Penile Prosthesis Implantation Surgery Research Articles

Surgical tips in difficult penile prosthetic surgery: a narrative review.

Penile prosthesis implantation continues to represent a reliable solution to address erectile dysfunction when oral medications fail, are not tolerated or are contraindicated, and most typically is associated with excellent satisfaction rates and durable results. Despite the dramatic improvements in the prostheses' design, in the surgical instruments and techniques over the years, certain categories of patients still pose a significant surgical challenge. The aim of the current review is to provide a quick and useful practical guidance based on our expertise in the identification and management of the difficult penile prosthesis implantation cases. A narrative review design was here preferred to fulfil our purpose. The search strategy included a range of terms, e.g. penile prosthesis, corporal fibrosis, infection, ischaemic priapism, Peyronie's disease, radical prostatectomy, pelvic surgery. Extensive corporal fibrosis after explantation of an infected device or after prolonged ischaemic priapism may represent the most difficult situations to deal with in penile prosthesis implantation surgery. Penile prosthesis implantation in patients with Peyronie's disease and in those who previously underwent radical prostatectomy also presents with an increased risk of complications. Experienced surgeons need to be able to recognise promptly and manage urethral perforation, cylinder crossover, tunical perforation and erosion, as these complications are more common when dealing with difficult penile prosthesis implantation cases. Applying penile lengthening techniques and principles can be useful in selected cases to ensure better postoperative satisfaction rates, especially in those patients who have experienced a more significant degree of loss of length preoperatively. High-volume-implanting surgeons should always be involved in complex cases to minimise the risk of complications. A thorough preoperative counselling can set realistic patients' expectations in this context, further contributing to postoperative satisfaction.

Electrophysiological evaluation of alterations in penile sensation due to penile prosthesis implantation in patients with erectile dysfunction

ObjectiveThe present study was aimed to determine the effect of penile prosthesis implantation (PPI) surgery on penile sensation by evaluating the penile electromyography (EMG) variables. MethodsThe research was designed as a prospective study. Thirty patients who were diagnosed with organic erectile dysfunction and had underwent PPI surgery between January 2017 and January 2018 in the Urology Clinic of Antalya Training and Research Hospital were included in this study. Penile sensory EMG was performed on each patient 1 day prior to the surgery by the Physical Therapy and Rehabilitation clinic. Additionally, the control EMG study was also performed in the 3rd and 6th postoperative months. ResultsWe included 27 patients in this study who attended regular follow-ups and had complete EMG results. Out of the 27 patients, 23 (85.2%) patients had received malleable (ProMedon) penile prosthesis, one (3.7%) patient had received a two-piece inflatable (Ambicor) penile prosthesis, and three (11.1%) patients had received a three-piece inflatable (AMS 700 CXR) penile prosthesis. The mean nerve conduction value (NCV) of the patients was 29.85 (standard derivation: 22.54; range: 0–78.4) m/s during the preoperative period, whereas it was 27.64 (standard derivation: 24.72; range: 0–83.3) m/s in the 3rd postoperative month and 24.80 (standard derivation: 22.31; range: 0–88.4) m/s in the 6th postoperative month. There was no significant difference between preoperative NCV and 3rd postoperative month NCV (p=0.607). Similarly, no significant difference was observed between preoperative NCV and 6th postoperative month NCV (p=0.276). Additionally, the change between NCV values at postoperative 3rd and 6th months was not statistically significant (p=0.553). ConclusionSignificant loss of penile sensation does not occur in patients who undergo PPI surgery.

MP27-20 HIGHER HbA1c OVER 8.5% IS NOT PREDICTIVE OF INCREASED INFECTION RATE FOLLOWING PENILE PROSTHESIS IMPLANT SURGERY IN DIABETIC PATIENTS WITH ERECTILE DYSFUNCTION

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation I (MP27)1 Sep 2021MP27-20 HIGHER HbA1c OVER 8.5% IS NOT PREDICTIVE OF INCREASED INFECTION RATE FOLLOWING PENILE PROSTHESIS IMPLANT SURGERY IN DIABETIC PATIENTS WITH ERECTILE DYSFUNCTION Raidh Talib, Ahmad Al-Qudimat, Ibrahim Alnadhari, Omar Aboumarzouk, Raed M. Al-Zoubi, Khalid Alnadhari, and Abdulla Al Ansari Raidh TalibRaidh Talib More articles by this author , Ahmad Al-QudimatAhmad Al-Qudimat More articles by this author , Ibrahim AlnadhariIbrahim Alnadhari More articles by this author , Omar AboumarzoukOmar Aboumarzouk More articles by this author , Raed M. Al-ZoubiRaed M. Al-Zoubi More articles by this author , Khalid AlnadhariKhalid Alnadhari More articles by this author , and Abdulla Al AnsariAbdulla Al Ansari More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002024.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Diabetes mellitus (DM) is associated with an increased risk of erectile dysfunction (ED). Penile prosthesis implantation (PPI) is an efficient complementary therapeutic option for the treatment of ED but is not without risk as infection remains a prominent concern. Objectives: To study the role of diabetes mellitus as a risk factor for PPI infection and examine the relationship between hemoglobin A1c (HbA1c) levels and infection rates. METHODS: This retrospective observational study was conducted at Hamad Medical Corporation, Qatar. All diabetic patients with ED who underwent PPI surgery between January 2012 and November 2019 were included. A total of 599 diabetic patients with ED had implantation. The relationship between infection and HbA1c was examined using Pearson’s correlation coefficients. Results: Mean age was 59.69±31.19. PPI infection rate was 0.83% (5/599), while the mean hemoglobin A1c level was 7.58±1.45 mmol/l, (range: 4.1-12.6). A comparison between diabetic patients with PPI infection and those without infection revealed no significant difference in the level of HbA1c between the two groups. Limitations include retrospective single-center design and low infection rates reducing sample number. RESULTS: Mean age was 59.69±31.19. PPI infection rate was 0.83% (5/599), while the mean hemoglobin A1c level was 7.58±1.45 mmol/l, (range: 4.1-12.6). A comparison between diabetic patients with PPI infection and those without infection revealed no significant difference in the level of HbA1c between the two groups. Limitations include retrospective single-center design and low infection rates reducing sample number. CONCLUSIONS: PPI infection rate in a large series of diabetic patients was low and no significant association between the HbA1c level and PPI infection was observed. Source of Funding: There is no funding source for this research © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e479-e479 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raidh Talib More articles by this author Ahmad Al-Qudimat More articles by this author Ibrahim Alnadhari More articles by this author Omar Aboumarzouk More articles by this author Raed M. Al-Zoubi More articles by this author Khalid Alnadhari More articles by this author Abdulla Al Ansari More articles by this author Expand All Advertisement Loading ...

HbA1c over 8.5% is not predictive of increased infection rate following penile prosthesis implant surgery in diabetic patients with erectile dysfunction.

Diabetes mellitus is associated with increased risk of erectile dysfunction. Penile prosthesis implantation is an efficient therapeutic option for erectile dysfunction, but not without risk, as infection remains a prominent concern. This study investigates diabetes mellitus as a risk factor for penile prosthesis implantation infection and the relationship between haemoglobinA1c levels and infection rates. All diabetic patients with erectile dysfunction who underwent penile prosthesis implantation surgery between January 2012 and November 2019 at Hamad Medical Corporation, Qatar, were included in this retrospective observational study. A total of 599 diabetic patients with erectile dysfunction had penile prosthesis implantation. Mean age was 59.69±31.19. Penile prosthesis implantation infection rate was 0.83% (5/599), while the mean haemoglobinA1c level was 7.58±1.45mmol/l (range: 4.1-12.6). A comparison between diabetic patients with penile prosthesis implantation infection and those without infection revealed no significant difference in the level of haemoglobinA1c between the two groups with mean haemoglobinA1c in patients with infected implants 7.14 and 7.59 for noninfected (p=0.491). Limitations include retrospective single-centre design and low-infection rates reducing sample number. Penile prosthesis implantation infection rate in a large series of diabetic patients was low with no significant association between haemoglobinA1c level and penile prosthesis implantation infection observed.

Expanding the Limits-Improving Penile Length With Inflatable Penile Prosthesis Implantation: A Review.

Erectile dysfunction is a multifactorial disorder that increases in prevalence as men age. When medical therapy fails or when men are unwilling to try it, surgical intervention becomes the urologist's next best tool. However, the loss of penile length is of great concern to many patients, and there have been a myriad of ways to try to combat this fear from both patients and the surgeons themselves. In this review, we evaluate the current literature of these various approaches to improve penile length in penile prosthesis surgery. To review novel techniques in penile prosthesis implantation surgery. A literature search using PubMed was conducted to identify relevant peer-reviewed studies to penile prosthesis surgery. Search terms included penile prosthesis, penile shortening, sliding technique, Peyronie's Disease, erectile dysfunction, nondegloving, penile length, and Multiple Slice Technique. Novel techniques included preoperative techniques such as use of vacuum-assisted erection device, intraoperative techniques of aggressive dilatation and maximal sizing, ventral phalloplasty and/or scrotoplasty, suprapubic fat pad excision, relaxing tunica albuginea incisions, a sliding or slicing technique, or the postoperative use of penile rehabilitation. In addition, recognizing recall bias or inconsistencies in measurement techniques is important when evaluating men with possible penile shortening after penile prosthesis surgery. Advancements in surgical techniques and managing patient expectations can be crucial in the success of penile prosthesis surgery. Panuganti S, Kannady C, Wang R, Expanding the Limits-Improving Penile Length With Inflatable Penile Prosthesis Implantation: A Review. Sex Med Rev 2021;9:498-506.

Shaeer's Anti-Scarring Technique: A Preventive Measure Against Corporal Fibrosis Upon Explantation of Infected Penile Implants.

IntroductionIn cases of explantation and delayed reimplantation of an infected penile prosthesis, the scarring that afflicts the corporal bodies renders reimplantation difficult and risky, with potential loss in penile size.AimMitomycin C is an antitumor, antibiotic agent with a potent antifibrotic action that can be used to limit corporal scarring following explantation with the aim of achieving easy and safe subsequent reimplantation, in addition to preserving penile size.MethodsThis was a prospective study involving 5 patients with infected penile prostheses who were referred to our tertiary implantation center. The infected prostheses were explanted, followed by corporal washout with antiseptics and antibiotics. Patients were rescrubbed and redraped. Mitomycin C, 10 mg in 250 cc saline, was instilled into the corpora cavernosa (125 cc each), avoiding extracavernous spilling and contact with corporotomy and skin edges. Corporotomy and skin edges were freshened and closed. Reimplantation was performed 10 to 12 weeks later.Main Outcome MeasureWe evaluated the ease of blunt dilatation upon reimplantation and success in implanting cylinders the same size as the ones explanted.ResultsWe were able to dilate the corporal bodies with ease in all cases using blunt Hegar dilators. All cases received the same size implant as the one explanted, in terms of length and girth, with the exception of a case where the length was only 1 cm shorter.ConclusionsIrrigation of the cavernous spaces with mitomycin C upon explantation of an infected penile prosthesis appears to ameliorate corporal scarring and keep the cavernous spaces open. On a larger scale, this approach could render the most feared complication of penile prosthesis implantation surgery much more manageable.Shaeer O, Abdel Rahman IFS, Shaeer K. Shaeer’s Anti-Scarring Technique: A Preventive Measure Against Corporal Fibrosis Upon Explantation of Infected Penile Implants. Sex Med 2019; 7:357–360.

Factors Predicting Male Satisfaction after Penile Prosthesis Implantation

Background: penile prosthetic surgery is associated with satisfaction rates> 90% for the general implant population. However, it is suggested that satisfaction rates may be lower in certain populations. Objective: to analyze the factors affecting male satisfactionrates after penile prosthesis implantation (PPI). Patients and Methods: this observational retrospective and prospective study included all patients who underwent PPI surgery at Al-Azhar University Hospitals [Al-Hussein and Sayed Galal]; Cairo; Egypt during the period from January 2015 to May 2019. One hundred and three men were eligible for the study. The age of patients, body mass index (BMI), associated medical co-morbidities, etiology of erectile dysfunction (ED), duration of ED before PPI, date of the surgery, and intra- and post-operative complications were evaluated. Men`s satisfaction with PPI was evaluated at a time point at least 6 months postoperatively by using the validated Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire. Results: seventy-six (73.8%) subjects were highly satisfied while 27 (26.2%) were less satisfied. The BMI of highly satisfied subjects was significantly lower than those less satisfied (21.3±2.2 kg/m2 vs. 27.5±1.4 kg/m2 ; p 24.5 kg/m2 , there is increase in the risk of less satisfaction by 11.1 times.

A Retrospective Cohort Study on Surgical Outcomes of Penile Prosthesis Implantation Surgery in Transgender Men After Phalloplasty

To assess surgical outcomes of penile prosthesis implantation in transgender men who underwent phalloplasty. Transgender men who underwent penile prosthesis implantation after phalloplasty between January 1989 and September 2018 were retrospectively identified. A chart study was performed recording patient demographics, perioperative complications, and reoperations. A total of 32 patients were identified: 22 underwent free radial forearm flap, 5 anterolateral thigh, 4 anterolateral thigh/free radial forearm flap, and 1 fibular flap phalloplasty. The median age at prosthesis implantation was 36 (range 21-59) years, the mean BMI 25.9 ± 4.0 kg/m2. At first implantation, 16 inflatable (AMS Dynaflex (n = 13), AMS Ambicor (n = 3)) and 16 malleable (Coloplast genesis (n = 14), AMS Spectra (n = 2)) prostheses were placed. Of these, 5 (16%) were removed/replaced because of infection, 2 (6%) because of leakage, 2 because of extrusion, 2 because of dislocation, 2 because of dysfunction, and 1 (3%) because of pain. The postoperative course was completely uneventful in 10 (31.3%) patients. Of all implanted prostheses, including revision procedures (n = 45), 21 (44%) were surgically replaced or removed. Prosthesis explantation, replacement, or revision surgery occurs frequently after penile prosthesis implantation. Patients need to be well-informed preoperatively on these complication rates.

Satisfaction rate at 1-year follow-up in patients treated with penile implants: data from the multicentre prospective registry INSIST-ED.

To investigate scores and predictors of patient satisfaction at 1 year after penile prosthesis implantation (PPI) using the validated Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire. Analyses were performed for 142 patients prospectively included in the national multicentre registry Italian Nationwide Systematic Inventarization of Surgical Treatment for Erectile Dysfunction (INSIST-ED), which provided 1-year follow-up data. Postoperative patient satisfaction was assessed using the validated QoLSPP tool. Linear logistic regression analyses assessed predictors of QoLSPP total and single domain scores, including age at surgery, erectile dysfunction aetiology, type of prosthesis, surgical approach, surgeon experience and complications. Locally weighted regression methods were used to explore the relationshipbetween surgeon experience and QoLSPP scores. Overall, high median functional, relational, social, personal and total QoLSPP scores were reported at 1 year after PPI. Patients implanted with hydraulic devices had higher functional (23 vs 21.5; P = 0.01) and total scores (68 vs 65.5; P = 0.03) than those with a malleable prosthesis. Surgeon experience emerged as the only independent predictor of higher satisfaction scores, depicting a non-linear association with both QoLSPP total and single domain scores (all P < 0.03). Data suggested that the higher the number of procedures per year, the greater the satisfaction scores, reaching a plateau after l5 procedures/year. This study reports high functional and patient satisfaction scores at 1 year after PPI surgery using a dedicated tool for the first time. Better outcomes should be expected for patients treated by surgeons with greater experience.

Life quality change after inflatable penile prosthesis implantation

Purpose It was aimed to evaluate the changes in quality of life in patients with erectile dysfunction (ED) after inflatable penile prosthesis implantation. Material and Methods Forty-one patients who underwent to an inflatable penile prosthesis implantation surgery due to ED were included in the study. The age of the patients, the indications for surgery, and the type of prosthesis implanted were recorded. All patients were implanted two-piece inflatable (AMS Ambicor™) or three-piece inflatable (AMS 700™) prostheses. A 36-item short form (SF-36) was used to assess the life quality of patients. The scores obtained from these forms were recorded and used to compare the preoperative and postoperative quality of life of the patients. Results The mean age of the patients was 59.9 (38–78) years. The mean follow-up was 25.1 (12–39) months. A three-piece inflatable penile prosthesis was implanted in 11 (26.8%) of the 41 patients and the others were implanted with a two-piece inflatable penile prosthesis. Average SF-36 scores were increased significantly after surgery in all groups. Conclusions Inflatable penile prosthesis implantation is one of the most satisfactory treatment methods of ED and our study shows that with this treatment the patients can be provided a significant improvement in life quality.

Is Hba1c level of diabetic patients associated with penile prosthesis implantation infections?

Background and objectives: Diabetes mellitus is an important risk factor for erectile dysfunction (ED). Penile prosthesis implantation surgery is the final solution for diabetic patients with ED, but infections thereof are still a serious risk factor. While some studies suggest that most infections associated with penile prosthesis implantation are associated to high glycated hemoglobin (HbA1c) levels, other research did support such relationship.Materials and methods: The current study assessed retrospectively, the association between HbA1c level and penile prosthesis surgery infection. We retrieved and reviewed the records of 300 diabetic patients who had penile prosthesis surgery at our Institution (January 2012–November 2016). Patients’ mean age was 55.26 ± 10.9 years (31% patients were <50 years of age), and mean HbA1c was 7.60 ± 1.90%.Results: Infection rate among diabetics was 0.67%. Prevalence of prosthesis infection among patients with HbA1c ≤ 9% was 0.9%, compared with 0% among patients with HbA1c > 9%. Prosthesis infection risk did not significantly increase with higher HbA1c levels, with no meaningful difference in the median or mean level of HbA1c in the infected and non-infected diabetic patients.Conclusion: Findings do not support the use of HbA1c values among diabetic patients who are candidates for penile prosthesis implantation surgery in order to identify and exclude those who might be prone to increased risk of prosthesis infections. Future studies would benefit from larger sample sizes in order to support or refute our findings.

Distinguishing Failure to Cure From Complication After Penile Prosthesis Implantation

BackgroundA successful penile prosthesis implantation (PPI) surgery can be defined by outcomes beyond the absence of complications. AimTo introduce the concept of failure to cure (FTC) in the context of PPI to more accurately gauge postoperative outcomes after PPI. MethodsConsecutive patients from our sexual function registry who underwent PPI from January 2011 to December 2013 were analyzed. Demographics, previous treatment of erectile dysfunction, comorbidities, social history, postoperative problems (POPs), and surgical outcomes were tabulated. Patients completed the International Index of Erection Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaires. We defined a complication, according to the Clavien-Dindo classification, as any deviation from the ideal postoperative course that is not inherent in the procedure and does not constitute an FTC. FTC was defined as a POP that was not a complication. The χ2 tests, t-tests, or Wilcoxon rank-sum tests were used. OutcomesPatient-reported and objective outcomes after PPI. ResultsOur enrollment consisted of 185 patients, and we contacted 124 (67%). Of these, 16 (12.9%) had a POP requiring reoperation. Eight patients developed surgical complications (three infections, four erosions, and one chronic pain). Eight patients had FTC (four malpositions and four malfunctions). Factors that correlated with POPs were previous PPI, body mass index higher than 30 kg/m2, and previous treatment with intracorporal injections (P < .05 for all comparisons). Patients who had POPs scored significantly lower on the IIEF erectile function and intercourse satisfaction domains (P < .05 for the two comparisons), but not on the orgasmic function, sexual desire, and overall satisfaction domains (P > .05 for all comparisons). Clinical ImplicationsPOPs after PPI surgery can be more accurately categorized using the Clavien-Dindo classification of surgical complications to more clearly distinguish surgical complications from FTC. Strengths and LimitationsLimitations of our study include its retrospective approach. Our series included a large proportion of patients treated for prostate cancer, which limits the generalizability of our findings. We also had a relatively short median follow-up time of 27 months. ConclusionsPatient-reported outcome assessments can vary greatly from what physicians determine to be successful PPI. An assessment of POPs encompasses more than just complication rates; it also reflects FTC. Even when POPs occur, patients can still derive satisfaction if they are correctively managed. Factors that possibly predispose to POPs include previous PPI surgery, body mass index greater than 30 kg/m2, and history of intracorporal injections.Pineda M, Burnett AL. Distinguishing Failure to Cure From Complication After Penile Prosthesis Implantation. J Sex Med 2017;14:731–737.

AB273. Challenge of AMS700CXR inflatable penile prosthesis for treating patients with severe ED in China

More than 50% of patients with erectile dysfunction (ED) showed erectile tissues pathological changes include corpus cavernous fibrosis, endothelial dysfunction, arterial and/or vein disorder, neuropathy and hormon disorder et al. Currently used on demanded treating ED therapies, include oral medication using PDE5i, intra-cavernosal injection (ICI) therapy, vacuum device et al., the clinical efficacies of reached to 70% with some kinks of adverse events, however, these therapies showed no effects on sever ED with sever pathological changes in erectile tissue. Penile prosthesis implantation (PPI) is the solution of choice in patients who have failed or present contraindication to the use of all conservative treatment for ED. We retrospectively evaluated the clinical outcome of PPI in Chinese patients with severe erectile dysfunction (SED) from July 2000 to December 2011, 224 patients, overall satisfaction with the PPI surgery was reported by 89.0% of men and 82.5% of partners, mechanical malfunction occurred in 4 cases (2.0%) and 3 cases were re-implanted new device, and 2 cases (1.0%) developed a mild curvature of the penis. Scrotal erosion with infection occurred in 1 case with diabetes mellitus (0.5%) and required complete removal of the implanted AMS 700 CXM. After 3 years no PPI device available in China, AMS 700CXR finally approved by China SDA recently, and the quality this device is improved very much compared to AMS700CXM, and the long-term mechanical reliability studies on AMS 700CXR noted that the clinical efficacy and device service of AMS 700CXR showed significantly better than that of AMS 700 CXM, which yields excellent results in terms of cosmetic and functional outcome and therefore has a significant impact on patients' satisfaction, sex life and overall quality of life. Overall, long term reliability has been significantly improved and complication rates are low in the hands of experienced surgeons.

Why Are Men Satisfied or Dissatisfied with Penile Implants? A Mixed Method Study on Satisfaction with Penile Prosthesis Implantation.

Studies have demonstrated high levels of satisfaction with penile prosthesis implantation (PPI). However, qualitative research exploring the experience of PPI through men's narratives is scarce. The main goals were to analyze (i) the level of sexual satisfaction (quantitatively), and (ii) the reasons for satisfaction and/or dissatisfaction with PPI (qualitatively). Participants were 47 men with erectile dysfunction who underwent surgery between 2003 and 2012, placed by a single surgeon. Structured telephone interviews were carried out. Satisfaction with PPI was a qualitative and quantitative measure assessed through the following four items: (i) "Would you repeat the PPI surgery?"; (ii) "Would you recommend the PPI surgery?"; (iii) "How satisfied are you with the PP?"; and (iv) "Could you explain the motives of your satisfaction/dissatisfaction?". The majority of men (79%) reported to be satisfied with PPI. Content analysis revealed four main themes for men's satisfaction with the PPI: (i) psychological factors were reported 54 times (n = 54) and included positive emotions, self-esteem, confidence, enhancement of male identity, major live change, and self-image; (ii) improvement of sexual function was reported 54 times (n = 54) and referred to achievement of vaginal penetration, increase of sexual desire, sexual satisfaction, penis size, and improvement of erectile function; (iii) relationship factors were reported 11 times (n = 11) and referred to relationship improvement and the possibility of giving pleasure to the partner; and (iv) improvement in urinary function (n = 3). The level of satisfaction with the implementation of penile prostheses is very high, therefore constituting a treatment for erectile dysfunction with a positive impact on the experience of men at sexual, psychological and relational level.

Does the etiology affect the outcome and satisfaction rates of penile prosthesis implantation surgery?

Our aim was to compare the outcomes and satisfaction rates of men undergoing penile prostheses implantation (PPI) secondary to radical prostatectomy (RP) and other causes of vasculogenic erectile dysfunction (ED). A total of 142 patients, of whom 60 underwent PPI due to ED following RP (Group 1) and 82 underwent PPI due to ED with other vasculogenic causes (Group 2) were included in this study. The preoperative erectile status was evaluated with the International Index of Erectile Function (IIEF). The satisfaction of patients and partners were evaluated by a telephone interview using Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire and Erectile Dysfunction Inventory of Treatment Satisfaction Partner Survey. Preoperative mean IIEF scores were significantly lower in Group 1 (17.5 ± 6.4 vs. 24.2 ± 5.1, p = 0.01). For Groups 1 and 2, the mean EDITS scores of the patients were 58 ± 10 and 71 ± 8, respectively, and that for the partners were 46 ± 8 and 65 ± 7, respectively. Group 1 had significantly lower scores both for the EDITS and the EDITS Partner Survey (p = 0.03, p = 0.01, respectively). Patients who had undergone RP and their partners were found to have lower satisfaction rates compared to patients with other causes of vasculogenic ED who had penile implant surgery. From this point of view, it is important to know the patient's expectations about the treatment outcomes and a preoperative psychological and sexual counseling should be managed for possible treatment alternatives after RP.

Penile prosthesis implantation in Chinese patients with severe erectile dysfunction: 10-year experience

We retrospectively evaluated the clinical outcome of penile prosthesis implantation (PPI) in Chinese patients with severe erectile dysfunction (SED). From July 2000 to December 2011, 224 patients (mean age: 35.9±11.8 years, range: 20-75 years) with SED underwent PPI by experienced surgeon according to standard PPI procedure at our centre. A malleable prosthesis (AMS 650) was implanted in 45 cases (20.1%), and a three-piece inflatable prosthesis (AMS 700 CXM or AMS 700 CXR) was implanted in 179 cases (79.9%). Surgical outcomes, including postoperative complications, clinical efficacy and couple satisfaction, were evaluated over than 6 months postoperatively using medical record abstraction, IIEF-5, quality of life (QoL) scores, and the patient/partner sexual satisfaction score proposed by Bhojwani et al. Of the 224 patients eligible for the study, 201 subjects (89.7%) completed follow-up. All of patients could perform sexual intercourse post PPI with the mean postoperative IIEF-5 and QoL scores were 20.02±2.32 and 5.28±0.76, respectively, which were significantly improved compared with the preoperative scores (6.29±1.5 and 2.13±0.84, P<0.01). Of the 201 men, mechanical malfunction occurred in four cases (2.0%) and three cases were re-implanted new device, and two cases (1.0%) developed a mild curvature of the penis. Scrotal erosion with infection occurred in one case with diabetes mellitus (0.5%) and required complete removal of the implanted AMS 700 CXM. Satisfactory sexual intercourse at least twice per month was reported by 178 men (88.6%), and overall satisfaction with the PPI surgery was reported by 89.0% of men and 82.5% of partners. Patient satisfaction in the three-piece inflatable prosthesis group was higher than in the malleable prosthesis group (P<0.05). Satisfaction, however, between the types of prostheses, did not differ in the partner survey. PPI is a safe and effective treatment option for Chinese patients with SED and experienced surgeon perform PPI according to standard PPI procedure could reduce the postoperative complications of PPI and could improve patient satisfaction ratio and QoL.

Editorial Comment

Infection is the bane of penile prosthesis implantation surgery. To eliminate the infection, removal of all of the prosthetic material is necessary. Implantation of a second device at a later date is complicated not so much by placement of the pump or fluid reservoir as it is by cylinder implantation. Infection causes varying degrees of corporeal smooth muscle death, with subsequent fibrosis. This scarring makes the penis smaller and makes cylinder implantation difficult. In some cases, the fibrosis is so pronounced that removal of corporeal fibrotic material (corporeal excavation) is necessary. 1 Montague D.K. Angermeier K.W. Corporeal excavation: new technique for penile prosthesis implantation in men with severe corporeal fibrosis. Urology. 2006; 67: 1072-1075 Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar Coated Implants and “No Touch” Surgical Technique Decreases Risk of Infection in Inflatable Penile Prosthesis Implantation to 0.46%UrologyVol. 79Issue 6PreviewTo explore whether a “no touch” enhancement to the surgical technique of inflatable penile prosthesis (IPPs) implantaion will further decrease infection rates. Full-Text PDF ReplyUrologyVol. 79Issue 6PreviewDiabetes was prevalent in our patient population, with 39% of noncoated implant patients, 37.9% of the standard technique patients, and 43% of the patients implanted with “no touch” having the disease. In our series, we had 28 infections total. Six patients (21%) had diabetes, 4 (14%) had erectile dysfunction (ED) after radical prostatectomy, 7 (25%) had hypertension as an associated condition, and 11 (39%) had other conditions. However, because the total number of infections was small, these figures lack statistical significance. Full-Text PDF

Inhibition of sympathetic neuroeffector transmission in human corpus cavernosum

What's known on the subject? and What does the study add? In the present study the mechanisms regulating EFS-evoked neurogenic contraction in the human corpus cavernosum (HCC) were investigated. Overall, our data adds to current knowledge that the NO-independent heme dependent activation of sGC and the RhoA/Rho-kinase signaling pathways play an important role in the regulation of neurogenic contractile activity in HCC tissue. To investigate the mechanisms of adrenergically mediated smooth muscle contraction in the human corpus cavernosum (HCC) using an organ bath approach. Human corpus cavernosum specimens were obtained from patients (aged 59-72 years) with erectile dysfunction (ED), undergoing penile prosthesis implantation surgery. Isolated HCC strips (1 × 1 × 6 mm) were suspended in tissue bath chambers for isometric tension recording. The effects of various drugs on neurogenic contractions evoked by electrical field stimulation (EFS) were investigated. The drugs included nitric oxide (NO) donors, phosphodiesterase 5 (PDE5) inhibitor, Rho kinase (ROCK) inhibitor, NO-independent stimulator, L-type Ca2+ channel blocker and α-receptor antagonist. Pre-incubation with the NO donor sodium nitroprusside (SNP; 10(4) M) significantly reduced the initial peak increase in tension evoked by EFS (by 71%, P < 0.05). The PDE5 inhibitor sildenafil (10(-4) M) reduced the increase in tension by 69%, while a combination of sildenafil and ROCK inhibitor, fasudil, inhibited tension by 81%. The EFS-induced contractile response at 80 Hz was decreased by 65% with fasudil and by 70% with isradipine (P < 0.001), while a combination of these drugs decreased the response by 88%. An NO-independent stimulator soluble guanylate cyclase (sGC), BAY 41-8543, significantly reduced the response (by 82%, P < 0.001) Phentolamine, an α-receptor antagonist, nearly eliminated the contractile response (98%, P < 0.001). These data suggest that neurogenic contractions are mediated by an increase in Ca(2+) influx via L-type voltage-gated Ca(2+) channels and that an increase in Ca(2+) sensitivity is mediated by the ROCK pathway and the PDE5 enzyme system as well as by the inhibitory NO/sGC/cGMP pathway. The neurogenic contractile response in HCC is mediated by several intracellular pathways, including adrenergic receptors, Ca(2+) entry, Ca(2+) sensitization and activation of the PDE5 enzyme. The Rho-kinase (ROCK) inhibitor fasudil, L-type Ca(2+) channel antagonist isradipine, and PDE5 inhibitor sildenafil, as well as a NO-independent stimulator of sGC, had similar inhibitory effects, suggesting parallel mechanisms in the HCC.

Penile prosthesis implantation surgery: a statewide population based analysis of 2354 patients.

Minimally invasive therapy for erectile dysfunction (ED) has changed the frequency of penile prosthesis surgery. The purpose of this study is to describe the changes in frequency, hospital stay, hospital charges and penile prosthesis type in North Carolina. The data source was a statewide hospital discharge database which includes data on hospitalized patients for all 151 hospitals in North Carolina. From 1988-1993, 2354 patients underwent implantation of penile prostheses. The total number of penile prostheses implanted has declined over this six year period. Similarly, hospital stay has declined from an average of 4.03-2.96 d with a 46.6% decrease in total hospital days. Despite this change in hospital stay, hospital charges rose significantly from an average of $7252.48 to $12,842.18 driving total charges from $2973,516.80 to $3,826,969.60 (1993) representing a 28.7% increase. Minimally invasive therapy and changes in reimbursement have had a major impact on the number of patients undergoing penile prosthesis implantation for ED. This downward trend may continue as more treatment options develop from the marked increase in research in this field. However, this may result in an increase of patients seeking treatment overall.