desire, intimacy, and mental health (3). Penile rehabilitation (PR) is defined as the use of any intervention or combination of procedures aimed not only at achieving an erection sufficient for satisfactory sexual intercourse but also at restoring erectile function to its preoperative level (4). Despite eff orts to preserve the neurovascular bundle during radical prostatectomy, ED remains a common outcome. Although prevalence rates of ED after the procedure vary widely, recent studies report rates as high as 85% (5). This is primarily due to the lack of control over factors that significantly influence the erection recovery, such as the patient’s age, preoperative erectile function, comorbidities, surgical approach (open, laparoscopic, or robot-assisted), surgical technique (non-, uni-, or bilateral nerve-sparing), and the surgeon’s skills and experience. The pathophysiology of postoperative ED is multifactorial. The primary mechanisms are believed to be damage to the cavernous nerves, whether through dis-section or neuropraxia, and vascular injury, which includes damage to the accessory pudendal arteries, hypoxia and fibrosis of the endothelium and smooth muscle, resulting in penile shortening (6-8). Although there is no consensus on the optimal approach to PR, accepted modalities include the use of phosphodiesterase type 5 inhibitors (PDE-5i; such as sildenafil, vardenafil, tadalafil) and vacuum erection de-vices (VED) or vacuum constriction devices (VCD) as first-line therapies. Second-line treatments involve prostaglandin E1 preparations for intracavernous, or intraurethral (MUSE – “Medicated Urethral System for Erection”) administration. The final therapeutic option is the implantation of penile prostheses (3-10).

Graduating resident and fellow readiness for general urologic practice during the COVID-19 pandemic A survey-based assessment of trainees and program directors.

Our goal was to compare the perceived readiness of graduating urologic residents and fellows to program directors (PDs) in U.S.-based postgraduate training programs. Additionally, we set out to assess the impact of COVID-19 on postgraduation plans to pursue fellowship training. Graduating residents, fellows, and PDs of accredited residency/fellowship programs in the U.S. were surveyed. The ranked preparedness of trainees to perform common urologic procedures was measured using a Likert scale from 1 (not comfortable) to 5 (fully proficient). The impact of COVID-19 was measured using a three-point Likert scale. Chi-squared and Kruskal-Wallis analyses were used to compare the groups. From 93 responders, 21 were residents, 19 were fellows, 24 were residency PDs, and 29 were fellowship PDs. The median levels of comfort for trans-urethral resection of the prostate, hydrocelectomy, vasectomy, and urethral sling were at or above (≥3) moderate for both PDs and trainees. PDs were more likely to report underperformance for hypospadias repair (60% vs. 39%), penile prosthesis implantation (39% vs. 26%), and orthotopic neobladder formation (57% vs. 18%) than the trainees. Fifty-three (57.0%) of the surveyors felt that COVID-19 did not impact the trainees' comfort in performing general urologic procedures. COVID-19 influenced trainees' decision to pursue a fellowship or opt to practice as general urologists (p=0.002). Our study suggests there may be a self-reported discrepancy between graduating trainees and their PDs regarding trainees' comfort levels performing general urologic procedures.

Factors Affecting Implant Length in Primary Inflatable Penile Prosthesis Placement

ObjectivesTo evaluate predictors of implant length for men undergoing primary IPP placement. MethodsA multicenter, retrospective cohort study was performed for men undergoing primary IPP placement at 16 high-volume surgical centers. Patient demographics, comorbidities, operative approach, and implanted cylinder and rear tip extender length were recorded. Associations between potential preoperative and intraoperative predictors of total device length were tested using non-parametric correlation and Kruskal-Wallis tests, followed by multiple regression. ResultsOf 3,951 men undergoing primary IPP placement from July 2016 – July 2021, the median implant length was 20 cm (IQR: 19 – 22). Shorter implant length was associated with increasing age in years (β = -0.01, p=0.009), Asian ethnicity (β = -2.34, p=0.008), history of radical prostatectomy (β = -0.35, p=0.001), and use of an infrapubic surgical approach (β = -1.02, p<0.001). Black or African American ethnicity was associated with the implantation of longer devices (β = 0.35, p<0.001). No significant associations were recorded with BMI, history of intracavernosal injections, diabetes mellitus, tobacco use, radiation therapy, Peyronie’s disease, priapism, or cavernosal dilation technique. ConclusionsThe length of an implanted penile prosthesis was found to be associated with preoperative and intraoperative factors including history of radical prostatectomy and operative approach. The knowledge of these associations may assist in the preoperative counseling of patients receiving IPP and help create accurate postoperative expectations.

Efficacy and safety of malleable penile prosthesis compared to inflatable penile prosthesis in erectile dysfunction patients.

Erectile dysfunction can cause self-withdrawal and decreased quality of life. Patients who do not respond to pharmacological therapy and other conservative treatments are urged to undergo penile prosthesis implantation. Malleable penile prosthesis was the first prosthesis developed, but then inflatable penile prosthesis was developed to give a more natural erection. There is no meta-analysis comparing inflatable and malleable penile prostheses in terms of safety and efficacy. This study is conducted to evaluate patient and partner satisfaction, ease of use, mechanical failure, and infection rate in patients who underwent penile prosthesis implantation. This meta-analysis followed Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocols. Five eligible studies were included from Pubmed, Scopus, ScienceDirect, and SemanticScholar databases. In this study, patient and partner satisfaction are significantly better (OR 3.39, 95% CI 1.66-6.93, p = 0.0008) (OR 2.32, 95% CI 1.75-3.08, p < 0.00001). Mechanical failure is also significantly higher in inflatable penile prostheses (OR 5.60, 95% CI 2.02-15.53, p = 0.0009). There is no significant difference in terms of ease of use and infection rate in inflatable or malleable penile prostheses. This study concluded that inflatable penile prosthesis is better in terms of patient and partner satisfaction, but mechanical failures occur more frequently in this type of prosthesis.

Penile prosthesis implantation is safe and effective in Peyronie's disease patients with and without erectile dysfunction.

Penile prosthesis (PP) is the mainstay of treatment in Peyronie's disease (PD) with co-existent refractory erectile dysfunction (ED). This study aimed to assess the clinical outcomes of patients who underwent PP as the first-line surgical treatment in PD without ED. A total of 636 patients underwent PP for PD from 2012 to 2022, but only 168 patients who underwent PP as first-line surgical management for PD with or without ED were included in the study. The mean (SD) age of 168 patients was 56.3 years (12.4). The mean curvature of the "PD with ED" group and the "PD without ED" group were 38.2 (5.6) degrees and 42.2 (5.9) degrees. The median (IQR) follow-up was 56.0 months (34.5- 61.4). Most (86.9%) patients underwent 3-piece inflatable PP. An important finding is that 33 patients (19.6%) without ED had undergone PP. Mechanical failure requiring revision surgery was less common in the 'without ED' group than in the ED group (6.8% vs. 10.2%, p 0.04). Most PD patients without ED (87.9%, 29/33) and with ED (88.9%, 120/135) were "satisfied" after PP implantation at six months, as defined by a score of ≥4 on a 5-point Likert scale. If surgery is offered in PD, PP may be considered a safe and effective first-line surgical treatment regardless of the ED, given the acceptable complications and high satisfaction rates. However, this new concept warrants further research.

Penile prosthesis for erectile dysfunction in France: A six-year nationwide database analysis

IntroductionUrological consultations for erectile dysfunction (ED) are increasing worldwide. Penile prosthesis (PP) implantations are performed when other treatments are unsuccessful. However, there is no data regarding PP implantations in France beyond the year 2016. ObjectivesThis study aimed to describe the changes in the number and type of PP implants used for the treatment of ED in France from 2016 to 2021 and the hospitalization rates following implantation using French national data from the Program for the Medicalization of Information Systems (PMSI). Materials and methodsWe analyzed data on PP implantations in all France hospitals. PPs were coded into three types according to the Common Classification of Medical Procedures (CCAM). The number of patients admitted to hospital with complications twelve months after implantation was also recorded. ResultsDuring the study period, 3675 men received 3868 PPs in France. A gradual increase in the total number of implanted PPs was observed, with an overall increase of 33.8%. In 2020, there was a sharp decline in the number of implanted PPs, primarily owing to the COVID-19 pandemic. The most commonly used implant was PPs with an extracavernous compartment, comprising 85% of all PPs. Twelve months after implantation, only 1–2% of the patients were rehospitalized. ConclusionPP implantation surgeries are highly reproducible and have a low incidence of complications, in terms of rehospitalization after one year of placement (1.8%). Moreover, there was an increase in the demand for penile prosthesis implantations in France between 2016 and 2021. Level of evidence4: Descriptive epidemiological study.