Penile Prosthetic Surgery and its Role in the Treatment of End-Stage Erectile Dysfunction – An Update

Abstract

Ann R Coll Surg Engl 2006; 88: 343-348 343Penile implants have been used for the treatment of erectile dysfunction for over 30 years. Initial results were far from excellent due to both mechanical problems and the dreaded complication of infection. Improved outcomes have been achieved in recent times due both to improved surgical care and also developments in device manufacture. The role of penile prostheses has been discussed previously.1 This review will concentrate on describing the most recent advances in this field. Literature searchA Medline search was carried out using the search terms 'penile prosthesis' and 'penile implants'. The reference lists of key articles were also reviewed. Articles published since 2000 that reported a modification of prosthesis design or surgical technique were chosen in order to ensure that the review reflected current practice. Implant types and improvements in implant mechanicsThe main categorisation of penile implants is between inflatable and non-inflatable devices.The non-inflatable devices are semi-rigid and may be silicone malleable rods (Fig. 1) or a series of articulating polyethylene discs with a central metal cable support. Noninflatable implants are relatively cheap and easy to insert with few mechanical complications. However, they provide a less than ideal result both in terms of cosmesis/concealment and quality of erection.Inflatable implants aim to reproduce normal function as much as possible in both allowing penile flaccidity when not in use and subsequent girth/length expansion during The treatment of erectile dysfunction has been revolutionised with the introduction of orally active phosphodiesterase inhibitors which are successful in 70-80% of men. However, there remain a group of men in whom conservative treatment fails and surgical insertion of a penile prosthesis is required. This type of surgery has in the past been associated with technical difficulties and a high complication rate. This has spurred numerous developments in prosthesis design and surgical technique with the field changing at a rapid pace. Perhaps the most significant is the use of antimicrobial coatings on prostheses that have been shown to reduce the infection rate significantly. This review highlights those developments reported in the last 5 years.