Types Of Penile Prostheses Research Articles

A narrative review on malleable and inflatable penile implants: choosing the right implant for the right patient.

A penile prosthesis/implant is an excellent option for men with erectile dysfunction refractory to medical treatment or with contraindications to medical management. In this narrative review, we discuss the different types of penile prostheses and the considerations for patient and device selection to maximize satisfaction. There are three main prosthesis types to choose from: three-piece inflatable devices, two-piece inflatable devices, and malleable/semirigid devices. The three-piece devices are the gold standard in advanced economy countries but require reservoir placement and manual dexterity, which can be limiting to some patients. The two-piece inflatable devices are a good option for patients who have standard-sized penises, lack significant penile pathology, have limited dexterity issues, or should avoid reservoir placement due to potential complications. The malleable devices are popular in countries where insurance coverage is limited but are increasingly used in advanced economy countries for length conservation in specific patient populations. Finally, not every patient needs an implant, and assessing partner sexual function is an important consideration for patient-partner satisfaction. Surgeons need to be familiar with the strengths and limitations of each device and the patient characteristics that will yield the best outcome from penile prosthesis surgery.

Does Medicaid Cover Penile Prosthesis Surgery? A State-by-State Analysis

ABSTRACT Introduction Malleable [MPP] and inflatable [IPP] penile prosthesis surgery for the management of erectile dysfunction is a reliable treatment option with high success rates and excellent patient satisfaction; however, Medicaid coverage transparency is poor leaving a knowledge gap in this population. Objective The present study seeks to assess Medicaid coverage for MPP and IPP by state as evidenced by inclusion in publicly available physician fee schedules. Methods State Medicaid websites were utilized to access public physician fee schedules. Individual search queries were performed for CPT codes 54400 and 54405 which represent insertion of MPP and IPP, respectively. Data were recorded for each device including the coverage status, physician fees, and the presence of clear documentation of a prior authorization requirement. Results Medicaid physician fee schedules were accessible for 49 out of 50 US states, and 28 states reported coverage for at least one type of penile prosthesis (Figure). Two states reported coverage for MPP only, one state reported coverage for IPP only, and 24 states reported coverage for both devices. One state reported that it did not cover either device, but listed coverage for a self-contained IPP (CPT 54401) only. Mean physician reimbursement was $477.15 (290.82–$1175.50) for MPP placement and $691.76 (421.68–$1794.27) for IPP (Table 1). Eleven states documented prior authorization requirements within their fee schedules, while the remaining 17 states did not. Criteria for approval for prior authorization were not clearly stated in any fee schedule. Conclusions Efforts to clearly document approval criteria and educate Men's Health providers on available coverage could result in a significant improvement in sexual satisfaction in the Medicaid population. Graphical representation of states offering Medicaid penile prosthetic coverage and physician reimbursement ranges are provided with comparison to Medicare rates (Figure). Limitations include heterogeneity in fee schedules, lack of prior authorization requirement details, inability to correlate to successful claims data, and the evolving nature of Medicaid coverage for the given procedures. Medicaid coverage exists for penile prosthetic surgery in 28 states, although often with significant non-transparent prior authorization criteria. Disclosure No

P0494 - Comparison of the surgical outcomes and couples’ satisfaction with the type of penile prosthesis; Malleable versus Inflatable penile prosthesis: From 157 patients with erectile dysfunction who underwent penile prosthesis implantation in single center

P0494 - Comparison of the surgical outcomes and couples’ satisfaction with the type of penile prosthesis; Malleable versus Inflatable penile prosthesis: From 157 patients with erectile dysfunction who underwent penile prosthesis implantation in single center

159 Preliminary study of a specific penile prosthesis conceived for phalloplasty, the ZSI® 475 FtM

Assessing security, feasibility and patient satisfaction of a new type of penile prosthesis specifically designed for phalloplasty. Patients were included from June 2016 to September 2017 at a single institution by a single surgeon. Medical data were collected from the patients’ hospital files. Patients were then proposed to answer a satisfaction questionnaire that included IIEF (International Index of Erectile Function) questionnaire, EDITS (Erectile Dysfunction Inventory of Treatment Satisfaction) questionnaire, SEAR (Self-Esteem and Relationship) questionnaire, and specific items. Twenty patients were included, mean age 37.9 years, and 21 prostheses were implanted. All had gender dysphoria and phalloplasty type were forearm flap (n=15, 75%), suprapubic (n=4, 20%) and pedicled inguinal (n=1, 5%). 17 patients (85%) had functional urethroplasty. Complications were 2 (10%) infections medically treated, 1 (5%) infection treated by explantation, 2 (10%) mechanical failures and 1 (5%) malposition. Mean operating time was 102.6 min (SD 13.2) and mean duration of hospitalization was 2.7 days (SD 0.5%). Fourteen patients (70%) answered the satisfaction questionnaire. Twelve (85.7%) patients had sexual relationship regularly. Mean IIEF was 20.2 over 25 (SD 7.9), mean SEAR was 84.5 over 100 (SD 9.9) and mean EDITS was 82 over 100 (SD 17.5). Thirteen patients (92.8%) were satisfied or very satisfied with the prosthesis.

Introduction to Imaging of Penile Prostheses: A Primer for the Radiologist

The purpose of this article is to provide radiologists with an introduction to the imaging appearances of various types of penile prostheses and discuss imaging pitfalls. Two major types of penile prostheses currently are in use: malleable penile prostheses and inflatable penile prostheses. Sonography is useful in the assessment of the pelvic reservoir and scrotal pump. MRI helps in the complete evaluation of all the prosthetic components, making it a "one-stop shop" imaging technique.

Trends in Penile Prosthetics: Influence of Patient Demographics, Surgeon Volume, and Hospital Volume on Type of Penile Prosthesis Inserted in New York State

IntroductionPenile prostheses (PPs) are a discrete, well-tolerated treatment option for men with medical refractory erectile dysfunction. Despite the increasing prevalence of erectile dysfunction, multiple series evaluating inpatient data have found a decrease in the frequency of PP surgery during the past decade. AimsTo investigate trends in PP surgery and factors affecting the choice of different PPs in New York State. MethodsThis study used the New York State Department of Health Statewide Planning and Research Cooperative (SPARCS) data cohort that includes longitudinal information on hospital discharges, ambulatory surgery, emergency department visits, and outpatient services. Patients older than 18 years who underwent inflatable or non-inflatable PP insertion from 2000 to 2014 were included in the study. OutcomesInfluence of patient demographics, surgeon volume, and hospital volume on type of PP inserted. ResultsSince 2000, 14,114 patients received PP surgery in New York State; 12,352 PPs (88%) were inflatable and 1,762 (12%) were non-inflatable, with facility-level variation from 0% to 100%. There was an increasing trend in the number of annual procedures performed, with rates of non-inflatable PP insertion decreasing annually (P < .01). More procedures were performed in the ambulatory setting over time (P < .01). Important predictors of device choice were insurance type, year of insertion, hospital and surgeon volume, and the presence of comorbidities. Clinical ImplicationsMajor influences in choice of PP inserted include racial and socioeconomic factors and surgeon and hospital surgical volume. Strengths and LimitationsUse of the SPARCS database, which captures inpatient and outpatient services, allows for more accurate insight into trends in contrast to inpatient sampling alone. However, SPARCS is limited to patients within New York State and the results might not be generalizable to men in other states. Also, patient preference was not accounted for in these analyses, which can play a role in PP selection. ConclusionsDuring the past 14 years, there has been an increasing trend in inflatable PP surgery for the management of erectile dysfunction. Most procedures are performed in the ambulatory setting and not previously captured by prior studies using inpatient data.Kashanian JA, Golan R, Sun T, et al. Trends in Penile Prosthetics: Influence of Patient Demographics, Surgeon Volume, and Hospital Volume on Type of Penile Prosthesis Inserted in New York State. J Sex Med 2018;15:245–250.

Usefulness of magnetic resonance imaging in the postsurgical assessment of patients with inflatable penile prostheses

ObjectiveTo describe the types of penile prostheses and their components, to review the appropriate magnetic resonance imaging (MRI) acquisition protocol, and to describe the normal imaging findings and possible complications in patients with inflatable penile implants. ConclusionThree-piece inflatable penile prostheses are the last link in the treatment chain for erectile dysfunction. They can develop complications, which are classified as non-infectious related to the surgical technique, infectious, or due to mechanical failure of the device. MRI is the most appropriate imaging technique for the postsurgical evaluation of penile prostheses. Images are acquired in three planes using sequences with high spatial resolution, first with the prosthesis at rest and then with the prosthesis activated.

Utilidad de la resonancia magnética en la valoración postquirúrgica de pacientes con prótesis hidráulica de pene

ObjectiveTo describe the types of penile prostheses and their components, to review the appropriate magnetic resonance imaging (MRI) acquisition protocol, and to describe the normal imaging findings and possible complications in patients with inflatable penile implants. ConclusionThree-piece inflatable penile prostheses are the last link in the treatment chain for erectile dysfunction. They can develop complications, which are classified as non-infectious related to the surgical technique, infectious, or due to mechanical failure of the device. MRI is the most appropriate imaging technique for the postsurgical evaluation of penile prostheses. Images are acquired in three planes using sequences with high spatial resolution, first with the prosthesis at rest and then with the prosthesis activated.

Évolution du nombre et du type de prothèses péniennes posées en France pour dysfonction érectile : analyse des données nationales de codage pour la période 2006–2013

Patients who are not responding to injectable and/or vacuum oral pharmacological treatments can receive a penile prosthesis. Three types of penile prostheses are used in France: rigid, semi-rigid and inflatable prostheses 3-piece or 2-piece. We have assessed the National surgical insertion practices between 2006and 2013 (number of prostheses insertions, types, procedure locations, number of surgeons and distribution [public or private sectors]). Data analysis from the French Technical Agency of Information on Hospitals (ATIH) (2006-2013) using the common classification of medical acts (CCAM) and after code extractions related to this surgery (JHLA002, JHLA003, JHLA004). Between 2006and 2013, the number of penile implants in France doubled (307to 633), inflatable penile prostheses with an extracavernous component remained the most frequently used (87%) (228to 552) (+142%). The use of semi-rigid prostheses declined by 26.7%. The distribution between the private and public sector was close to 1in 2013. More than half of French penile prostheses were implanted in three regions (Île-de-France, Languedoc-Roussillon, Rhône-Alpes). Nearly 62% of surgeons implanted only one or two three-compartment prostheses in 2013. The number of penile prostheses in France doubled between 2006and 2013. Three regions were particularly active as far as this surgery is concerned (Île-de-France, Languedoc-Roussillon, Rhône-Alpes). They were boosted by 5surgeons with more than 20prostheses surgeries a year. 4.

Quand la fibromyalgie n’en est pas une : douleurs neuropathiques généralisées

More than half of intraoperative complications occur during dilatation of the corpora cavernosa, a critical step in the placement of any type of penile prosthesis, which can be especially difficult in a patient with corporal fibrosis. A late manifestation of cylinder placement can be impending erosion with lateral extrusion or medial deviation (into the urethra) of the distal tips. There are many different approaches to try and fix these surgical issues.The review article evaluates the many different surgical techniques prosthetic surgeons use in the management of intraoperative complications and lateral extrusion.A review of the literature was preformed with published results being evaluated to try to help guide the management of intraoperative complications and impending distal erosion. There is a special focus on dilation of the corpora cavernosa.The article reviews and evaluates the outcomes of the landmark papers in the management of intraoperative complications and impending distal erosion.Intraoperative complications of penile implant placement can be distressing for the prosthetic surgeon, but with proper recognition, most of these complications can be navigated with excellent postoperative results.This review article summarizes many of the techniques, outcomes, and new developments in the complicated field of penile prosthetic surgery to help guide the implanting surgeon. Henry GD and Laborde E. A review of surgical techniques for impending distal erosion and intraoperative penile implant complications: Part 2 of a three‐part review series on penile prosthetic surgery. J Sex Med 2012;9:927–936.

A Review of Surgical Techniques for Impending Distal Erosion and Intraoperative Penile Implant Complications: Part 2 of a Three‐part Review Series on Penile Prosthetic Surgery

More than half of intraoperative complications occur during dilatation of the corpora cavernosa, a critical step in the placement of any type of penile prosthesis, which can be especially difficult in a patient with corporal fibrosis. A late manifestation of cylinder placement can be impending erosion with lateral extrusion or medial deviation (into the urethra) of the distal tips. There are many different approaches to try and fix these surgical issues. The review article evaluates the many different surgical techniques prosthetic surgeons use in the management of intraoperative complications and lateral extrusion. A review of the literature was preformed with published results being evaluated to try to help guide the management of intraoperative complications and impending distal erosion. There is a special focus on dilation of the corpora cavernosa. The article reviews and evaluates the outcomes of the landmark papers in the management of intraoperative complications and impending distal erosion. Intraoperative complications of penile implant placement can be distressing for the prosthetic surgeon, but with proper recognition, most of these complications can be navigated with excellent postoperative results. This review article summarizes many of the techniques, outcomes, and new developments in the complicated field of penile prosthetic surgery to help guide the implanting surgeon.

Experience with the Jonas penile prosthesis in the treatment of impotence.

The penile prosthesis has become established as a mode of therapy for organic and chronic psychogenic impotence. The Jonas type of penile prosthesis has been implanted into 10 patients and has achieved both functional success and excellent acceptance by the partner. Mechanical and pathological complications have a very low incidence. This penile prosthesis should be made available to carefully selected impotent patients who are deemed psychologically suitable candidates and in whom medical treatment has failed or is not indicated. It represents an important advance in the treatment of the male with erectile impotence.

Management of intraoperative penile implant complications

The three-piece inflatable penile prosthesis has the highest patient satisfaction and lowest mechanical revision rate of any medically implanted device. Revisions of inflatable penile prostheses are more often required for nonmechanical reasons than for device failure. Intraoperative complications of penile implant placement can be distressing for the prosthetic surgeon, but with recognition of the dilemma, most of these complications can be navigated with excellent postoperative results. More than half of these intraoperative complications occur during dilatation of the corpora cavernosa. Dilation of the corpora cavernosa is a critical step in the placement of any type of penile prosthesis and can be especially difficult in a patient with corporal fibrosis. This review article summarizes the techniques, outcomes, and new developments in the field of complicated penile prosthetic surgery.

A SURVEY OF PATIENTS WITH INFLATABLE PENILE PROSTHESES FOR SATISFACTION

We assessed patient satisfaction with 3 types of penile prostheses, namely the AMS 700 Series(R), Mentor Alpha 1(R) and Mentor Alpha NB(R). The subjects consisted of 330 patients selected by stratified, systematic random sampling from among 1,298 subjects undergoing virgin 3-piece inflatable penile implant surgeries performed by the same surgical team at 1 hospital between January 1992 and December 1998. Data were collected by computer assisted telephone interviewing with a survey developed by the authors. The survey consisted of 37 questions in 7 sections, including 1 demographic section and 6 patient satisfaction sections. Of the 330 patients selected 248 (75%) could be contacted. Of these, 199 (80%) responded to the full survey and the remaining 49 (20%) agreed to respond only to the question, "How satisfied are you with the prosthesis?" Of the 199 full responders 12 (6%) had AMS implants and 187 (94%) had Mentor implants. Of the 49 single question responders 5 (10%) had AMS implants and 44 (90%) had Mentor implants. Of the 248 patients the overall satisfaction rate was 69%. Although there was no significant difference at the 5% level in patient satisfaction by implant type, responses tended to favor the Alpha IPPs in terms of overall sexual satisfaction (p =0.058), natural feeling of the prosthesis (p =0.061), flaccid appearance of the penis when deflated (p =0.054), and education with demonstration of inflation and deflation (p =0.075). There was a high degree of overall patient satisfaction across implant types.

Current status of penile prosthesis implantation.

Today most men with erectile dysfunction (ED) can be effectively treated with less invasive means than penile prosthesis implantation. Nevertheless, there remain men who do not respond to simple treatments such as systemic medication and who either do not respond to or reject intermediate treatment such as penile injection therapy. For these men, penile prosthesis implantation remains a reasonable option. This review discusses types of penile prostheses, how to choose among prosthesis types, key features of implant techniques, infection management, penile reconstruction related to prosthesis implantation, and patient and partner satisfaction.

Surgical Complications Related to Insertion of Penile Prostheses with Emphasis on Infection and Cost

We initiated a prospective study of penile prosthesis implant surgery to evaluate risk factors for infection and other complications. Twenty-one patients admitted for surgery or related complications were evaluated over a seven-month period. The two types of penile prostheses implanted were (1) inflatable and (2) semirigid. Nine of 21 patients (43%) developed postoperative complications. Although cephapirin and gentamicin were given prophylactically, four of nine patients had four wound infections and one case of pneumonia. One case of Bacteroides fragilis bacteremia was due to stool incontinency during surgery. In two of the wound infections, removal and reinsertion of the prosthesis was necessary. Other complications included hypotension during surgery, prosthesis malfunction and malposition, and urethral tears. There were no significant associations between infection and age, length of surgery, or type of prosthesis used. These complications contributed to prolonged hospital stay and readmission (87 extra days for the infected patients at a cost of $44,000). Antibiotic costs to treat the infections totaled $1,900. Prospective evaluation by infection control practitioners of various elective surgeries can be useful in quantitating the complication rate and targeting patients at risk, with the goal of minimizing hospital costs. [Infect Control Hosp Epidemiol 1988;

Surgical complications related to insertion of penile prostheses with emphasis on infection and cost.

We initiated a prospective study of penile prosthesis implant surgery to evaluate risk factors for infection and other complications. Twenty-one patients admitted for surgery or related complications were evaluated over a seven-month period. The two types of penile prostheses implanted were (1) inflatable and (2) semi-rigid. Nine of 21 patients (43%) developed postoperative complications. Although cephapirin and gentamicin were given prophylactically, four of nine patients had four wound infections and one case of pneumonia. One case of Bacteroides fragilis bacteremia was due to stool incontinency during surgery. In two of the wound infections, removal and reinsertion of the prosthesis was necessary. Other complications included hypotension during surgery, prosthesis malfunction and malposition, and urethral tears. There were no significant associations between infection and age, length of surgery, or type of prosthesis used. These complications contributed to prolonged hospital stay and readmission (87 extra days for the infected patients at a cost of $44,000). Antibiotic costs to treat the infections totaled $1,900. Prospective evaluation by infection control practitioners of various elective surgeries can be useful in quantitating the complication rate and targeting patients at risk, with the goal of minimizing hospital costs.

Surgical Complications Related to Insertion of Penile Prostheses with Emphasis on Infection and Cost

We initiated a prospective study of penile prosthesis implant surgery to evaluate risk factors for infection and other complications. Twenty-one patients admitted for surgery or related complications were evaluated over a seven-month period. The two types of penile prostheses implanted were (1) inflatable and (2) semirigid. Nine of 21 patients (43%) developed postoperative complications. Although cephapirin and gentamicin were given prophylactically, four of nine patients had four wound infections and one case of pneumonia. One case of Bacteroides fragilis bacteremia was due to stool incontinency during surgery. In two of the wound infections, removal and reinsertion of the prosthesis was necessary. Other complications included hypotension during surgery, prosthesis malfunction and malposition, and urethral tears. There were no significant associations between infection and age, length of surgery, or type of prosthesis used. These complications contributed to prolonged hospital stay and readmission (87 extra days for the infected patients at a cost of 1,900. Prospective evaluation by infection control practitioners of various elective surgeries can be useful in quantitating the complication rate and targeting patients at risk, with the goal of minimizing hospital costs.

Treatment of impotence. 2. Surgical methods.

Most patients with an organic or physical cause of their impotence can be helped, because noninvasive diagnostic testing to identify the disorder and specialized surgical techniques to repair it are available. Occlusion or leakage of the blood supply to the penis is treated with graft bypass, endarterectomy, transluminal balloon angioplasty, or vein ligation. Patients with persistent Peyronie's disease may require plaque excision and graft placement, and sometimes, a penile prosthesis. Different types of penile prostheses have been used successfully.

Mentor inflatable penile prosthesis: A reliable mechanical device

Forty-six patients have undergone implantation of a penile prosthesis using the Mentor inflatable device. All patients are at least six months postimplantation, with the average follow-up being twenty-one months. Six patients have required reoperation due to technical problems, but there have been no mechanical failures. This low mechanical failure rate greatly enhances the attractiveness of this type of penile prosthesis when comparing it with the semirigid devices.