Electrophysiological evaluation of alterations in penile sensation due to penile prosthesis implantation in patients with erectile dysfunction

Objective The present study was aimed to determine the effect of penile prosthesis implantation(PPI)surgery on penile sensation by evaluating the penile electromyography(EMG)variables.Methods The research was designed as a prospective study.Thirty patients who were diagnosed with organic erectile dysfunction and had underwent PPI surgery between January 2017 and January 2018 in the Urology Clinic of Antalya Training and Research Hospital were included in this study.Penile sensory EMG was performed on each patient 1 day prior to the surgery by the Physical Therapy and Rehabilitation clinic.Additionally,the control EMG study was also performed in the 3rd and 6th postoperative months.Results We included 27 patients in this study who attended regular follow-ups and had complete EMG results.Out of the 27 patients,23(85.2%)patients had received malleable(ProMedon)penile prosthesis,one(3.7%)patient had received a two-piece inflatable(Ambicor)penile prosthesis,and three(11.1%)patients had received a three-piece inflatable(AMS 700 CXR)penile prosthesis.The mean nerve conduction value(NCV)of the patients was 29.85(standard derivation:22.54;range:0-78.4)m/s during the preoperative period,whereas it was 27.64(standard derivation:24.72;range:0-83.3)m/s in the 3rd postoperative month and 24.80(standard derivation:22.31;range:0-88.4)m/s in the 6th postoperative month.There was no significant difference between preoperative NCV and 3rd postoperative month NCV(p=0.607).Similarly,no significant difference was observed between preoperative NCV and 6th postoperative month NCV(p=0.276).Additionally,the change between NCV values at postoperative 3rd and 6th months was not statistically significant(p=0.553).Conclusion Significant loss of penile sensation does not occur in patients who undergo PPI surgery.

Prospective and long-term evaluation of erect penile length obtained with inflatable penile prosthesis to that induced by intracavernosal injection

We compared erect penile length after inflatable penile prosthesis （IPP） implantation with that induced by intracavemosal injection （ICI） before surgery. A total of 11 patients with full erections induced by ICI of 0.25 mL of Trimix （papaverine, phentolamine and prostaglandin E 1） at the time of penile color duplex Doppler ultrasonograpby were enrolled in this study. The patients subsequently underwent IPP implantation as the ultimate treatment for their erectile dysfunction （ED）. Erect penile length consequent to IPP implantation was measured at 6 weeks, 6 months and at I year after surgery. The Sexual Health Inventory for Men （SHIM） was administered before, and at 6 months and 1 year after IPP implantation. Erect penile length （mean ± s.c.） as induced by ICI was 13.2 ± 0.4 cm, whereas the lengths attained with IPP were 12.4 ± 0.3, 12.5 ± 0.3 and 12.5 ± 0.4 cm at the sixth week, sixth month and 1-year follow-ups, respectively. There were 0.83 ± 0.25, 0.75 ± 0.20 and 0.74 ± 0.15 cm decreases in erect penile length at 6 weeks, 6 months and 1 year, respectively, after IPP implantation when compared with that after ICI （P 〈 0.05）. The SHIM scores for patients reporting shorter penises were the same as those for patients without complaints at the 6-month and 1-year follow-ups （P 〉 0.05）. To our knowledge, this is the first study to objectively show a significant decrease in erect penile length after IPP implantation when compared with that after ICI. However, this decrease did not affect the effectiveness of IPP in treating ED.

Penile prosthesis implantation in Chinese patients wit severe erectile dysfunction： 10-year experience

We retrospectively evaluated the clinical outcome of penile prosthesis implantation （PPI） in Chinese patients with severe erectile dysfunction （SED）. From July 2000 to December 2011, 224 patients （mean age： 35.9±11.8 years, range： 20-75 years） with SED underwent PPI by experienced surgeon according to standard PPI procedure at our centre. A malleable prosthesis （AMS 650） was implanted in 45 cases （20.1%）, and a three-piece inflatable prosthesis （AMS 700 CXM or AMS 700 CXR） was implanted in 179 cases （79.9%）. Surgical outcomes, including postoperative complications, clinical efficacy and couple satisfaction, were evaluated over than 6 months postoperatively using medical record abstraction, IIEF-5, quality of life （QoL） scores, and the patient/partner sexual satisfaction score proposed by Bhojwani etaL Of the 224 patients eligible for the study, 201 subjects （89.7%） completed follow-up. All of patients could perform sexual intercourse post PPI with the mean postoperative IIEF-5 and QoL scores were 20.02±2.32 and 5.28±0.76, respectively, which were significantly improved compared with the preoperative scores （6.29±1.5 and 2.13±0.84, P〈0.01）. Of the 201 men, mechanical malfunction occurred in four cases （2.0%） and three cases were re-implanted new device, and two cases （1.0%） developed a mild curvature of the penis. Scrotal erosion with infection occurred in one case with diabetes mellitus （0.5%） and required complete removal of the implanted AMS 700 CXM. Satisfactory sexual intercourse at least twice per month was reported by 178 men （88.6%）, and overall satisfaction with the PPI surgery was reported by 89.0% of men and 82.5% of partners. Patient satisfaction in the three-piece inflatable prosthesis group was higher than in the malleable prosthesis group （P〈0.05）. Satisfaction, however, between the types of prostheses, did not differ in the partner survey. PPI is a safe and effective treatment option for Chinese patients with SED and experienced surgeon perform PPI according to standard PPI procedure could reduce the postoperative complications of PPI and could improve patient satisfaction ratio and QoL.

Penile prosthesis implantation and tunica albuginea incision without grafting in the treatment of Peyronie＇s disease with erectile dysfunction

We evaluated penile prosthesis implantation with tunica albuginea-relaxing incisions without grafting in the treatment of Peyronie＇s disease associated with erectile dysfunction. Between April 2005 and June 2011, 62 patients underwent surgery due to severe Peyronie＇s disease associated with erectile dysfunction. Malleable and inflatable penile prostheses were inserted in 49 and 13 cases, respectively. Penile prostheses were inserted into the corpora cavernosa using the standard ventral approach. After lifting the neurovascular bundle, the tunica albuginea was incised and opened at the plaque region to correct the deformities and to lengthen the penis. Subsequently, the wide neurovascular bundle was replaced, and all incisions of the tunica albuginea were covered to prevent corporal grafting. In the median follow-up of 35 months （range 14-82 months）, the penis was completely straightened in 59 （95%） patients. Numbness of the glans, which the patients found initially upsetting, decreased or disappeared spontaneously 3-6 months later. Penile prosthesis implantation with tunica albuginea incisions is a viable alternative in the treatment of Peyronie＇s disease because the extensive dissection of the neurovascular bundle allows a good approach to the plaque and provides excellent covering of the incised tunica albuginea without additional grafting.

Initial experience of a single center with the use of ZSI 475 penile prosthesis

Objective:To evaluate surgical outcomes after implantation of the Zephyr ZSI 475 inflatable penile prosthesis(IPP)and patients’quality of life.Methods:From December 2014 to September 2018,15 patients underwent prosthesis implantation with ZSI 475.A retrospective review of clinical data was performed.Patients’quality of life after implantation was investigated with Quality of Life and Sexuality with Penile Prosthesis(QoLSPP)questionnaire.Results:The median age of patients was 57 years and the average follow-up time was 22 months.Twelve patients received a standard implantation due to severe erectile dysfunction(ED);three patients also presented penile curvature and additional corporoplasty with grafting was necessary.Three procedures had to be interrupted due to defects of the insertion tools.In one case a manufacturing defect resulted in a pump leak.In one case,a severe postoperative complication occurred,which requested explanation of the device.During the follow-up,four patients experienced mechanical failure of the prosthesis.Results of QoLSPP questionnaire at 12 months were skewed toward the positive end of the scale in all domains.Conclusion:In our initial experience,ZSI 475 suffered a high rate of mechanical failures;on the other hand,the company showed great commitment in order to improve the quality and reliability of the device.The lower cost of ZSI 475 may add to the chances of the product to become a cost-effective alternative to treat those patient who need a IPP.

Penile prosthesis implantation in a transsexual neophallus

Reconstruction surgery for a female to male transsexual usually involves mastectomy, hysterectomy and creating anaesthetically appealing neophallus. We have successfiflly inserted an inflatable prosthesis using the AMS CX prosthesisin a 45 year old transsexual, who had a large bulky neophallus constructed from the anterior abdominal subcutaneousfat, about 9 years ago. The single cylinder CX prosthesis was well anchored to the symphysis pubis using a dacronwindsock tubing, the activation pump was placed in the dependent pouch of the right labium and the reservior in theusual perivesical space. The patient subsequently had debulking procedure using liposuction to create a more aestheticand functional phallus. To date, the inflatable neophallus prosthesis is functioning well. (Asian J Androl 2000 Dec;2: 304-306)

Simultaneous penile prosthesis and male sling/artificia urinary sphincter

Erectile dysfunction （ED） and stress urinary incontinence （SUI） from urethral sphincteric deficiency is not an uncommon problem. The commonest etiology is intervention for localized prostate cancer and/or radical cystoprostatectomy for muscle invasive bladder cancer. Despite advances in surgical technology with robotic assisted laparoscopic prostatectomy and nerve sparing techniques, the rates of ED and SUI remain relatively unchanged. They both impact greatly on quality of life domains and have been associated with poor performance outcomes. Both the artificial urinary sphincter and penile prosthesis are gold standard treatments with proven efficacy, satisfaction and durability for end-stage SUI and ED respectively. Simultaneous prosthesis implantation for concurrent conditions has been well described, mostly in small retrospective series. The uptake of combination surgery has been slow due in part to technical demands of the surgery and to an extent, a heightened anxiety over potential complications. This paper aims to discuss the technical aspect of concurrent surgery for both disease entity and the current published outcomes of the various surgical techniques with this approach.

Outcome of implanting penile prosthesis for treating erectile dysfunction： experience with 42 cases

Aim： To report a short-time result of three-piece inflatable penile prosthesis （IPP） implantation on treating patients with organic erectile dysfunction （ED）. Methods： Three-piece IPPs were implanted in 42 Chinese patients with ED refractory to systemic treatment between May 2002 and May 2004. The etiologies of ED were neurogenic （28 with paraplegia and seven with traumatic nervi-erigentes injury）, congenital venous leakage （5 cases）, fibrosis of corpus cavernosum （lcase） and Klinefelter＇s syndrome （1 case）. The follow-up period ranged from 24 to 57 months. Results： Implantation procedures were successfully performed upon all 42 patients. The length of implanted prosthesis was from 13 cm to 18 cm, and the diameter was 1 cm. The implanted prosthesis was made by the Medical Instrumentation Company of Muping （Muping, Shandong, China）. Localized infection occurred in only one patient and mechanical complications occurred in five patients. Coitus could be performed in 41 cases （97.6%）. Three patients with congenital venous leakage made their spouses pregnant after implantation. Conclusion： Implantation of three-piece IPP is an effective and safe modality for treating patients with ED. It can be well accepted by Chinese patients because of its efficacy.

Antibiotic-coated medical devices: with an emphasis on inflatable penile prosthesis

One of the most serious complications associated with the use of the inflatable penile prosthesis is infection. This can lead to significant morbidity for the patient, as well as significant health care costs. A number of methods have been used in attempts at minimizing the infection risk, including applying an antibiotic coating to the medical devise. This review aims to evaluate the effectiveness of these products in preventing clinically significant infections.

Three-dimensional mapping and comparative analysis of the distal human corpus cavernosum and the inflatable penile prosthesis

The intricate anatomy of the corpus cavernosum in both the flaccid and tumescent state has not been fully elucidated. We report our experience using a three-dimensional （3D） scanner to reconstruct cadaveric casts and compare them with 3D images of two prototypes of penile prosthesis. Two different models of the Titan Coloplast inflatable penile prosthesis were analyzed using a 3D scanner. The first was the standard model and the second was a newer model with a rounder silicone tip. Two cadaveric phalluses were harvested using Smooth-Cast 300Q polyurethane molding. The molds were excised and scanned along side the penile prosthesis. 3D scans were completed and analyzed using Leios Mesh software, and GOM Inspect software. The 3D scans demonstrated the mean human corporal radii 2 mm from the distal tip to be 36.51 mm （36.01-37.0 mm）, which is an obtuse angle. The standard Titan penile prosthesis spherical radius at the same level was 202.52 mm, while the new silicone tip prosthesis had a radius of 139.33 mm. 3D mapping further demonstrated the trajectory of the cavernosa appeared curvilinear and the distal ends appeared blunt. The use of cadaveric cavernosal molds in combination with the 3D scanner allowed us to accurately image the corpus cavernosum for the first time. Our findings suggest that anatomically accurate corporal tips appear to be relatively blunt and that the new Titan silicone tip penile prosthesis more closely resembles the human corporal tip.

Complex reimplantation of an inflatable penile prosthesis with scar tissue excision and distal corporal defect repair with Tutoplast®pericardium allograft

Background:Patients with inflatable penile prostheses(IPP)may experience erosions after years of use or after indwelling Foley catheter placement.IPP erosions should be managed as an infection with the entire IPP removed.Replacing IPPs in erosion patients can be challenging due to extensive scarring development.Using proper graft materials may be necessary to close and reinforce the corporal defect after difficult corporal dilation or significant scar removal for the long‐term success of IPP reimplantation.Case Presentation:Herein we report a patient with a history of IPP placement in 2007 for erectile dysfunction and Peyronie's disease,presenting in 2018 with dysuria and a feeling of IPP displacement following Foley catheter placement for coronary artery bypass graft surgery.The left cylinder of the IPP was observed by physical examination and a defect near the fossa navicularis was discovered during office cystoscopy.A complete explantation of IPP was then performed.Reimplantation of the IPP was performed in 2021 which required excision of corporal scar tissue and repair of a left distal corporal defect using a Tutoplast®pericardium allograft.The procedure was successful with proper IPP position and good function without any penile deformity.Conclusion:The use of graft materials in the management of corporeal defects should be considered in the setting of complex IPP revision.The Tutoplast®pericardium allograft reinforcement can provide long‐term durability,flexibility,and a lower risk of infection.

Age is not a number when it comes to penile prosthesis surgery:A case series and mini literature review

Backgound:Given the overall aging of the population,erectile dysfunction(ED)has become an increasingly relevant issue.When elective surgery is offered,the patient's age is often noted as a potential limiting factor.The aim of this study is to investigate the safety of implanting penile prostheses(PPs)in men 90 years and older,and report the potential complications associated with this population.Methods:The database was screened between the years 2003 and 2023 to identify patients at least 90 years and older who underwent implantation of PP by a single surgeon at MD Anderson Cancer Center and Memorial Hermann Texas Medical Center.We collected demographic information,their anesthesia perioperative assessment,surgical procedure details,and postoperative pathway.Results:Between 2003 and 2023,2000 men underwent PP surgery.Three patients were 90 years or older at the time of PP surgeries.All surgeries were performed without intraoperative or postoperative complications.Following the surgery,patients were monitored,and the patients with implantations demonstrated the ability to use the device and reported satisfaction.Conclusion:This case series demonstrates that implantation of PP is a safe and effective treatment for elderly men with ED.Maintaining a satisfactory sexual life in this age group is vital and achievable through inflatable PP insertion.There are several factors that must be considered prior to operating on an older patient.However,with proper patient selection and preoperative optimization,this operation can be effectively performed in these patients.

Implantation of AMS 700 LGX penile prosthesis preserves penile length without the need for penile lengthening procedures

Implantation of an inflatable penile prosthesis （IPP） is a well-established definitive solution for erectile dysfunction when conservative treatments fail. Penile implants may shorten the penis. The AMS 700 LGX IPP is in common use but reports on its mechanical reliability, medium-term postsurgical patient satisfaction, and mean penile length preservation are lacking. We investigate the mean penile length, mechanical reliability, and patient satisfaction at 6 and 12 months after implantation of the AMS 700 LGX. This prospective study consecutively enrolled men undergoing first-time IPP implant surgery from February 2009 to April 2012. Stretched flaccid penile length, penile length at 50% and 100% of stiffness （PSO and P100） and International Index of Erectile Function （IIEF） and Erectile Dysfunction Inventory of Treatment Satisfaction （EDITS） scores, were measured at 6 and 12 months postsurgery. Of 45 patients who underwent AMS 700 LGX implantation （median age 61 years） and completed 6 months＇ follow-up, 36 （80%） completed the study. A significant difference in stretched flaccid penile length was seen between 6 and 12 months （P= 0.033）. P100 was also significantly increased at 6 and 12 months, with a mean 10% increase （1.3 ±0.4 cm） from baseline to 12 months. Differences in mean IIEF scores at 6 and 12 months were significant for the desired domain （P = 0.0001） and for overall satisfaction （P = 0.002）; however, mean EDITS scores at 6 and 12 months were not significantly improved. AMS 700 LGX is a powerful tool for preserving penile length in men undergoing penile prosthesis implantation.

Outcome of penile prosthesis implantation： are malleable prostheses an appropriate treatment option in patients with erectile dysfunction caused by prior radical surgery？

The aim of our study was to evaluate the outcome of penile prosthesis implantation in patients with various comorbidities as a cause of erectile dysfunction （ED）. The data of 181 patients who underwent surgery between 1998 and 2012 in two centers were evaluated. The mean age of the patients was 52.2 years （range： 31-71 years）. The study group contained 162 patients （89.5%） with malleable prostheses and 19 （10.5%） with inflatable implants. All patients were re-evaluated 1 month later to assess prosthesis function and complications, and further re-examinations were performed if needed. Satisfaction was defined as having satisfactory intercourse and happiness with the device in general. The follow-up period was at least 12 months for each patient. The postoperative complication rate was 32% （n = 58）. The number of complications with inflatable and malleable prostheses was 7 （3.9%） and 51 （28.1%）, respectively. Overall, 21 prostheses （11.6%） had to be removed because of various complications and patient dissatisfaction. Patients with prior radical surgery had higher extraction rates （n = 14.606, P 〈 0.05, Chi-square test）. The main reasons for removal were erosion （n = 11; 6.1%） and infection （n = 3; 2.1%）. With respect to satisfaction during intercourse, we found that 104 （57.5%） patients described themselves as very satisfied with the prosthesis, while 21 （11.6%） were unsatisfied. The high explantation rate in patients with prior surgery was remarkable in our study. Our results revealed that a malleable prosthesis should not be the preferred type of implant for patients with prior surgery.

Management of residual penile curvature after penile prosthesis placement

Residual penile curvature is a common situation following the implantation of a penile prosthesis in patients with Peyronie’s disease.Currently,there is a variety of options for the correction of residual curvature,including penile modeling,plication techniques,as well as tunical incision/excision with or without grafting.A literature search of PubMed and Medline databases was conducted from 1964 until 2020,using search terms for all articles in the English language.In this article,we provide a review of the techniques and the outcomes,according to the published literature.

Novel protective penile collar following inflatable penile prosthesis placement: the “Wang Collar”

Penile rehabilitation after inflatable penile prosthesis(IPP)implantation for the treatment of erectile dysfunction includes leaving the device partially inflated so as to preserve the penile length and to maintain hemostasis.With a partially inflated device,the penis becomes more sensitive and more susceptible to unintended insults during the immediate postoperative management.The“Wang Collar,”a device intended to protect the penis in the early postoperative period,is hereby described.Three hundred and forty-eight patients had the 44Wang Collar"included as part of their post-1 PP management from August 2014 to February 2019.The protective collar,devised from a polystyrene cup with the bottom removed,is secured with a tape over the previously dressed and partially inflated penis.In order to evaluate the effectiveness of this device,we conducted surveys on the perioperative staff at three different institutions.The“Wang Collar”has been found to be beneficial in the early postoperative care of patients.Based on the answers to our questionnaire,the perioperative personnel found this device to be highly protective,especially when transporting the patient after IPP surgery,easy to work with,and almost never bothersome or irritative to the patient.We present a novel penile device after IPP placement,which we have found to improve patient satisfaction in the postoperative period.In addition,it eases the care of the patient by the perioperative staff.It is now our routine to use this device after IPP surgery.Further research is necessary to evaluate whether this device can decrease postoperative wound complications.

Penile reconstruction

During the most recent years, a variety of new techniques of penile reconstruction have been described in the literature. This paper focuses on the most recent advances in male genital reconstruction after trauma, excision of benign and malignant disease, in gender reassignment surgery and aphallia with emphasis on surgical technique, cosmetic and functional outcome.

Risk of connective—tissue disease in men with testicular or penile prostheses：a preliminary study

AIM: To help clarifying the possibility of connective-tissue diseases in men with penile or testicular prostheses. METHODS: Eight patients underwent inflatable penile prostheses and 15, testicular prostheses consented to the study. Their medical records were reviewed and a follow-up interview and physical and serological examinations were performed. RESULTS: In patients with penile prostheses, there was no abnormal antinuclear antibody (ANA) or IgM elevation. The serum levels of the rheumatoid factor (RF), C4, IgA and IgG were abnormal in one patient, and the levels of erythrocyte sedimentation rate (ESR) and C3, abnormal in two. Four had elevated IgE. In patients with testicular prostheses, there was no abnormal RF, ANA or IgM. The serum levels of ESR and IgA were abnormal in two, and three had abnormal C4, ten abnormal C3, and eleven decreased IgG. All had increased IgE. Men with penile prostheses had higher serum levels of IgG and IgM than those with testicular prostheses (P=0.001, P=0.016, respectively). The rates of abnormal values of IgE and IgG were higher in men with testicular prostheses than in men with penile prostheses (P=0.008, P=0.009, respectively). Physical examination was normal in all patients and nobody had documented symptoms pertinent to connective-tissue diseases. CONCLUSION: Our findings suggest that the risk of connective-tissue diseases is not higher in patients wearing prostheses as the ANA is negative and there is no apparent manifestation suggestive of connective-tissue diseases.

Current devices,outcomes,and pain management considerations in penile implant surgery:an updated review of the literature

Penile prosthesis surgery is a definitive treatment for erectile dysfunction(ED).The two categories of penile prosthesis are endorsed by professional guidelines,inflatable penile prosthesis(IPP)and malleable penile prosthesis(MPP).Each modality of penile prosthesis offers distinct advantages and incorporates specific design features,allowing for personalized device selection that aligns with individual needs and preferences.While the overall complication rate of penile implant surgery remains low,surgeons should maintain a high index of suspicion for complications in the perioperative time period.Multimodal analgesic regimens including nerve blocks and narcotic-free pathways should be administered to manage perioperative pain.Finally,the high patient satisfaction after penile prosthesis surgery underscores the success of this ED treatment option.

Surgery for Peyronie＇s disease

Peymnie＇s disease （PD） is most simply referred to as a fibrotic wound-healing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, hinging, narrowing and shortening, which may compromise sexual function. Although a variety of non-surgical treatments have been suggested, none to date offer a reliable and effective correction of the penile deformity. As a result, surgery remains the gold standard treatment option, offering the most rapid and reliable treatment which will be the focus of this article. We review the preoperative evaluation, surgical algorithm, graft materials and postoperative management of PD. Outcomes for tunical shortening, tunical lengthening and penile prosthesis placement for penile straightening are reviewed. Tunica albuginea plication is the preferred method of straightening for men with adequate rigidity and less severe disease defined as curvature less than 70° without narrowing/hinging. Men who have more severe, complex deformity, but maintain strong preoperative erectile function should be considered candidates for straightening with plaque incision or partial excision and grafting. Finally, for those men who have inadequate rigidity and PD, penile prosthesis placement with straightening is the best approach to address both problems.