Penile prosthesis – a viable solution for erectile dysfunction refractory to conservative therapy

Erectile Function and Sexual Satisfaction Before and After Penile Prosthesis Implantation in Radical Prostatectomy Patients: A Comparison with Patients with Vasculogenic Erectile Dysfunction

AUA-recommended Antibiotic Prophylaxis for Primary Penile Implantation Results in a Higher, Not Lower, Risk for Postoperative Infection: A Multicenter Analysis.

Background Erectile Dysfunction is defined as the inability to achieve and maintain an erection sufficient for satisfactory sexual performance. Erectile dysfunction (ED) is a common disorder that affects at least 50% of males aged 50–70 years according to EAU Guidelines on male sexual dysfunction. Many therapeutic modalities have been implemented for the treatment of ED, including. Psychosexual therapy, PDE5i, intracavernous injection, external vacuum device, and finally penile prosthesis implantation after failure of the previous line of treatment. Penile prosthesis implantation is considered to be a satisfactory treatment of ED. To describe and evaluate the current evidence regarding the assessment of patient and partner satisfaction after semirigid penile prosthesis implant in our center. Methods This study included 20 patients with erectile dysfunction non-responding to PDE5-i and other medical treatment methods for erectile dysfunction and planning for penile prosthesis. This study was done from 1.1.2024 to 1.7.2024 in Znata hospital. Inclusion criteria: patient diagnosed with erectile dysfunction. Exclusion criteria: Peyronie’s disease, prostatitis, prostate cancer, BPH, and uncontrolled diabetic profile. Assessment of all cases was done by complete history and clinical examination of all cases and complete blood profile and renal profile, endocrine profile, and diabetic patients. Penile duplex ultrasound was done for all cases in our center. All cases were inserted semirigid penile prosthesis; the Tactra Boston Scientific type was done by M.A. and T.A. Results 20 CASES had successful of a penile prosthesis was inserted Satisfaction rate was observed by the Erectile Dysfunction Inventory of Treatment Satisfaction score and the International Index of Erectile Function score. The satisfaction rate is about 80% of the patient and partner. Complications in some cases, like hematoma, wound infection. Controlled by close observation and covered antibiotic. Conclusion Semirigid penile prosthesis Tactra Boston Scientific is an effective approach in the treatment of erectile dysfunction with underlying comorbidity, with an acceptable rate of postoperative complications. and was a high satisfaction rate for patients and partners, with improvement of quality of life.

Penile Prosthesis Implantation in Patients With Peyronie's Disease: Results of the PROPPER Study Demonstrates a Decrease in Patient-Reported Depression

Objectives Erectile dysfunction (ED) is traditionally viewed as a condition affecting older men, with insertion of a penile prostheses (PP) reserved for refractory cases. However, there has been a notable increase in the incidence of ED amongst younger males, leading to an increased need for PPs in men aged 35 yrs and younger. Methods Between August 2007 and February 2024, all patients aged 35 yrs and younger undergoing virgin implantation of a PP were collected. Patients undergoing PP implantation secondary to phalloplasty were excluded. Results A total of 56 men aged 35 yrs or younger received a PP, with a mean age of 29 yrs (±4 yrs, range 18-35 yrs). Indications for implantation included priapism (19/56, 33.9%), psychogenic ED (17/56, 30.4%), and vasculogenic or neurogenic ED (20/56, 35.7%). Notably, 17 patients (30.4%) reported lifelong ED, having never experienced a spontaneous erection suitable for penetration. Among the 17 patients with psychogenic ED, 64.7% (11/17) had previously engaged with clinical psychology, and 58.8% (10/17) had received a formal psychiatric diagnosis. A malleable prosthesis was implanted in 17 patients (30.4%), while 39 (69.6%) received a three-piece inflatable prosthesis. Overall, 75% (42/56) of patients expressed satisfaction with their prosthesis, with dissatisfaction primarily attributed to perceived short length. Patient satisfaction in the inflatable prosthesis group (33/39, 84.6%) was higher than in the malleable prosthesis group (9/17, 52.9%). The revision rate at five years was 32.1% (18/56), with 33.3% (6/18) of these patients undergoing conversion from a malleable to an inflatable prosthesis. There was only 1 (1.8%) case of implant infection which necessitated removal and subsequent delayed re-implantation. Conclusions This case series highlights the growing prevalence of treatment-resistant ED in men aged 35 yrs and younger requiring PP insertion. Our findings indicate that a substantial proportion of these cases are psychogenic in nature, emphasising the need for comprehensive psychological evaluation prior to surgical intervention. The high satisfaction rates among patients with inflatable prostheses suggest that, despite the challenges posed by younger patients, effective outcomes can be achieved with appropriate selection and management. Conflicts of Interest Nil to declare.

Risk of Infection With an Antibiotic Coated Penile Prosthesis at Device Replacement for Mechanical Failure

The treatment of erectile dysfunction (ED) using penile prosthesis implantation (PPI) has recently garnered significant interest, but reports of bibliometric analyses of studies on PPI have yet to appear. Therefore, the purpose of this study is to use visualization techniques to statistically and qualitatively assess the state of knowledge, current research topics, and trends in this field. The Science Citation Index-Expanded (SCI-E) from the Web of Science Core Collection (WoSCC) was searched for publications about PPI from the inception of the database to 2023. VOSviewer (version 1.6.19), CiteSpace (version 6.2. R2), and Excel (version 2021) were used for the data analysis. The results show a total of 1015 original articles and reviews on PPI published over this nearly 50 years, with an increasing trend in the number of studies published each year. The United States is the country with the most published studies (n = 578). Mayo Clinic is the organization with the most publications overall (n = 46). The Journal of Sexual Medicine has the most publications (n = 184). The most prolific author is Wilson, Steven K (n = 31). The most commonly used terms were erectile dysfunction (n = 509), penile prosthesis (n = 332), implantation (n = 207), satisfaction (n = 201), surgery (n = 200), infection (n = 134), outcomes (n = 128), Peyronie's disease (n = 121), men (n = 115), and experience (n = 109). Current research focuses on four main areas: complications of PPI, the current status of inflatable penile prosthesis (IPP), the use of PPI in radical prostatectomy and Peyronie's disease populations, and patient satisfaction after PPI. Improving patient satisfaction with PPI through improved mechanical design and surgical techniques is a key concern for future research.

Despite significant scientific advances in the modern three-piece inflatable penile prosthesis implant surgery, it is not without surgical risks and can carry additional cosmetic and psychosocial consequences in poorly selected and consented individuals. To address this problem, an international group of key opinion leaders and high-volume prosthetic surgeons reviewed the current guidelines and clinical evidence, discussed their experiences, and formed a consensus regarding inflatable penile prosthesis surgery. The findings of this consensus panel were presented at the 17th biennial Asia Pacific Society of Sexual Medicine scientific meeting. The experts concluded that proper patient selection, informed consent and strict adherence to safe surgical principles are important to optimize clinical outcomes. Furthermore, most intraoperative complications, if recognized, can be addressed intraoperatively to enable placement of the device at the time of initial surgery. Men with significant corporal fibrosis due to Peyronie's disease, prior prosthesis explantation and priapism, and men who have undergone construction of a neophallus, as well as men who receive concurrent continence surgery, are complex cases requiring additional care and advanced techniques to obtain optimal surgical outcomes. Variability in patient care - in terms of postoperative antibiotic use, pain management, scrotal care, and cycling of the penile prosthesis implant - must be reduced to enable optimization and assessment of outcomes across patient groups.

Penile Surgery for ED, Urologists and Sexologists

MP76-04 EVALUATION OF PENILE PROSTHESIS IMPLANTATION IN OLDER ADULTS WITH BLADDER CANCER AFTER RADICAL CYSTECTOMY

Erectile dysfunction (ED) is a major quality-of-life disorder that affects greater than 30 million American men each year. Since the introduction of Viagra, more and more men are presenting with ED that is not responding to oral or local therapies. Penile prosthesis implantation is recognized as the most effective, although most invasive, ED therapy with a high satisfaction rate. With an aging population both aware of and requesting therapy for ED, the number of penile prosthesis implantations will remain stable, especially at centers specializing in ED treatment. Therefore, a better understanding of the techniques used for placement of the penile prosthesis is necessary. The following review will discuss the techniques and a few clinical pearls in the placements of inflatable penile prostheses.

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

BackgroundProstate cancer, a prevalent malignancy in men, often results in erectile dysfunction (ED), particularly following treatments like radical prostatectomy (RP) and radiotherapy, significantly affecting quality of life. Managing ED in prostate cancer survivors is critical. Inflatable penile prosthesis (IPP) implantation is a well‐established treatment for ED, yet the literature on satisfaction rates for patients with a history of androgen deprivation therapy (ADT) remains sparse. We aimed to investigate the impact of ADT on satisfaction rates in patients undergoing IPP implantation following RP or radiation therapy (XRT).MethodsA retrospective review of 529 patient charts identified 96 eligible patients who underwent IPP implantation post‐prostate cancer treatment and completed the 11‐item Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. Patients were stratified into two groups based on ADT status, and their satisfaction scores were compared. Effect sizes were used to assess clinical relevance alongside statistical significance (p = 0.0344).ResultsPatients receiving ADT had significantly lower EDITS scores (p = 0.0344) compared to those not on ADT. RP patients reported higher satisfaction post‐IPP compared to XRT patients, even after controlling for ADT. Additionally, coronary artery disease (CAD) was associated with lower satisfaction scores.ConclusionADT significantly lowers patient satisfaction post‐IPP, with RP patients generally reporting higher satisfaction than XRT patients. These findings highlight the importance of counseling prostate cancer patients on ADT's impact on long‐term sexual satisfaction and suggest areas for further research to enhance outcomes.

<b>PURPOSE: </b> The purpose of this review was to examine the role of penile prosthesis implantation in the era of multiple treatment options for erectile dysfunction (ED). <b> METHODOLOGY: </b> A literature search was performed to identify reports of three-piece inflatable penile prosthesis survival, free of mechanical failure in which results were given as Kaplan-Meier projections. Patient and partner satisfaction articles were also identified and reviewed. <b> CONCLUSIONS: </b> With multiple treatment options for ED, the percentage of men going on to penile prosthesis implantation is decreasing. However, because of the attractiveness of new treatment options and increased public awareness, more men with ED are presenting today for treatment. Penile prosthesis implantation is the only option which is applicable to nearly every man with ED and thus penile prosthesis implantation continues to play an important role in the management of ED. Patient and partner satisfaction with penile prosthesis implantation, particularly with three-piece inflatable devices, is higher than for any other treatment option.

Dorsal Penile Nerve Block Prior to Inflatable Penile Prosthesis Placement: A Randomized, Placebo‐Controlled Trial