Comparative study of penile size before and after penile prosthesis implantation

Salem, Ahmed; Shaeer, Osama; Abdel-Aal, Alla; Younes, Mohammad

doi:10.1097/01.xha.0000415084.67485.67

Cited by 5 publications

(2 citation statements)

References 13 publications

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“…One study reported shortening in the range of 0.74 ± 0.15 cm [11] . Another study reported that length was 9.5% shorter postoperatively [12] . Despite the relatively minor decrease in post-implantation length, the complaint of a shorter penis following PPI remains prevalent , with 72% of patients reporting a decrease in penile length [13] .…”

Section: Discussionmentioning

confidence: 99%

Oversizing Penile Prosthesis Length as per the Erect Length by Intra-Cavernosal Injection of Vasoactive Material

Shaeer

AbdelRahman

2017

JGS

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Introduction: Penile prosthesis implantation (PPI) is becoming increasingly popular for treatment of erectile dysfunction that will not respond to medical treatment. However, reasons for dissatisfaction with PPI, decreased penile size was among the reasons stated by the patients, quoting "it got small, the prosthesis is short, it does not have enough thickness, it does not get to the front". Aim of Study: To evaluate patient and partner's impression of penile length when implanting penile prosthesis with cylinder length determined in the erect state, compared to regular implantation as per the flaccid stretched length. Patients and Methods: A 3-piece girth expanding penile prosthesis was implanted in 38 patients: 16 patients with cylinder length sized in the erect state, induced by intra-cavernosal injection of vasoactive material (ICI) (study group), compared to regular implantation as per the flaccid stretched length (control group; n=22). Patients in the study group were educated as to signs of pending perforation and instructed to seek urgent consultation if such signs set in. Patients were followed up for 20-24 months. Complications and patients/partner impression of post-operative erect length compared to their recall of erect length before ED had set in. Results: In the study group, 6.2% of patients and 12.5% of partners reported shorter length, compared to 81.9% of patients and 95.5% of partners in the control group (p<0.001). One case (6.3%) in the study group showed signs of pending anterior perforation by the ninth month post-operatively. Re-operation was performed, removing a 1 cm rear tip extender from each cylinder. Conclusion: Implantation of an inflatable penile prosthesis with cylinder length determined in the erect state is both safe and effective in preserving impression of penile length, provided the benefits outweigh the slightly higher risk of anterior perforation, and that pending perforation is detected early enough in which case the implant can be shortened.

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Section: Discussionmentioning

confidence: 99%

Oversizing Penile Prosthesis Length as per the Erect Length by Intra-Cavernosal Injection of Vasoactive Material

Shaeer

AbdelRahman

2017

JGS

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“…In younger patients with ED refractory to treatment, this makes the decision for PPI much more critical. Furthermore, PPI has been reported to be associated with unfavorable changes in the length of the penis [1], resulting in dissatisfaction of a subset of patients.…”

Section: Introductionmentioning

confidence: 99%

Same-Session Dorsal Vein Ligation and Testing by Intracavernous Injection Prior to Penile Prosthesis Implantation (DVL-ICI-PPI)

Shaeer¹,

Shaeer²

2014

The Journal of Sexual Medicine

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Introduction Complications of penile prosthesis implantation (PPI) are rare, nevertheless can be grave. In cases with veno-occlusive dysfunction (VOD), alternative surgical techniques such as dorsal vein ligation (DVL) are controversial. Some patients may opt for trial at DVL to avoid the possible complications of PPI. However, this may be associated with disappointment if DVL fails and another procedure is required. Aim The aim if this study is to evaluate the results of a combined approach involving DVL, same-session testing by intracavernous injection (ICI) of prostaglandin E1 (PGE1), and immediate implantation of a penile prosthesis (PPI) in case of poor response to DVL. Main Outcome Measures Long-term erectile function in cases with favorable intraoperative response to DVL. Methods Twenty-six patients with refractory VOD were operated upon. Through a peno-pubic incision, DVL was performed, followed by ICI of 20 µg PGE1 in two divided doses, 10 µg each, 15 minutes apart. Group 1 exhibited full rigidity in response to the first dose. Group 2 exhibited full rigidity in response to the second dose. PPI was not performed for either. Group 3 exhibited suboptimal response to both doses, and PPI was performed through the same incision. Patients were followed up from 24 to 48 months using International Index of Erectile Function-5 scoring. Results For Group 1 (n = 8), six patients experienced normal erectile function following DVL throughout the whole follow-up period of 48 months (23.1% of all patients), and two patients relapsed. Group 2 (n = 6) (23.1%) reported normal erectile function for an average of 6 months, then relapsed. Group 3 (n = 12) had a penile prosthesis implanted in the same setting. Conclusion Combined DVL-ICI-PPI can spare around 23.1% of young patients with VOD from PPI, at no additional risk. Full response to 10 µg PGE1 at intraoperative testing carries good prognosis to DVL on the long run. Investigation of a larger number of patients is necessary before reaching a final conclusion.

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Simultaneous Suprapubic Lipectomy and Penile Prosthesis Implantation

Shaeer

AbdelRahman

2018

The Journal of Sexual Medicine

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Introduction A shorter penis is a frequent complaint following penile prosthesis implantation (PPI), and a large redundant suprapubic fat pad can conceal the penis and possibly compromise patient and partner satisfaction with length. Aim To evaluate feasibility and outcome of same-session, same-incision, PPI and suprapubic lipectomy (SPL). Methods In 22 patients, SPL was performed through an abdominal crease incision. Through the same incision, the superficial perineal pouch was opened to gain access to the base of the penis. Penile prosthesis was implanted (semirigid in 16 patients and girth-expanding 3-piece inflatable in 6). Scarpa’s fascia, subcutaneous fat, and the abdominal crease skin incision were closed. Main Outcome Measure Evaluation was in terms of implant survival, preoperative vs postoperative patient and partner satisfaction with penile length on a 5-point rating scale, subjective opinion over penile length postoperatively, compared with recall of erect length before erectile dysfunction (ED) had set in (longer, same, or shorter), and penile length with the implant rigid, compared in the supine and standing positions postoperatively (pubic skin to tip, using a rigid ruler). Results No infections or extrusions or mechanical failures were encountered. There was a 53.3% increase in patient satisfaction with length comparing preoperative (2.55 ± 0.67) to postoperative (4.77 ± 0.43) ratings, P < .0001. Partner satisfaction showed a 40.2% increase, from 1.77 ± 0.61 to 4.41 ± 0.50, P < .0001. 19 of 22 patients reported that postoperative length was longer than their recall of erect length before ED had set in, and 3 patients reported that length was the same. With the implant rigid, there was no statistically significant difference in visible length between the supine and standing positions (14.1 cm ± 2.3 and 13.9 cm ± 2.3, respectively, P = .38). Clinical Implications Patients with refractory ED and a concealed penis can be counseled as to the option of simultaneous SPL and PPI (SPL-PPI), a modification that may help avoid patient and partner dissatisfaction with length. Strength & Limitations Strengths include objective evaluation of the efficacy of the procedure by comparing supine and standing penile length. Limitations of the current study include inability to evaluate erect length preoperatively owing to refractory ED, and subjectivity of patient and partner opinion. Conclusion Same-incision SPL-PPI appears to be a safe and effective procedure, with high patient and partner satisfaction rates.

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Comparative study of penile size before and after penile prosthesis implantation

Cited by 5 publications

References 13 publications

Oversizing Penile Prosthesis Length as per the Erect Length by Intra-Cavernosal Injection of Vasoactive Material

Oversizing Penile Prosthesis Length as per the Erect Length by Intra-Cavernosal Injection of Vasoactive Material

Same-Session Dorsal Vein Ligation and Testing by Intracavernous Injection Prior to Penile Prosthesis Implantation (DVL-ICI-PPI)

Simultaneous Suprapubic Lipectomy and Penile Prosthesis Implantation

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