Risk factors for penile prosthetic infection

OBJECTIVES: To determine the risk factors for penile prosthesis infection. METHODS: The records of 135 penile prosthesis implantation in 127 patients were reviewed. Of the 135 prothesis, 115 were malleable, 12 were self-contained and 8 were inflatable. Of these procedures, 111 were primary, 9 were primary with reconstructions and 15 were secondary. Mean follow-up was 47 months (minimum 6 months). All of the reconstructions were penile plications or plaque excisions for Peyronie's disease. RESULTS: The ratio of penile prosthesis infection was 8.89%. Secondary implantation, paraplegia, non-controlled diabetes mellitus (p < 0.001) and surgeon's inexperience (p < 0.05) were detected as the risk factors for penile prosthesis infection. But age, smoking, alcohol consumption, obesity, atherosclerosis, presence of diabetes mellitus (DM), history of penile surgery, simple penile reconstruction, type of the erectile dysfunction (ED), type of the penile prostheses and incision and were not found as the risk factors (p > 0.05). CONCLUSIONS: Paraplegie, non-controlled diabetes mellitus, secondary implantation and surgeon's inexperience appear to be the risk factors for penile prosthesis infection. In secondary implantation, longer operation time is detected as a factor increasing the risk of penile prosthesis infection. For these patients, careful preoperative preparation, more attention to perioperative antisepsis and postoperative follow-up are required. Since it has been determined that surgical experiences decrease the complication rate, these patients should be operated by experienced surgeons.     

原发动脉性阴茎勃起功能障碍1例报告及文献复习

目的: 探讨阴茎动脉畸形与原发动脉性勃起功能障碍(ED)的关系,提高对原发动脉性ED的认识与诊治水平。　方法: 报告 1例原发动脉性ED患者诊治资料。　结果: 动脉血管造影提示阴茎背动脉直径较细,而双侧阴茎海绵体动脉缺如。行阴茎三件套假体植入术,术后患者可正常勃起。　结论: 原发动脉性ED临床少见,应提高对原发动脉性ED的认识,明确诊断和治疗手段。     

Penile prosthesis implantation

The development of effective systemic therapy for the treatment of erectile dysfunction has resulted in a significant increase in the number of men presenting for treatment. Not all men with erectile dysfunction will respond to systemic therapy; those who fail may be candidates for penile prosthesis implantation if second and third lines of treatment also fail or are rejected by the patient and his partner. Penile prosthesis implantation continues to play a role in the treatment of erectile dysfunction. There is a potential for the number of penile prosthesis implantation procedures to actually increase. The ideal penile prosthesis is a three-piece inflatable device that permits good penile flaccidity and increases in size and becomes rigid with inflation.     

Penile prosthesis infection: approaches to prevention and treatment

Epidemiologic studies have estimated that more than 50% of men ages 40 to 70 have some form of erectile dysfunction. Penile prosthesis implantation remains a mainstay for treatment of erectile dysfunction unresponsive to other less-invasive methods. Improvements in penile prosthesis design have extended the long-term survival of implants. As the improved design of prostheses has led to their increased mechanical survival, other complications, such as infection, have emerged as the leading causes of implant failure. This article focuses on approaches to prevention and treatment of penile prosthesis infection.     

Penile prosthesis implantation in the era of medical treatment for erectile dysfunction

Penile prosthesis implantation, the oldest of the modern treatments for erectile dysfunction (ED), still plays an important role despite the advent of less invasive alternatives. For some men with ED, penile prosthesis implantation is the only effective or acceptable treatment. Penile prosthesis implantation remains a viable option in the contemporary management of ED as evidenced by annual penile prosthesis implantation cases in the United States rising from 17,540 in 2000 to 22,420 in 2009. Improvements in prosthesis design and implantation techniques have resulted in significant increases in device survival and patient satisfaction.     

Sexual experiences between partners after penile prosthesis: Who is more satisfied?

Penile prosthesis implantation (PPI) is the final stage treatment in erectile dysfunction (ED). In this study, we planned to investigate the effect of PPI application on sexual functionality in the patients and their partners. After taking permission and consent for the study, from 20 male patients who were applied penile prosthesis due to ED between March 2013 and June 2018 and their partners, the couples were included in the study. Patients and partners filled in Arizona Sexual Experiences Scale (ASEX) form before PPI. After starting to use prosthesis, 20 patients and 19 partners were asked to fill in modified EDITS and ASEX form in the follow-ups in the sixth month. Average age was 54.35 years for the patients and 43.84 for the partners. Although post-PPI sexual satisfaction ratio was detected higher in female partners compared with the male patients, this difference was not statistically significant (p = .71). A significant recovery was also observed in total scale score, physiological stimulation, orgasm capacity and satisfaction scores in both groups after PPI. Penile prosthesis implantation is an operation providing high satisfaction for both the partner and the patient and is still one of the best options of ED.     

10 years of experience with penile prosthesis implantation in Taiwanese patients

PURPOSE: We evaluated the long-term results of penile prosthesis implantation during the last 10 years. Special considerations were examined concerning Asian corporeal diameter, device survival and sociocultural factors influencing patient-partner satisfaction. MATERIALS AND METHODS: We followed 331 patients who underwent penile prosthesis implantation from December 1985 to May 1996. Surgical data, postoperative complications and information from a survey on satisfaction are reported. RESULTS: The most prevalent corporeal diameter in our patients was 11.0 to 11.5 cm. Postoperatively wound infection was the most serious surgical complication. The 5-year device survival was similar in the malleable and inflatable types except for a poorer outcome with the self-contained inflatable Hydroflex penile prosthesis. Overall patient satisfaction with surgery was 86.6%. CONCLUSIONS: Penile prosthesis implantation still has its place as definitive therapy in some patients with uncorrectable erectile dysfunction. In Taiwanese society more consideration of prosthesis selection, surgical preparation and patient-partner counseling is the basis for further success in the future.     

Penile prosthesis implantation and tunica albuginea incision without grafting in the treatment of Peyronie's disease with erectile dysfunction

We evaluated penile prosthesis implantation with tunica albuginea-relaxing incisions without grafting in the treatment of Peyronie''s disease associated with erectile dysfunction. Between April 2005 and June 2011, 62 patients underwent surgery due to severe Peyronie''s disease associated with erectile dysfunction. Malleable and inflatable penile prostheses were inserted in 49 and 13 cases, respectively. Penile prostheses were inserted into the corpora cavernosa using the standard ventral approach. After lifting the neurovascular bundle, the tunica albuginea was incised and opened at the plaque region to correct the deformities and to lengthen the penis. Subsequently, the wide neurovascular bundle was replaced, and all incisions of the tunica albuginea were covered to prevent corporal grafting. In the median follow-up of 35 months (range 14–82 months), the penis was completely straightened in 59 (95%) patients. Numbness of the glans, which the patients found initially upsetting, decreased or disappeared spontaneously 3–6 months later. Penile prosthesis implantation with tunica albuginea incisions is a viable alternative in the treatment of Peyronie''s disease because the extensive dissection of the neurovascular bundle allows a good approach to the plaque and provides excellent covering of the incised tunica albuginea without additional grafting.     

Evaluación de las expectativas preoperatorias y postoperatorias del candidato a prótesis peneana. Estudios de satisfacción

Penile prosthesis implantation is a good option for the treatment of refractory erectile dysfunction. However, the patient's expectations, among other factors, condition his satisfaction after surgery. This review article aims to present the scientific evidence available concerning patient satisfaction with penile prosthesis surgery.     

Increasing size with penile implants

Penile prosthesis implantation is suitable treatment for men with erectile dysfunction when nonsurgical treatment options fail or are otherwise unsatisfactory. Three-piece inflatable penile prostheses closely approach the ideal of producing normal penile flaccidity and erection. Nevertheless, even in men with normal corpora cavernosa, many report their prosthetic erection is shorter than their former natural erection. This is due to the lack of glans tumescence and the use of penile cylinders, which only expand in girth. Using girth-and length-expanding cylinders can decrease the loss of penile length frequently seen with prosthesis implantation. Some penile prosthesis recipients have abnormal corpora following radical prostatectomy or after removal of an infected penile prosthesis, or as the result of Peyronie’s disease, obesity, or ischemic priapism. In these men with abnormal corpora, associated penile-lengthening procedures can be combined with penile prosthesis implantation. However, experience is limited with these combined procedures.     

Penile prosthesis implantation: past, present and future

Penile prosthesis implantation is the oldest effective treatment for erectile dysfunction. This review examines the past, present and future of penile prosthesis implantation. Advances in prosthetic design and implantation techniques have resulted today in devices that produce nearly normal flaccid and erect states, and have remarkable freedom from mechanical failure. The future of prosthetic design holds promises for even more improvements.     

Penile prosthesis implant: when,what and how

Penile prosthetic surgery represents a valid option in the treatment of different penile diseases. There are several types of prostheses and we have witnessed remarkable developments since their commercialisation in the 1970s. Penile prostheses can be semi-rigid or inflatable. Semi-rigid prostheses can be malleable and mechanical, while inflatable prostheses may have two or three components.A penile prosthesis implant is recognised as a valid approach for treating those cases of erectile dysfunction (ED) where pharmacological agents have not proved useful. This treatment is also indicated in cases of penile fibrosis, priapism, Peyronie's disease and in phalloplasty for sex reassignment or demolition surgery.The implantation of a penile prosthesis is characterised by the relative ease of the surgical technique and by the speed of the procedure. The incision is usually performed at a penoscrotal or infrapubic level for inflatable prostheses, while semi-rigid cylinders are placed through a subcoronal or penoscrotal incision. The procedure is performed by a corporotomy of both sides and the subsequent insertion of the cylinders. The pump is inserted in the scrotum. If the procedure includes the insertion of a three piece prosthesis, then the reservoir is located in the Retzius space and then filled with 65 ml or 100 ml saline solution depending on its size. At the end of the procedure the surgeon inserts a drain in the scrotum, the wound is closed and the device is tested.The first month following surgery can be characterised by variable pain and oedema with spontaneous resolution in most cases. Several complications may occur including mechanical complications, infections and erosion of the cylinders.Penile prosthesis implants represent a valid and safe therapeutic option for achieving satisfactory sexual intercourse in those patients where other approaches have failed. Recent literature has shown that couples’ satisfaction with the use of a prosthesis can reach 97%.     

Visión global de las guías clínicas en cirugía de la disfunción eréctil: EUA-AUA

IntroductionThe implantation of a penile prosthesis is considered a third-line treatment and is indicated in patients who do not respond adequately to pharmacotherapy or require definitive treatment. Currently, the most used devices are 3-component penile prostheses, which presently account for more than 90% of the implants used.Material and methodsWe reviewed the evidence and the recommendations of the clinical practice guidelines regarding surgery in patients with erectile dysfunction.ResultsThe recommendations of the clinical practice guidelines on surgery in patients with erectile dysfunction are summarized as follows: men with erectile dysfunction should be informed about the option of penile prosthesis implant treatment, commenting on the benefits, risks and consequences; men with erectile dysfunction who have agreed to receive penile prosthesis should be advised on post-surgical expectations; penile prosthesis implants should not be performed in patients with systemic, cutaneous or urinary tract infection; in young men with erectile dysfunction and focal penile or pelvic arterial obstruction who do not have generalized vascular disease or veno-occlusive dysfunction, penile arterial reconstruction can be considered; in men with erectile dysfunction, penile venous surgery is not recommended.ConclusionsThe use of penile prostheses offers high satisfaction rates to both the patient and his partner. However, it is crucial to adequately inform and warn patients about possible complications and consequences.     

Platelet Indices as a marker for early prediction of erectile dysfunction in diabetic patients

Erectile dysfunction is one of the major concerns in diabetic patients. Platelet Indices including mean platelet volume, platelet count and platelet distribution width are important biomarkers for platelet activation and pathophysiology of atherothrombosis. Measurement of Platelet Indices may early predict erectile dysfunction in diabetic men. This study aimed to measure Platelet Indices in diabetic patients with erectile dysfunction and to correlate between them and erectile dysfunction especially of vasculogenic type. The study included 30 diabetic patients with diagnosed erectile dysfunction and 20 normal males as a control. Each patient was evaluated by history, International Index of Erectile Function‐5, general and local examination, HbA1c, pharmaco‐penile duplex ultrasonography and blood sample to measure Platelet Indices. Platelet distribution width and mean platelet volume were significantly higher in patients than controls (p < 0.001). Their levels were significantly higher in vasculogenic erectile dysfunction than other types (p < 0.001). No statistically significant association regards the platelet count (p > 0.05). We concluded that Platelet Indices are high in diabetic patients with erectile dysfunction especially those with vasculogenic aetiology. They can predict erectile dysfunction in diabetic men early, and so they may be considered as cheap, available and useful biomarker for early diagnosis of vasculogenic erectile dysfunction in diabetic patients.     

三件套可控性阴茎假体植入术治疗器质性勃起障碍

目的观察三件套可控性阴茎假体植入术治疗器质性阴茎勃起障碍(ED)的疗效、安全性及可靠性。方法我科自1999年3月~2003年10月起使用国产/进口可控性阴茎假体对7例器质性ED患者进行假体植入治疗,并对其进行随访观察。结果7例器质性ED假体植入患者术后1周内均有不同程度的阴茎疼痛,其中1例因长期焦虑症状和阴茎勃起疼痛取出假体;其余假体目前使用情况良好。结论可控性阴茎假体植入术治疗器质性ED有效、安全、疗效可靠。良好的医患沟通,严格掌握手术适应证,正确仔细术中操作,正确及时假体使用指导是手术成功有效的保证。     

Implante de prótesis peneana: indicaciones y abordaje penoescrotal

Inflatable penile prosthesis was developed in 1973 as a definitive treatment for erectile dysfunction. Since then these prosthetic devices underwent huge modifications, and scientific and technologic advances were accomplished, improving reliability, longevity and the surgical outcomes. Surgical implantation of a penile prosthesis may be considered in patients with erectile dysfunction who do not respond to pharmacotherapy or who prefer a permanent solution to their problem. According to the 2019 EAU Guidelines, regardless of the indication, prosthesis implantation has one of the highest satisfaction rates (92-100% in patients and 91-95% in partners) among the treatment options for erectile dysfunction based on appropriate consultation. The penoscrotal handling is the most common approach accounting for >80% of inflatable penile prosthesis placed worldwide. Most frequent complaints and dissatisfaction with inflatable penile prosthesis are related to technical issues or poor surgical outcomes such as the final length of the penis. There is an urgent need to improve the patient awareness in inflatable penile prosthesis in the preoperative arena, including the high expectation management, and an effort to select the proper patients for definitive treatment.     

Efficacy, safety and patient satisfaction outcomes of the AMS 700CX inflatable penile prosthesis: results of a long-term multicenter study. AMS 700CX Study Group

PURPOSE: We performed a long-term multicenter study of the AMS 700CX 3-piece inflatable penile prosthesis, focusing on longevity, morbidity and patient satisfaction in men implanted up to 134 months with a median followup of 47.7 months. MATERIALS AND METHODS: We performed a large scale retrospective multicenter study in 2 phases. Phase 1 was a medical record review of 372 men who underwent implantation with the AMS 700CX penile prosthesis from 1987 to 1996 by 7 frequent penile prosthesis implanters. Phase 2 included a structured telephone interview of 207 patients by a neutral observer. RESULTS: For the 372 men in phase 1 mean device mechanical reliability plus or minus standard deviation was 92.1% + or - 3.3% after 3 and 86.2% + or - 4.6% after 5 years. Patient age was 21 to 79 years (mean 57.6 + or - 11.0) at implantation. The etiology of erectile dysfunction was vascular in 27.7% of the cases, Peyronie's disease in 16.9%, diabetes mellitus in 12.9% and radical surgery in 11.6%. Of the men 55.6% received previous treatment for erectile dysfunction. Postoperative infection and device malfunction developed in 3.2% and 17.5% of the cases, respectively. Of the 207 men interviewed in phase 2, 86% still had an AMS 700CX penile prosthesis implanted, including 87.1% with erection suitable for coitus. Currently 79% of those with a device use it at least twice monthly and 88.2% would recommend an implant to a relative or friend. CONCLUSIONS: The AMS 700CX penile implant produced suitable erection and excellent patient satisfaction at long-term followup in the majority of men. Implant reliability is excellent and postoperative morbidity is low.     

Surgical niche for the treatment of erectile dysfunction

Penile erection implicates arterial inflow, sinusoidal relaxation and corporoveno-occlusive function. By far the most widely recognized vascular etiologies responsible for organic erectile dysfunction can be divided into arterial insufficiency, corporoveno-occlusive dysfunction or mixed type, with corporoveno-occlusive dysfunction representing the most common finding. In arteriogenic erectile dysfunction, corpora cavernosa show lower oxygen tension, leading to a diminished volume of cavernosal smooth muscle and consequential corporoveno-occlusive dysfunction. Current studies support the contention that corporoveno-occlusive dysfunction is an effect rather than the cause of erectile dysfunction. Surgical interventions have consisted primarily of penile revascularization surgery for arterial insufficiency and penile venous surgery for corporoveno-occlusive dysfunction, whatever the mechanism. However, the surgical effectiveness remained debatable and unproven, mostly owing to the lack of consistent hemodynamic assessment, standardized select patient and validated outcome measures, as well as various surgical procedures. Penile vascular surgery has been disclaimed to be the treatment of choice based on the currently available guidelines. However, reports on penile revascularization surgery support its utility in treating arterial insufficiency in otherwise healthy patients aged <55 years with erectile dysfunction of late attributable to arterial occlusive disease. Furthermore, it is noteworthy that penile venous surgery might be beneficial for selected patients with corporoveno-occlusive dysfunction, especially with a better understanding of the innovated venous anatomy of the penis. Penile vascular surgery might remain a viable alternative for the treatment of erectile dysfunction, and could have found its niche in the possibility of obtaining spontaneous, unaided and natural erection.     

Current use of penile implants in erectile dysfunction

Penile implants became popular with the introduction of effective models more than 30 years ago. Today they play a secondary but definitive role in the treatment of erectile dysfunction at times when more conservative therapies have failed. Improvements in reducing the incidence of infection, treating infection with antiseptic washes, enhancing device longevity, and instituting new techniques to manage complicated implantation procedures have made them more acceptable to patients. Although penile implants are the least often chosen and most invasive treatment for erectile dysfunction, they have the highest satisfaction rate—in the range of 80% to 90%—among both patients and partners.     

Penile prosthesis for the treatment of erectile dysfunction

The erectile dysfunction is a pathology that, with different degrees of intensity, affects nearly the 20% of the spanish adult men. The treatment is usually performed in stages, reserving the penile prosthesis for when other previous treatments have failed. The aim of this work is to evaluate, according to the state of present knowledge, the effectiveness and security of the penile prosthesis for the treatment of the erectile dysfunction. With this purpose 52 articles were selected, observing a 5 years prosthesis survival of 78-91% and a 3-8% of surgical complications. Mechanical failures and infection percentages were smaller in the semi-rigid prosthesis that in the inflatable ones, with high levels of postoperative satisfaction in patients as well as in their couples, even greater than in other treatments available at the present time. The penile prosthesis implantation must be reserved for the organic erectile dysfunction when previous treatments have failed, evaluating the risk-benefit relation and informing the patient of the results that are hoped to be obtained and of the possible complications that can arise. In view of the great concern of our society with the erectile function and the availability of effective drugs, an increase in the demand of penile prosthesis implantation is predictable in those patients highly motivated, but refractory to the less invasive treatments.