Surgical Outcomes and Patient Satisfaction With the Low-Cost, Semi-Rigid Shah Penile Prosthesis: A boon to the Developing Countries

Abstract

Introduction In developing countries most patients with refractory erectile dysfunction cannot afford a penile prosthesis (PP) due to its cost and non-coverage by insurance companies. Aim To assess the patient satisfaction outcomes with a novel, low-cost, semi-rigid PP. Methods 52 patients who had received the Shah semi-rigid PP between January 2013 and December 2018 were included in this bidirectional study. Patient demographics including age, etiology, body mass index, length of PP received and post-operative complications were recorded. Patient satisfaction with the PP was evaluated using the modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) Questionnaire. Main outcome measures The primary outcome measures were overall satisfaction, total EDITS and mean EDITS score. The secondary outcome measures were residual penile tumescence, ease of concealment and post-operative complications. Results The mean age of the patients was 38.79 years (25–68). Overall satisfaction (EDITS Q-1) of 4 (0–4) was reported by 84.62% (44/52) of patients. There was no significant difference ( P > .7) in the total EDITS and overall satisfaction based on various etiological factors. The mean EDITS scores (0–100) were 95.67 ± 10.76, 95.53 ± 8.46 and 91.72 ± 22.42 in 52 patients with BMI <25, 25–29.9 and >30 kg/m2 respectively. During sexual arousal after PP implantation, 26 (50%), 17 (32.7%) and 9 (17.3%) patients noted “good”, “some” or “no” residual penile tumescence respectively. 47 (90.4%), 4 (7.7%) and 1 (1.9%) patients reported “good”, “fair” and “poor” concealment respectively. In the prospective group, major and minor post-operative complications were seen in 10.7% (3/28) and 21.4% (6/28) of patients respectively. Conclusion The semi-rigid Shah PP is a safe, effective and affordable option to treat patients with refractory ED. The ability to remove 1 or both sleeves in the Shah PP helps achieve a good fit with a small inventory. Krishnappa P, Tripathi A, Shah R. Surgical Outcomes and Patient Satisfaction With the Low-Cost, Semi-Rigid Shah Penile Prosthesis: A boon to the Developing Countries. Sex Med 2021;9:100399.

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“…First, although our institution has a high-volume of patients undergoing PPS, all patients did not complete an EDITS questionnaire. Like as mentioned above, utilizing a validated survey in assessing sexual and device satisfaction is important when evaluating PPS patients (9,36,37). Many PPS satisfaction studies are limited by using non-validated assessments in capturing data.…”

State-of-art review of current malleable penile prosthesis devices in the commercial market

“… 23 To date, three reports have been published with the Shah penile prosthesis; a single case report in a neophallus 24 while the other study showed good residual penile tumescence in 50% of cases and more than 90% of patients reported no problem with device concealment. 25 In another paper comparing Shah’s device and AMS 650 prostheses, there were no significant differences reported in the ED Inventory of Treatment Satisfaction (EDITS) questionnaire and EDITS partner survey at 80.66 ± 4.49 and 75.66 ± 6.57, respectively, at 12 months after surgery and 71.73 ± 8.10 and 65.6 ± 6.49, respectively, at 24 months after surgery. 26 Major and minor postoperative complications were seen in 10.7% (one infection, one urethral injury and one impending erosion) and 21.4% (6/28) of patients, respectively.…”

“…23 To date, three reports have been published with the Shah penile prosthesis; a single case report in a neophallus 24 while the other study showed good residual penile tumescence in 50% of cases and more than 90% of patients reported no problem with device concealment. 25…”