Optimizing Outcomes in the Virgin Penile Implant Patient

Abstract

Purpose of Review

Patient satisfaction with inflatable penile prosthesis (IPP) is an elective procedure that restores erectile function.

Recent Findings

While the return of usable erections is almost always achieved with IPP, patients may still be unhappy with the procedure if the outcome has not met their expectations. Optimizing patient satisfaction and outcomes should incorporate considerations for pre-, intra-, and postoperative factors. Length optimization regimens and improved pain control options have dominated the recent literature.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Rajpurkar A, Dhabuwala CB. Comparison of satisfaction rates and erectile function in patients treated with sildenafil, intracavernous prostaglandin E1 and penile implant surgery for erectile dysfunction in urology practice. J Urol. 2003;170:159–63.

    CAS  Article  Google Scholar 

  2. 2.

    Tefilli MV, Dubocq F, Rajpurkar A, Gheiler EL, Tiguert R, Barton C, et al. Assessment of psychosexual adjustment after insertion of inflatable penile prosthesis. Urology. 1998;52:1106–12.

    CAS  Article  Google Scholar 

  3. 3.

    Deveci S, Martin D, Parker M, Mulhall JP. Penile length alterations following penile prosthesis surgery. Eur Urol. 2007;51:1128–31.

    Article  Google Scholar 

  4. 4.

    Habous M, Giona S, Tealab A, Aziz M, Sherif H, Abdelwahab O, et al. Penile length is preserved after implant surgery. BJU Int. 2018. https://doi.org/10.1111/bju.14604.

  5. 5.

    Montorsi F, Rigatti P, Carmignani G, Corbu C, Campo B, Ordesi G, et al. AMS three-piece inflatable implants for erectile dysfunction: a long-term multi-institutional study in 200 consecutive patients. Eur Urol. 2000;37:50–5.

    CAS  Article  Google Scholar 

  6. 6.

    Levine LA, Rybak J. Traction therapy for men with shortened penis prior to penile prosthesis implantation: a pilot study. J Sex Med. 2011;8:2112–7.

    Article  Google Scholar 

  7. 7.

    Montague DK. Penile prosthesis implantation for end-stage erectile dysfunction after radical prostatectomy. Rev Urol, suppl. 2005;7:S51.

    Google Scholar 

  8. 8.

    Bernal RM, Henry GD. Contemporary patient satisfaction rates for three-piece inflatable penile prostheses. Adv Urol. 2012:707321.

  9. 9.

    Sellers T, Dineen M, Salem EA, Wilson SK. Vacuum preparation, optimization of cylinder length and postoperative daily inflation reduces complaints of shortened penile length following implantation of inflatable penile prosthesis. Adv Sex Med. 2013;3:14–8.

    Article  Google Scholar 

  10. 10.

    •• Trost LW, Baum N, Hellstrom WJ. Managing the difficult penile prosthesis patient. J Sex Med. 2013;10:893. A review of urology and non-urologic cosmetic surgery literature which identified factors associated with patient satisfaction. Identified “high risk” factors associated with patient dissatisfaction–907.

    Article  Google Scholar 

  11. 11.

    • Habous M, Tal R, Tealab A, et al. Predictors of satisfaction in men after penile implant surgery. J Sex Med. 2018;15:1180 Multi-center study of 902 patients utilizing a single question assessment at 6 months after penile implant. Complication type and rates were correlated with satisfaction scores. Any complication and particularly major complication lowered satisfaction scores.

    Article  Google Scholar 

  12. 12.

    Montgomery BD, Lomas DJ, Ziegelmann MJ, Trost LW. Infection risk of undergoing multiple penile prostheses: an analysis of referred patient surgical histories. Int J Impot Res. 2018;30:147–52.

    Article  Google Scholar 

  13. 13.

    Montague DK, Angermeier KW. Cylinder sizing: less is more. Int J Impot Res, suppl. 2003;15:S132–3.

    Article  Google Scholar 

  14. 14.

    Henry G, Houghton L, Culkin D, Otheguy J, Shabsigh R, Ohl DA. Comparison of a new length measurement technique for inflatable penile prosthesis implantation to standard techniques: outcomes and patient satisfaction. J Sex Med. 2011;8:2640–6.

    Article  Google Scholar 

  15. 15.

    Ball TP Jr. Surgical repair of penile “SST” deformity. Urology. 1980;15:603–4.

    Article  Google Scholar 

  16. 16.

    Ziegelmann MJ, Alom M, Bole R, Kohler T, Trost L. Modified glanulopexy technique for supersonic transporter deformity and glanular hypermobility in men with penile prostheses. J Sex Med. 2018;15:914–9.

    Article  Google Scholar 

  17. 17.

    Welliver C, Kottwitz M, Ahmad AE, et al. Manufacturers’ data show increasing implanted cylinder sizes and measured corporal lengths in inflatable penile implants. World J Urol. 2016;34:993.

    Article  Google Scholar 

  18. 18.

    Szostak MJ, DelPizzo JJ, Sklar GN. The plug and patch: a new technique for repair of corporal perforation during placement of penile prostheses. J Urol. 2000;163:1203–5.

    CAS  Article  Google Scholar 

  19. 19.

    Mooreville M, Adrian S, Delk JR 2nd, et al. Implantation of inflatable penile prosthesis in patients with severe corporeal fibrosis: introduction of a new penile cavernotome. J Urol. 1999;162:2054–7.

    CAS  Article  Google Scholar 

  20. 20.

    Knoll LD, Furlow WL, Benson R, et al. Management of nondilatable cavernous fibrosis with the use of a downsized inflatable penile prosthesis. J Urol. 1995;153:366–7.

    CAS  Article  Google Scholar 

  21. 21.

    Jordan GH, Alter GJ, Gilbert DA, Horton CE, Devine CJ. Penile prosthesis implantation in total phalloplasty. J Urol. 1994;152:410–3.

    CAS  Article  Google Scholar 

  22. 22.

    Wilson SK. Surgical techniques: rear tip extender sling: a quick and easy repair for crural perforation. J Sex Med. 2010;7:1052–5.

    Article  Google Scholar 

  23. 23.

    Sexton SJ, Granieri MA, Lentz AC. Survey on the contemporary management of intraoperative urethral injuries during penile prosthesis implantation. J Sex Med. 2018;15:576–81.

    Article  Google Scholar 

  24. 24.

    Mulcahy JJ. Prevention and correction of penile implant problems. AUA Update Series. 1994; 13: lesson 27.

  25. 25.

    Antonini G, Busetto GM, Del Giudice F, et al. Distal corporal anchoring stitch: a technique to address distal corporal crossovers and impending lateral extrusions of a penile prosthesis. J Sex Med. 2017;14:767–73.

    Article  Google Scholar 

  26. 26.

    Henry G, Hsaio W, Karpman E, Bella AT, Carrion R, Jones L, et al. A guide for inflatable penile prosthesis reservoir placement: pertinent anatomical measurements of the retropubic space. J Sex Med. 2014;11:273–8.

    Article  Google Scholar 

  27. 27.

    Chung PH, Morey AF, Tausch TJ, Simhan J, Scott JF. High submuscular placement of urologic prosthetic balloons and reservoirs: 2-year experience and patient-reported outcomes. Urology. 2014;84:1535–40.

    Article  Google Scholar 

  28. 28.

    Clavell Hernandez J, Trost L, Kohler T, et al. Emerging complications following alternative reservoir placement during inflatable penile prosthesis placement: a 5-year multi-institutional experience. J Urol. 2018;199. https://doi.org/10.1016/j.juro.2018.10.013.

  29. 29.

    Ziegelmann MJ, Viers BR, Lomas DJ, Westerman ME, Trost LW. Ectopic penile prosthesis reservoir placement: an anatomic cadaver model of the high submuscular technique. J Sex Med. 2016;13:1425–31.

    Article  Google Scholar 

  30. 30.

    Gross MS, Stember DS, Garber BB, Perito PE. A retrospective analysis of risk factors for IPP reservoir entry into the peritoneum after abdominal wall placement. Int J Impot Res. 2017;29:215–8.

    CAS  Article  Google Scholar 

  31. 31.

    Miranda-Sousa A, Keating M, Moreira S, Baker M, Carrion R. Concomitant ventral phalloplasty during penile implant surgery: a novel procedure that optimizes patient satisfaction and their perception of phallic length after penile implant surgery. J Sex Med. 2007;4:1494–9.

    Article  Google Scholar 

  32. 32.

    Sulaver R, Welliver R, Kottwitz M, et al. PD26-08 SCROTOPLASTY at time of penile implant is at high risk for dehiscence in diabetics. J Urol. 2015;193:e569.

    Article  Google Scholar 

  33. 33.

    Köhler TS, Hellstrom JG. Using wound drains for the uncomplicated penile prosthesis. J Urol. 2011;186:1187–9.

    Article  Google Scholar 

  34. 34.

    Sadeghi-Nejad H, Ilbeigi P, Wilson SK, Delk JR, Siegel A, Seftel AD, et al. Multi-institutional outcome study on the efficacy of closed-suction drainage of the scrotum in three-piece inflatable penile prosthesis surgery. Int J Impot Res. 2005;17:535–8.

    CAS  Article  Google Scholar 

  35. 35.

    Cotta BH, Welliver C, Brahmamdam A, Bednarchik CL, Dynda D, Kohler TS. Long-acting liposomal bupivacaine decreases inpatient narcotic requirements in men undergoing penile prosthesis implantation. Turk J Urol. 2016;42:230–4.

    Article  Google Scholar 

  36. 36.

    • Tong CMC, Lucas J, Shah A, et al. Novel multi-modal analgesia protocol significantly decreases opioid requirements in inflatable penile prosthesis patients. J Sex Med. 2018;15:1187 Study utilizing multi-modal anesthesia protocol (acetaminophen, meloxicam, gabapentin, and intraoperative nerve blocks) for peri- and postprocedural pain control. Differences in pain scores and narcotic use were found.

    Article  Google Scholar 

  37. 37.

    Mulhall JP, Ahmed A, Branch J, et al. Serial assessment of efficacy and satisfaction profiles following penile prosthesis surgery. J Urol. 2003;169:1429–33.

    Article  Google Scholar 

  38. 38.

    Mulhall JP, Jahoda A, Aviv N, Valenzuela R, Parker M. The impact of sildenafil citrate on sexual satisfaction profiles in men with a penile prosthesis in situ. BJU Int. 2004;93:97–9.

    CAS  Article  Google Scholar 

  39. 39.

    Henry GD, Carrion R, Jennermann C, Wang R. Prospective evaluation of postoperative penile rehabilitation: penile length/girth maintenance 1 year following Coloplast Titan inflatable penile prosthesis. J Sex Med. 2015 May;12(5):1298–304.

    Article  Google Scholar 

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Correspondence to Charles Welliver.

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Charles Welliver is a paid consultant for Coloplast.

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Welliver, C. Optimizing Outcomes in the Virgin Penile Implant Patient. Curr Urol Rep 20, 14 (2019). https://doi.org/10.1007/s11934-019-0876-6

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Keywords

  • Penile implant
  • Patient satisfaction