The future of penile prostheses for the treatment of erectile dysfunction

Lindsey, John P.; Lue, Tom F.; Shindel, A.W.

doi:10.21037/tau.2019.09.01

Cited by 5 publications

(3 citation statements)

References 47 publications

(54 reference statements)

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“…for ED management 9 as many men become refractory to medical therapy and/or are seeking a more effective and permanent therapy. 10 Penile prosthesis is a well-known treatment option with high satisfaction rates (92%-100% in patients and 91%-95% in their partners).…”

Section: Discussionmentioning

confidence: 99%

“…3 Per AUA guideline recommendations, it is imperative to ensure that all types of effective ED treatments are consistently accessible to patients. IPPs are an essential component in the urologist’s armamentarium for ED management 9 as many men become refractory to medical therapy and/or are seeking a more effective and permanent therapy. 10 Penile prosthesis is a well-known treatment option with high satisfaction rates (92%-100% in patients and 91%-95% in their partners).…”

Section: Discussionmentioning

confidence: 99%

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Implantable Penile Prosthesis for Erectile Dysfunction: Insurance Coverage in the United States

Khera,

Langston,

Pollard

et al. 2023

Urology Practice

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Study Need and Importance: The extent of insurance coverage for implantable penile prostheses (IPPs) for erectile dysfunction (ED) has not yet been adequately ascertained; hence, it is unclear whether this is a barrier to access for IPP treatment. This study utilized a manufacturer's benefit verification databases to ascertain insurance coverage for IPP for ED. What We Found: IPP insurance coverage was most extensive for government-based insurance (Medicare 98.7%, Medicare Advantage 97.1%, Tricare 100%, and Veterans Affairs 80.0%) but was also favorable for commercial insurance (75.0%; see Figure ). The most common reason for lack of coverage was employer exclusion; the proportion of patients with no coverage due to exclusion increased from 13.5% in 2019 to 17.5% in 2021. Analyses of the employer-sponsored health plan database (n[3,083 patients) showed that 63.1% of patients were approved or verified for coverage and 34.2% did not have coverage due to health plan exclusions. Limitations: The data represent the cases that providers submitted to the manufacturer benefit verification system and may not be generalizable to all patients seeking IPP for ED. Also, retrospective databases may have clerical inaccuracies, coding errors, or missing data. Interpretation for Patient Care: Approximately 80% of patients have IPP insurance coverage. Employer exclusion is the most common reason for lagging coverage, with rates of exclusion increasing 29.3% from 2019 to 2021. There may be a misnomer that plans will likely not cover IPP placement and a lack of awareness of available support in seeking coverage from benefit verification services. Figure.Implantable penile prosthesis approval status for the allpayer cohort by type of insurance status. Case status meanings: Verified: medical benefits were verified, and the procedure is covered. Approved: the health plan approved a prior authorization for the procedure. No Coverage-Exclusion: the employer's health plan excludes medical benefits through the employer-sponsored health plan for a penile prosthesis. Cancelled: A request was sent by the physician's office to cancel the verification of benefits. Denied-Not Medically Necessary: the request for the procedure was denied for not being medically necessary. Material Not Provided: the insurance benefit verification process was unable to be continued as the medical documentation requested was not received from the provider's office. No Coverage-Medicaid: the state Medicaid excludes coverage for penile prosthesis. EPO indicates exclusive provider organization; HMO, health maintenance organization; OAP, open access plus; POS, point-of-service; PPO, preferred provider organization; VA, Veterans Affairs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Implantable Penile Prosthesis for Erectile Dysfunction: Insurance Coverage in the United States

Khera,

Langston,

Pollard

et al. 2023

Urology Practice

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“…The BC remained "in situ" after six months, with a mass effect, being incorporated into the tissue, permeated by normal inflammatory infiltrate. The volumetric density of the constituents revealed the predominance of macrophages and multinucleated giant cells of the foreign body type, in addition to fibroblasts and blood vessels, a process expected after the injection of any exogenous material in the body (25,26). Histochemistry technique, demonstrated the presence of elastic fibers, essential for the elasticity of erectile tissue (26) and after immunohistochemistry the presence of neoformed blood vessels, of small caliber, located peripherally to the implant, corroborating the tissue biocompatibility observed in previous studies using the same cellulose bacteria (9,11).…”

Section: A B C Dmentioning

confidence: 96%

Injectable semi rigid penile prosthesis: study in rabbits and future perspectives

Lima¹,

Chagas²,

Monteiro³

et al. 2021

Transl Androl Urol

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Background: Penile prostheses are the third option in the treatment of erectile dysfunction, however, despite their proven effectiveness, the occurrence of infections, advanced age of patients and comorbidities are the main limiting factors for this treatment modality. In the continuous search for biointegrated, clinically durable and minimally invasive treatment options, a possible model of penile prosthesis was sought through the use of intracavernous bacterial cellulose (BC) gel, in an experimental model of orchiectomized rabbits.Methods: Thirty adult New Zealand rabbits were equally distributed into three groups: BC; vehicle and control. Each group was then subdivided according to the follow-up time of 3 and 6 months.Bilateral orchiectomy was performed 3 weeks before injection in the BC and vehicle groups. Pachymetry measurements of the penile axis, diameter and length were performed in situ. Histomorphometry analyzes of the corpora cavernosa (CC), thickness of the tunica albuginea, cell density, collagen and elastic fibers postinjection were also performed, in addition to immunohistochemistry for newly formed vessels. Results:The implant of BC increased both the length and thickness of the penis three and six months after the last injection, with a consequent increase in the diameter of the CC. On the other hand, the filling effect was not observed in the control and vehicle groups, confirming the degradation of this tissue after orchiectomy and the effectiveness of BC as a filling agent. Histomorphometry analyzes corroborate the mass effect of BC integrated into the tissue, permeated by predominantly lymphomononuclear inflammatory infiltrate, multinucleated giant foreign body cells, fibroblasts, elastic fibers and newly formed vessels, without degradation or loss of volume, even after six months of implantation.Conclusions: Biocompatibility and biointegration to the host tissue make BC a prosperous penile filling material, with local application and minimally invasive.

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