UroToday – While erectile dysfunction has been described since ancient times, adequate treatment has only been available for the last three decades. Modern penile prosthetic devices were first developed in the early 1970s when Small et al. along with Scott et al. reported the implantation of penile prosthetic devices into the corpora cavernosa to fill the corpora cavernosa and provide a physiologically functional erection with good cosmetic results.

Semirigid rod and mechanical prostheses available today are the successors of the devices designed in the 1970s. These devices, while easier to implant, have few advantages over the newer inflatable devices because infection and mechanical malfunction rates are similar. The semirigid devices consist of a central metal core and a silicone elastomer rod while the mechanical Dura II implant is a series of disks held in position by a central cable. The latter design facilitates positioning of the implant between uses.

The three-piece inflatable penile prostheses vary in construction from three-layer silicon/Dacron/Lycra to a single layer of silicon or Bioflex . Options include girth expansion and/or length elongation. Design modifications over the past two decades have decreased mechanical malfunction rates from greater than 30% to less than 5% and antibiotic coating has reduced the infection rates from over 4% to fewer than 1%.

The three-piece inflatable penile prostheses continue to be the most satisfactory prostheses. These prosthetic devices produce the most natural appearing erection in girth, length, and with satisfactory rigidity and excellent flaccidity for optimal concealment. They also have advantages for many patients with complex penile implantations because the flaccid position removes pressure from the corporal cavernosa and decreases the possibility of erosion in these highly difficult implantations.

Patients chosen for penile implantation therapy are usually those that have failed PDE5 inhibitors and less invasive therapy. Careful informed consent is critical in counselling patients before surgery. Post operatively patients should be counselled to cycle their devices daily and that satisfaction increases over 3 to 6 months after implantation. Multicenter studies have documented the long term satisfaction and normal mechanical function of penile implants and their satisfaction rates. Patients queried 5 years after surgery were using their implants an average of three times monthly.

Presented by: Culley C. Carson, MD, at the Masters in Urology Meeting – July 31, 2008 – August 2, 2008, Elbow Beach Resort, Bermuda

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