Contemporary Aspects of Penile Prosthesis Implantation

181

109

Introduction Long-term revision-free survival, greater than 10 years has never been reported for inflatable penile prostheses. We conducted a historical prospective study to estimate 10 and 15 years survival of first time (virgin) implantations in 2,384 patients with four different models. Aim Evaluation of 10- and 15-year mechanical and overall revision-free survival of inflatable penile prostheses. Main Outcome Measures Kaplan–Meier product limit method, and comparison using the log rank test, were used to estimate the 10- and 15-year revision-free survival. Methods Data were obtained from medical records and patient interviews, entered into a computerized database, and analyzed by a third party. Information included implant type, date, revision history with date, and reason. Fourteen different inflatables were examined. Mentor Alpha 1, Mentor Alpha NB, AMS 700 CX, and AMS 700 Ultrex had usage for an extended period of time. Because of failure times being confounded as a result of prior implants, only virgin implants were examined. Results For the entire series, estimated 10-year revision-free survival for all reasons was 68.5% and the 15-year revision-free survival was 59.7%. Freedom from mechanical breakage at 10 years was 79.4%; 15 years was 71.2%. Recent mechanically enhanced models did even better. In 1992, Mentor Alpha added pump reinforcement to forestall mechanical breakage. This improved 10-year survival from 65.3% to 88.6% (P = 0.0001). In January 2001, AMS CX added a parylene coating to the cylinders that increased 3-year mechanical survival from 88.4 to 97.9% (P = 0.0002). Conclusions This is the first report on long-term reliability of inflatable penile prostheses. We estimated 60% of these virgin implants would survive 15 or more years without revision or extraction. Newer enhanced models are currently available, and our tracking predicts even better long-term survival for these devices.

Section: Discussionmentioning

confidence: 99%

Long-Term Survival of Inflatable Penile Prostheses: Single Surgical Group Experience with 2,384 First-Time Implants Spanning Two Decades

Wilson

Delk

Salem

et al. 2007

181

109

“…Other possible causes of extrusion include oversizing the cylinders and overly vigorous distal dilation, especially with small caliber dilators [5]. Although semi-rigid rods have been associated with erosion because of the constant pressure they exert [6], comparative series have not found that rods have a higher complication rate compared with inflatable penile prostheses (IPP) [7,8].…”

Section: Management Of Lateral Extrusionmentioning

confidence: 99%

Management of Perforation Injuries During and Following Penile Prosthesis Surgery

Stember

Köhler

Morey

2015

Introduction Distal extrusion of penile prosthesis cylinders is a challenging problem that is associated with pain and imminent erosion through penile skin. Distal extrusion and other perforation injuries, including crural and urethral, are other manifestations of tunica albuginea injuries that result in poor clinical outcomes and patient satisfaction. Aim A description of Dr. John Mulcahy’s landmark article for management of lateral extrusion is presented along with discussion of techniques for managing other types of perforation injuries associated with penile implants. Methods Dr. Mulcahy’s original article is reviewed and critiqued. Surgical methods to manage perforation injuries are discussed. Main Outcomes Measures The main outcome measures used were the review of original article, subsequent articles, and commentary by Dr. Mulcahy. Results Knowledge of techniques for management intraoperative and postoperative complications related to tunical perforation is necessary for implant surgeons. Conclusions Perforation injuries are challenging noninfectious complications of penile prosthesis surgery. Familiarity with techniques to manage these problems is essential for ensuring good outcomes and patient satisfaction.

“…Sildenafil citrate has overall success rates for all etiologies of ED of 50-80%; however, if PDE5 treatments fail, a VED is a safe and effective second choice in certain patients [29]. In a study of patients who were using other agents or devices for ED who were offered sildenafil citrate, the drug was statistically no more effective than VED or intracavernosal injection [24] Penile implants [25] 83-85 86.2-93.6 NR Surgical therapy [26] Vascular surgery 30 NR NR Vacuum erection devices.…”

Section: Ved As Second-line Therapymentioning

confidence: 99%

Vacuum Erection Devices Revisited: its Emerging Role in the Treatment of Erectile Dysfunction and Early Penile Rehabilitation Following Prostate Cancer Therapy

Pahlajani

Raina

Jones

et al. 2012

Introduction Vacuum erection devices (VEDs) are becoming first-line therapies for the treatment of erectile dysfunction and preservation (rehabilitation) of erectile function following treatment for prostate cancer. Currently, there is limited efficacy of the use of phosphodiesterase type 5 inhibitors in elderly patients, or patients with moderate to severe diabetes, hypertension, and coronary artery disease. Aim The article aims to study the role of VED in patients following prostate cancer therapy. Results Alternative therapies such as VED have emerged as one of the primary options for patients refractory to oral therapy. VED has also been successfully used in combination treatment with oral therapy and penile injections. More recently, there has been interest in the use of VED in early intervention protocols to encourage corporeal rehabilitation and prevention of postradical prostatectomy veno-occlusive dysfunction. This is evident by the preservation of penile length and girth that is seen with early use of the VED following radical prostatectomy. There are ongoing studies to help preserve penile length and girth with early use of VED following prostate brachytherapy and external beam radiation for prostate cancer. Recently, there has also been interest in the use of VED to help maintain penile length following surgical correction of Peyronie’s disease and to increase penile size prior to implantation of the penile prosthesis. Conclusion VEDs can be one of the options for penile rehabilitation after prostate cancer therapy.