Penile Prosthetic Implantation Research Articles

Evolución clínica en los pacientes con implante de prótesis peneana

OBJECTIVES: 1). To evaluate the satisfaction and clinical outcome in patients with penile prosthesis implant as a treatment to Severe Biogenic Erectile Dysfunction. 2). To identify the most frequent complications associated with the surgical intervention. 3). To compare the behaviour of sexual satisfaction in partners and patients with penile prosthesis implant before and after the application of the treatment.METHODS: A descriptive, (longitudinal) study with quantitative and qualitative methodology was done, where 25 men with penile prosthesis implants, performed at Faustino Perez Hospital, were evaluated. RESULTS: The complications presented in the procedures were perforation of the tunica albuginea, postoperatory pain, thin penis and the expulsion of one or two cylinders, this latter case in a patient who presented periprosthetic sepsis.CONCLUSIONS: The penile prosthetic implant constitutes an option of effective treatment which achieves an 88 % of sexual satisfaction in patients.Both partners and patients treated with penile prosthetic implantation referred increase in erotism, satisfactory sexual activity, improvement of self-esteem, quality of communication with their partner, better labour results, interpersonal and social relationships and strengthening of couple’s bonds

Modified salvage for inflatable penile prosthesis revision

Although penile prosthetic implants are reliable and postoperative morbidity is low, infection related to prosthetic surgery is still a concern. Treatment of infected penile prostheses entails considerable medical and surgical costs. Various salvage approaches have been advanced in recent years, with varying rates of success. Ultimately, modified salvage with antiseptic solutions and vigorous irrigation seems to decrease the infection rate and bacterial presence during penile prosthesis revision for noninfectious reasons.

T05-P-10 Quality of life and penile implants

Introduction and objectives The functional and surgical results after penile prosthetic implants has been reported in numerous studies but only in some of them authors assessed the quality of life (QOL) comparing to the degree of satisfaction between the patient (Pts) and the partners. We reviewed our case with the objective to verify the results, the complications and particularly the degree of satisfaction of Pts and their partners through a specific questionnaire we have built. Materials and methods Between October 1996 and February 2007 we performed 96 penile implants for ED. Median pts age 51yrs. 64 pts and their partner accepted to be reavualeted completing a self-evaluation questionnaire. Results The follow-up varies from 3 to 132 months. The complications have been: 8 infections (8%) 4 malfunctions (4%), which have required revision and/or replacement of the implant. The questionnaire showed that the degree of rigidity was judged “not satisfactory” in 3 cases (4, 7%), “satisfactory” in 30 (46.9%) and “excellent” in 31 (48.4%) and the length of the penis was judged “unchanged” in 16 Pts (25%), reduced less than 1 CM IN 28 (43.7%), in 20 (31.2%) more than 1 cm. The main reason for partners's-unsatisfaction is “partner unsatisfaction”. 31 partners (48.4%) have not observed a penile length reduction, 20 (31.2%) less than 1 CM and 13 (20, 3%) more than 1 cm. The frequency of sexual intercourses modified from 1-2 in a month to 1-4 a week. The degree of satisfaction measured was more than 90% in both patients and partners. Conclusions The High rate of satisfaction found after the surgery demonstrates that penile implants is a valid solution for improving the quality of life of Pts with serious DE and their partners. With a 64 months follow-up (range 3-132 months) effectiveness was very high (> 80%) in all domains explored by the questionnaire.

T05-O-17 Penile prosthetic implants in man older than 65 years of age

Patients over 65 years of age would like to continue in enjoying sexual activity but sometimes they suffer some metabolic or vascular pathology interfering with correct erection. 868 patients, between 65 and 80 years of age, visited our centre from 1986 to 2006, complaining ED and searching a medical treatment or solution. We considered 15 patients (68-80 yrs) submitted to penile implants. All pts were married; 3 of them reported not to have sexual activity with their wives. All pts refused ICIs, Sildenafil or Vacuum Devices. Penile prostheses were proposed as the only option to restore their penetrative function and 15 pts accepted. AMS600 (5 pts), Mentor Acu Form (3 pts), AMS Hydroflex (1 pt), AMS Dynaflex (2 pts), Mentor Alpha I (2 pts), AMS 700 (2 pts) prostheses. Spinal (13 pts) and local anaesthesia (2 pts) were utilized. All patient were checked 12 months after surgery. After one year we recorded 4 deaths, not linked to prostheses or sexual intercourses. 3 pts had prostatic surgery 2-3 years after prosthetic implant. Only 2 patients reported general unsatisfaction probably due to a scarce acceptance or refusal by their wives. 13 patients reported complete satisfaction to the annual control and follow-up. Data of our experience show that the prosthetic solution can represent a valid option for patient over 65 who desire to maintain their sexual function and who do not respond or can not currently use other available pharmacological solutions.

The Role of Surgery in Sexual Medicine

From the realms of quackery, to Viagra®, inflatable penile prostheses, and stem cell research, our understanding of sexual medicine has come a long way over the years. The current status of surgical intervention in sexual medicine is presented in this lecture. Broadly, surgery in sexual medicine may be classified as under: (I) Surgery for male sexual dysfunction (II) Surgery for female sexual dysfunction (III) Gender reassignment surgery (IV) Others. Surgery for male sexual dysfunction includes vascular surgery for erectile dysfunction, penile prosthetic implantation surgery, surgery for penile curvature, Peyronie's disease, priapism, ejaculatory disorders, etc. Surgery for female sexual dysfunction includes surgery for vulvar vestibulitis, Bartholin's gland cysts, clitoral phimosis, hypertrophic Skene's glands, urethral prolapse, labiaplasty, reversal of clitoral circumcision and infibulations, and excision of benign and malignant vulvar lesions that interfere with sexual function. Gender reassignment is usually performed on adults with gender dysphorias and children with intersex disorders. The last group includes all other operations. Sexual surgery encompasses many specialties, including urology, andrology, gynecology, plastic and reconstructive surgery, pediatric surgery, etc. With the emergence of sexual medicine as a separate specialty, it is hoped that all these interventions will someday soon be possible in stand-alone sexual medicine departments, under one roof.

Infrapubic implantation of the three-piece inflatable penile prosthesis

Penile prosthetic surgery has a fascinating history. Presumably inspired by Aristotle's observation in animals of the bony os penis or baculum, prosthetic implantation of costal cartilage homograft was reported initially in 1936 and more extensively in 1943 as a reconstructive technique for wartime penile trauma. Because this biologic material rapidly succumbed to bending and reabsorption, acrylic and later polyethylene and silicone were used as intracavernosal implants in the 1950s. By the late 1960s, these rigid penile prosthetic implants generally were accepted as treatment for impotence. The technology of penile implantation was refined greatly in the 1970s with the development of semirigid rod-type implants, intraoperative sizing, and inflatable prostheses.

Guidelines for Treating Erectile Dysfunction Issued

THE AMERICAN Urological Association (AUA) released new guidelines for the treatment of organic erectile dysfunction at the World Meeting on Impotence, held in San Francisco, Calif. The new preferred name of the disorder may in part reflect the need to talk about a once-taboo subject by the millions of men (and their partners) of the "baby boom" generation. Many of these men are now facing the risk of sexual dysfunction from prostate cancer surgery and other age-related health problems. Based on an extensive medical literature review conducted during the past 6 years by its Erectile Dysfunction Clinical Guidelines Panel, the AUA is recommending 3 different therapies as effective in treating organic erectile dysfunction. The therapies include vacuum constriction devices, vasoactive drug injection therapy, and penile prosthetic implants. The panel also recommends against the use of yohimbine, a commonly prescribed drug, which in controlled studies to date does not appear to

Management of Nondilatable Cavernous Fibrosis With the Use of a Downsized Inflatable Penile Prosthesis

The basic underlying cause of inability to implant a penile prosthesis is cavernous fibrosis resulting in unsatisfactory cavernous dilation. During the last 3 years, 20 patients with severe cavernous fibrosis underwent penile prosthetic implantation with a downsized inflatable penile prosthesis, obviating the need for additional cavernous reconstruction. After a mean followup of 20 months 19 of the 20 patients had a functional device with only 1 requiring explantation for infection. We believe that this downsized penile prosthesis is a valuable addition to the urological armamentarium when considering reimplantation or implantation in a patient with intracavernous fibrosis and scarring.

Prosthetic Penile Infection: “Rescue Procedure” with Rifamycin

Penile prosthetic implantation is a successful procedure for the management of male erectile impotence. However, infection remains the most serious complication requiring removal of the device. Later reinsertion can be difficult due to fibrosis and a shortened penis. We present 3 cases of penile infection with Staphylococcus epidermidis in which a new penile prosthesis was placed after 72 hours of continuous irrigation of the corpora cavernosa with rifamycin. The procedure requires judicious selection of patients and a stable clinical status.

Risk Factors Associated with Penile Prosthesi Infection

We reviewed all 269 patients who underwent penile prosthetic implantation during the last 10 years. The data were analyzed to determine the rate of penile prosthesis infection and to determine the risk factors associated with these infections in this group. We also examined the effect of strict surgical technique, intraoperative scrub and perioperative antibiotics on these implant infections. All patients had perioperative antibiotics, an intraoperative shave and a 15-minute intraoperative skin preparation. There were 162 semirigid and 107 inflatable prostheses inserted. Mean followup was 32 months (range 2 to 123 months). Only 6 patients had an infection, with 5 prostheses being removed. All 6 patients had a history of urinary tract infection. Furthermore, all 6 patients had either a neurogenic bladder (4), diabetes (1) or an ileal conduit (1), which increased the risk of a urinary tract infection. Cultures of the infected prostheses revealed only enteric organisms. No staphylococci were cultured. We conclude that perioperative antibiotics, intraoperative shave and scrub, and strict surgical technique resulted in a low prosthesis infection rate (1.9%) in these patients. However, a group of patients still exist that despite these precautions are at risk for infection due to conditions that may predispose them to urinary tract infections.

Penile prosthetic implants: a radiographic atlas.

This article provides an atlas of penile prosthetic implants currently in use. It is believed that an understanding of the structure and mechanism of these prostheses is essential to an accurate radiologic assessment of their integrity and to the recognition of the cause in cases of malfunction.

Infectious Complications of Penile Prosthetic Implants

An infectious complication involving placement of a penile prosthesis is a disastrous event. A review of more than 300 devices placed between 1979 and 1984 at this center reveals an infectious complication rate of 8.3 per cent. Perioperative risk factors predisposing to infection included reoperation for technical failures, inadequate antibiotic coverage (specifically for Staphylococcus epidermidis), failure to perform a circumcision at the time of placement in uncircumcised patients and simultaneous placement with an artificial urinary sphincter device. No group of patients nor type of prosthesis was more susceptible to the development of a postoperative infection.

The Failed Penile Prosthetic Implantation Despite Technical Success

Successful implantation of a penile prosthesis involves more than an operation_ Psychological factors can be crucial before, during and after the operation. If these issues are not addressed the true goal of restoring the pleasure of sexual intercourse will not be achieved, regardless of the type of prosthesis used or the technical success of the procedure.

Psychological treatment of erectile disorders in diabetic patients.

Psychological and organic factors may interact in the impairment of erectile capacity. This interaction must be considered in the accurate assessment of the extent of organic defect and the choice of psychological approaches for treatment of diabetic men with erectile disorders. Psychosexual evaluation must be done to select patients for penile prosthetic implantation.