Penile prostheses for the management of the neuropathic bladder and sexual dysfunction in spinal cord injury patients: long term follow up

Abstract

During the last 10 years, 90 penile prostheses were implanted in 82 patients with spinal cord injury. Surgery was done 1 month to 25 years (average 4.8 years) after the injury. The follow up period ranged from 1 to 10 years (average 4 years). A prosthesis was implanted for urinary management in 51 patients (62%), for sexual dysfunction in 10 patients (12%) and for both purposes in 21 patients (26%). Ninety-three per cent of the patients who used the implant for urinary management and 64% of the patients who used it for sexual dysfunction were satisfactory. We experienced three extrusions and nine surgical removals due to pain, difficulty of catheterisation and infection (the complication rate was 13.3%). Generally speaking, a penile prosthesis improves the quality of life of patients with spinal cord injury significantly; however, extrusion and infection are still significant problems.

Quality of life in patients with spinal cord injury receiving VIAGRA® (sildenafil citrate) for the treatment of erectile dysfunction

“…A previous report indicated an improvement in QoL with a vacuum erection device but a loss of erection during sexual activity, resulting in 67% discontinuation of treatment in the sample population. 36 Penile prostheses and prostaglandin E 1 treatment improved the QoL of patients with SCI as well; however, for patients with SCI and ED, complications resulted from penile implants and prostaglandin E 1 treatment, 6,36,37 underscoring the importance of an eective and noninvasive treatment for ED.…”

Erectile dysfunction in spinal cord-injured men: different treatment options

“…3,10 Treatment options for ED in patients with SCI include intracavernosal injection of vasoactive substances, VCD and surgical implantation of penile prothesis. 3,6,8 The American Urological Association Panel on the treatment of organic ED stated that the ultimate goal is a therapy that is reliable, has minimal side effects and is simple to use. 9 Sildenafil appears to meet these specifications.…”

“…3 Patients also tend to reject the use of external VCD because they want to have more naturally occurring erections within the context of sexual stimulation by a partner. 8 Derry et al, 2 however, reported that sildenafil is efficacious and well tolerated by SCI patients.…”

“…[3][4][5] Treatment options for ED in patients with SCI included intracavernosal injection of vasoactive substances (ICI), vacuum constriction devices (VCD) and surgical implantation of penile prosthesis. 3,[6][7][8] Although these therapies have been reported to address the needs of patients with SCI who have ED, they are rarely ideal; for example, ICI although the most used treatment option, has been associated with a dropout rate of more than 50%. 3 Patients also tend to reject the use of external VCD because they want to have more naturally occurring erections within the context of sexual stimulation by a partner.…”

Specific aspects of erectile dysfunction in spinal cord injury

“…21,22 Any man with SCI, regardless of age, cause, or level and extent of injury, may be treated with these methods while bearing in mind the absolute or relative contraindications for each treatment method.…”