eMedicine Specialties > Urology > Erectile Dysfunction, Premature Ejaculation, and Sexual Disorders

Penile Prosthesis Implantation: Follow-up

Author: Richard A Santucci, MD, FACS, Chief of Urology, Detroit Receiving Hospital; Specialist-in-Chief of Urology, Detroit Medical Center; Chief of Urologic Trauma Surgery, Sinai Grace Hospital; Director, The Center for Urologic Reconstruction; Clinical Professor of Urology, Michigan State College of Medicine
Coauthor(s): Curtis N Crane, MD, Fellow in Genitourinary Trauma and Reconstructive Urology, Wayne State University School of Medicine
Contributor Information and Disclosures

Updated: Apr 22, 2009

Outcome and Prognosis

Generally, the authors' experience at Wayne State University Department of Urology is that the vast majority of patients in whom conservative therapy has failed and who subsequently underwent a penile prosthesis implantation are very satisfied with inflatable penile prostheses. Of men who have undergone this procedure, 95% are happy about their decision to have surgery. Patient satisfaction with surgery is bolstered by supportive staff and low infection and malfunction rates.

National multicenter studies show similar satisfaction rates, ranging from 69%-89%. Using validated questionnaires, Akin-Olugbade et al (2006) reported that predictors of lower satisfaction included Peyronie disease, a body mass index of greater than 30 kg/m2, and previous radical prostatectomy.10 Of all modes of ED treatment, surgical therapy yielded the highest satisfaction rates. Interestingly, even despite good mechanical function, the satisfaction rating of the patients’ sexual partners is comparatively lower (60%-70%). Some experts attribute this to a psychological factor (ie, unrealistic expectation of the implantation). Jarow et al (1996) recommended counseling the patient and partner on realistic goals of implants and informing them that an implant may not be as satisfying as a natural erection.11

On average, patients may wear out their prosthesis in 4-8 years. Revisions become more common as time passes. Some of the older patients have undergone as many as 4 revisions over 2 decades of use.

Goldstein et al (1997), studying the 3-piece Mentor Alpha 1 prosthesis in multicenter trials, reveals a Kaplan-Meier actuarial device survival rate of 98% at 12 months, 93% at 24 months, and 85% at 36 months.12 Dhar et al (2006) studied the AMS 700CX/CXM and found that the implant mechanical survival rate was 81% after a median follow-up of 91.5 months.13 Lux et al (2007) reported on 147 patients with newest version of the AMS Ambicor 2-piece device, and only one implant had a mechanical failure over a mean follow-up of 38 months.14

With steady improvements regarding prosthesis material and construction, long-term survival of the modern implants shows promise.

Future and Controversies

The popularity and success of sildenafil (Viagra) and it competitors, vardenafil (Levitra) and tadalafil (Cialis), has brought to light the prevalence of erectile dysfunction (ED). Men who would have ignored their ED problem in the past are now realizing the potential help available.

Along with development of surgical/prosthesis improvements, new medical agents are emerging for evaluation. Among them is apomorphine, a direct central dopamine receptor agonist. Used for parkinsonism in the past, it has a lasting side effect of eliciting durable erections in small studies of patients. It has a sublingual formulation, which is currently under clinical investigation, but time will tell if it proves as successful as the phosphodiesterase-5 inhibitors.

When men with ED begin trying conservative therapy (which fails in some), the authors believe that these patients will eventually seek surgical options such as inflatable penile prostheses. With this new influx, urologists may witness a second wave of patients seeking surgical correction for their impotence.

The future holds more promise. Currently, Mentor 3-piece inflatable prostheses come equipped with a lockout valve designed to prevent autoinflation. Initial studies have shown a decreased incidence of autoinflation, from 11% to 2%.15 The remaining 2% incidence was attributed mainly due to improper usage. The newest AMS 700 devices now also incorporate a lockout mechanism, and anecdotal reports have been positive.

Other mechanical improvements include buttressing of the sites most prone to breakage, notably the tubing junctions. The incorporation of rear-tip extenders that lock onto the prosthesis cylinders are one of the newest improvements for both the Mentor and AMS implants. This innovation is of particular value when explanting or replacing a device, since rear-tip extenders commonly slip off the main body of the cylinder and can be difficult to retrieve from the proximal corpora. Retrieving these old rear-tip extenders is critical before implanting a new device in order to minimize infection. The new locking rear-tip extenders appear promising in avoiding this problem.

Prostheses impregnated with antibiotics, such as the InhibiZone coating (rifampin and minocycline hydrochloride) used in the AMS 700 series, is proving to significantly decrease the incidence of postoperative infection.3,16 Similarly, the new Mentor Titan 3-piece device is coated with polyvinylpyrrolidone, a hydrophilic substance that decreases bacterial adherence and absorbs topical antibiotics. This innovation has also been shown to decrease the incidence of infection.17 Another avenue being explored to increase satisfaction with penile prostheses is dealing with "cold glans," which is expected because the prosthesis does not affect glans engorgement. Topical alprostadil cream is showing some preliminary promise as an adjunct to penile prosthesis in increasing erectile satisfaction by increasing engorgement of the glans.18

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthors Yao-Jen Chang, MD, and Christopher Knopick, MD, to the development and writing of this article.



More on Penile Prosthesis Implantation

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Treatment: Penile Prosthesis Implantation
Follow-up: Penile Prosthesis Implantation
Multimedia: Penile Prosthesis Implantation
References
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Further Reading

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Keywords

prosthetic penis, penile prosthesis implantation, erectile dysfunction, ED, male sexual dysfunction, penile implant, inflatable penile prosthesis, IPP, potency, impotence, impotency, cavernosography, inflatable prosthetic penis, semirigid intracorporal devices, penile revascularization, semirigid rod prosthesis, Dura II, AMS, Acu-Form, Mentor, malleable rod, mechanical rod, unitary inflatable penile prosthesis, Dynaflex, Hydroflex, Ambicor, Mark II, 700 series, Alpha 1, Titan, AMS 700, AMS 650, AMS 600, Ultrex, XC, Bioflex, organic erectile dysfunction, organic ED, psychogenic erectile dysfunction, psychogenic ED, vasculogenic impotence

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Contributor Information and Disclosures

Author

Richard A Santucci, MD, FACS, Chief of Urology, Detroit Receiving Hospital; Specialist-in-Chief of Urology, Detroit Medical Center; Chief of Urologic Trauma Surgery, Sinai Grace Hospital; Director, The Center for Urologic Reconstruction; Clinical Professor of Urology, Michigan State College of Medicine
Richard A Santucci, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, and Société Internationale d'Urologie (International Society of Urology)
Disclosure: Nothing to disclose.

Coauthor(s)

Curtis N Crane, MD, Fellow in Genitourinary Trauma and Reconstructive Urology, Wayne State University School of Medicine
Disclosure: Nothing to disclose.

Medical Editor

Gamal Mostafa Ghoniem, MD, FACS, Fellowship Program Director, Clinical Professor of Surgery, Head, Section of Voiding Dysfunction, Female Urology and Reconstruction, Cleveland Clinic Florida
Gamal Mostafa Ghoniem, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urogynecologic Society, American Urological Association, Florida Medical Association, International Continence Society, and International Urogynaecology Association
Disclosure: Astellas Honoraria Speaking and teaching; Coloplasty Consulting fee Consulting; Uroplasty Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Shlomo Raz, MD, Professor, Department of Surgery, Division of Urology, University of California at Los Angeles School of Medicine
Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, and California Medical Association
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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