Penile Prosthesis Implant Following Pelvic Surgery

Objectives: The Italian Society of Andrology, i.e. “Società Italiana di Andrologia” (S.I.A.), launched on December 2014 a prospective, multicenter, monitored and internal review board approved Registry for penile implants, the “INSIST-ED” (Italian Nationwide Systematic Inventarisation of Surgical Treatment for ED) Registry. Purpose of this first report is to present a baseline data analysis of the characteristics of penile implant surgery in Italy. Material and methods: The INSIST-ED Registry is open to all surgeons implanting penile prostheses (all brands, all models) in Italy, providing anonymous patient, device, surgical procedure, outcome, follow-up data, for both first and revision surgeries. A Registry project Board overviews all the steps of the project, and a Registry Monitor interacts with the Registry implanting surgeons. Results: As by April 8, 2016, 31 implanting surgeons actively joined the Registry, entering 367 surgical procedures in its database, that comprise: 310 first implants, 43 prosthesis substitutions, 14 device explants without substitution. Implanted devices account for: 288 three-component devices (81,3%), 20 two-component devices (5,4%), 45 non-hydraulic devices (12,3%). Leading primary ED etiologies in first implant surgeries resulted: former radical pelvic surgery in 111 cases (35,8%), Peyronie’s disease in 66 cases (21,3%), diabetes in 39 cases (12,6%). Two intraoperative complications have been recorded. Main reasons for 57 revision surgeries were: device failure (52,6%), erosion (19,3%), infection (12,3%), patient dissatisfaction (10,5%). Surgical settings for patients undergoing a first penile implant were: public hospitals in 251 cases (81%), private environments in 59 cases (19%). Conclusions: The INSIST-ED Registry represents the first European experience of penile prosthesis Registry. This baseline data analysis shows that: three-pieces inflatable prosthesis is the most implanted device, leading etiology of erectile dysfunction (ED) in patient receiving a prosthesis is former radical pelvic surgery, primary reason for revision surgery is device failure, primary settings for first penile implant surgery are public hospitals. Evaluation of penile implant impact on recipients quality of life is presently ongoing.

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Intra-peritoneal versus retropubic implantation of three-piece inflatable penile prosthesis: Patient-reported outcomes and complications

Urologia Journal ◽

10.1177/0391560320967876 ◽

2020 ◽

pp. 039156032096787

Author(s):

Alessandro Natali ◽

Simone Grisanti Caroassai ◽

Giovanni Tasso ◽

Gianmartin Cito ◽

Luca Gemma ◽

...

Keyword(s):

Quality Of Life ◽

Penile Prosthesis ◽

Long Term Results ◽

Pelvic Surgery ◽

Inflatable Penile Prosthesis ◽

Retropubic Space ◽

Patient Reported ◽

Tissue Alteration ◽

Device Use

Introduction: The role of reservoir position was investigated in this series of patients treated with three-pieces penile prosthesis implantation (PPI). The outcomes and the patients’ reported quality of life after insertion of the balloon in the retropubic space, or the Retzius’s space (SOR), were compared with the outcomes of patients who received an intraperitoneal implantation (IP). The study aimed to analyze how the anatomy of the SOR influenced the long-term results of PPI, especially in patients who have been previously exposed to pelvic surgery or radiotherapy. The SOR has usually been identified as ideal for concealing and protecting the reservoir; nevertheless, an increasing rate of patients that ask for a PPI do not conserve the typical favorable characteristic of the SOR. In these cases, the tissue alteration can cause a higher rate of undesired events and can impair the satisfaction from device use. In the recent literature, few articles focus on the topic of reservoir position and very poor information is available about the results of the IP insertion. Materials: Our cohort of patients was retrospectively inspected; the two different subgroups, according to the reservoir position (SOR or IP) were evaluated considering the pre-operative condition, the post-operative complication, the development of undesired events or uncomfortable sensations during the follow-up. The quality of life after PPI was observed as well, with a questionnaire specifically developed for patients treated with PPI. The surgical technique adopted for the intraperitoneal implantation was described. Results: The results of penile prosthesis functionality and patients’ and partners’ reported quality of life (QoL) showed similar results between the two groups but greater satisfaction in the relational domain of the questionnaires adopted was described in the IP subgroup. Conclusion: According to our observations, the IP reservoir insertion guarantees good functionality and lower rates of undesired events after PPI.

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Radical cystectomy and orthotopic neobladder in a patient with a preexisting three-components inflatable penile prosthesis

Urologia Journal ◽

10.1177/03915603211033165 ◽

2021 ◽

pp. 039156032110331

Author(s):

Giacomo Rebez ◽

Ottavia Runti ◽

Michele Rizzo ◽

Carlo Trombetta ◽

Giovanni Liguori

Keyword(s):

Erectile Dysfunction ◽

Urothelial Carcinoma ◽

Radical Cystectomy ◽

Penile Prosthesis ◽

Pelvic Surgery ◽

Orthotopic Neobladder ◽

Inflatable Penile Prosthesis ◽

Oncologic Patients ◽

Carcinoma Of The Bladder ◽

Three Components

Introduction and objectives: As erectile dysfunction is more commonly being diagnosed and treated with a preexisting inflatable penile prosthesis (IPP) insertion at younger ages, surgeons will increasingly encounter pre-placed abdominal reservoirs when performing pelvic surgery. Materials and methods: A 69-year-old Caucasian man with BCG refractory carcinoma-in-situ (CIS) and past history of non-invasive high-grade urothelial carcinoma of the bladder was a candidate for a radical cystectomy and an ileal-neobladder diversion. He had a three-components IPP inserted for the treatment of Peyronie disease and organic erectile dysfunction (ED). During the radical cystectomy the reservoir was encapsulated on the left lateral pelvic wall over the external iliac vessels. It was isolated and IPP was inflated to reduce the reservoir size. After accurate disinfection, the reservoir was removed from Retzius space without disconnecting it from the pump. Then, the radical cystectomy was carried out without any intraoperative complications and Studer ileal orthotopic neobladder was performed. At the end of the surgery, the reservoir was disinfected with the Mulcahy protocol and then placed in the same position. Results: A week after catheter removal the IPP was successfully activated. The patient’s postoperative recovery was uneventful and no postoperative complication occurred. Definitive histological examination described a multifocal urothelial carcinoma of the bladder: pG3Tis N0 R0. The patient reports excellent functionality of the penile prosthesis and is currently using it. Conclusions: Sexual functionality preservation in oncologic patients should be pursued when possible. In this report, the functionality of the IPP was preserved, while still performing oncologically radical procedures. A multicenter study is needed to assure more solid recommendations on this rare procedure that is surely burdened by a lot of risks.

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Self and partner satisfaction rates after 3 part inflatable penile prosthesis implantation

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2014.3.219 ◽

2014 ◽

Vol 86 (3) ◽

pp. 219 ◽

Cited By ~ 2

Author(s):

Abdulmuttalip Simsek ◽

Onur Kucuktopcu ◽

Faruk Ozgor ◽

Unsal Ozkuvanci ◽

Murat Baykal ◽

...

Keyword(s):

Doppler Ultrasound ◽

Penile Prosthesis ◽

The Other ◽

Pelvic Surgery ◽

Prosthesis Implantation ◽

Satisfaction Rate ◽

Inflatable Penile Prosthesis ◽

Synthetic Materials ◽

Partner Satisfaction ◽

Satisfaction Rates

Objective: To evaluate and present satisfaction rates of our patients and their partners after 3 part inflatable penile prosthesis implantation. Materials and methods: We searched our hospital electronic data for patients who underwent inflatable penile prosthesis implantation between January 2008 and July 2013. Computer and archived file data were used to get information and reach the patients. We made telephone calls to patients and asked questionnaires about self and partner satisfaction rates. Results: 36 patients underwent prosthesis implantation during the 5 year period. We were able to reach by telephone call 18 of them. The mean age of 18 patients was 55.7 ± 9.4 years and mean body mass index was 24.6 ± 2.1 kg/m2. The etiology was diabetes mellitus on 14 (77.8%) and radical pelvic surgery on 4 (22.2%) patients. 14 of 18 patients had penile Doppler ultrasound test. Doppler ultrasound demonstrated venous insufficiency in 8 and arterial insufficiency in 6 patients. Mean time from implantation to study was 20.8 ± 13.9 months. Out of 18 patients 2 had prosthesis removal operation because of infection in one patient and perforation in the other. Satisfaction rate was 88.9%, and recommendation rate was 94.4%. Causes of dissatisfaction were pain in one patient and insufficient rigidity plus shortening of the penis in the other one. Partner satisfaction rate was 94.4%. Conclusion: Penile Prosthesis Implantation (PPI) is the gold standard treatment of erectile dysfunction (ED) irresponsive to medical treatment. Infection and mechanical failure rates are going to be less according to the improvements in synthetic materials and coverings of the prosthesis, so patient and partner satisfaction rates will be higher.

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Inflatable penile prosthesis in the radical prostatectomy patient: a review

F1000Research ◽

10.12688/f1000research.15241.1 ◽

2018 ◽

Vol 7 ◽

pp. 770 ◽

Cited By ~ 3

Author(s):

Nelson Bennett ◽

I-shen Huang

Keyword(s):

Prostate Cancer ◽

Erectile Function ◽

Penile Prosthesis ◽

Review Article ◽

Pelvic Surgery ◽

Significant Issue ◽

Inflatable Penile Prosthesis ◽

Special Patient Population ◽

Special Patient ◽

Urinary Control

In the population of patients with prostate cancer, survivorship has come to the forefront of continuity-of-care. In addition to urinary control, erectile function is a significant issue after radical pelvic surgery. Penile prosthesis surgery remains an excellent option for restoring erectile function to those for whom more conservative measures have failed. This review article outlines the anatomical, surgical and post-operative consideration involved in the placement of a penile prosthesis in this special patient population.

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Comparison of penile prosthesis types' complications: A retrospective analysis of single center

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2020.4.386 ◽

2020 ◽

Vol 92 (4) ◽

Author(s):

Erdem Kisa ◽

Mehmet Zeynel Keskin ◽

Cem Yucel ◽

Murat Ucar ◽

Okan Yalbuzdag ◽

...

Keyword(s):

Postoperative Complication ◽

Penile Prosthesis ◽

Diabetes Type 2 ◽

Pelvic Surgery ◽

Complication Rates ◽

Initial Surgery ◽

Significant Difference ◽

Lower Complication ◽

Group 2 ◽

Group 1

Objectives: The aim of this study was to compare clinical outcomes and complication rates associated with semirigid (malleable) and inflatable penile prostheses (PPs) and investigate the factors that influence these complications. Material and methods: The records of 131 patients who had undergone penile prosthesis implantation (PPI) in our clinic due to erectile dysfunction (ED) between January 2010 and March 2019 were retrospectively reviewed. The initial surgery included 116 primary implants and 15 men had two revision operations. Patients were assigned to two groups as semirigid (malleable) PPI (group 1) and inflatable PPI (group 2) patients, and obtained data were compared across these two groups. Results: Group 1 included 93 patients, while Group 2 included 38 patients. Postoperative complication rates of Group 1 were 8.6% (n = 8), and Group 2 were 21% (n = 8), and the comparison of postoperative complication rates revealed a statistically significant difference between the two groups (p = 0.025). The majority of these complications (50%) was constituted by mechanical failure associated with inflatable PPs. When patients were further segregated as those with and without diabetes type 2 (DM) and those who had and had not undergone radical pelvic surgery (RPS), the comparison of complication rates across these subgroups did not yield any significant difference. Conclusions: We determined in this study that semirigid (malleable) PPs were associated with lower complication rates compared to the inflatable group, particularly with regard to mechanic failure, and that DM and history of RPS did not make a difference in complication rates in patients planned to undergo PPI.

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Patient’s satisfaction after 2-piece inflatable penile prosthesis implantation: An Italian multicentric study

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2016.1.1 ◽

2016 ◽

Vol 88 (1) ◽

pp. 1 ◽

Cited By ~ 13

Author(s):

Giorgio Gentile ◽

Alessandro Franceschelli ◽

Paolo Massenio ◽

Agostino Tuccio ◽

Andrea Cocci ◽

...

Keyword(s):

Erectile Dysfunction ◽

Penile Prosthesis ◽

Functional Results ◽

The Elderly ◽

Sexual Life ◽

Pelvic Surgery ◽

Multicentric Study ◽

Patient’S Satisfaction ◽

Inflatable Penile Prosthesis

Introduction: Penile prosthesis implant represents a valuable solution for pts with severe erectile dysfunction (ED), non-responders to medical management. The aim of our study was to evaluate the satisfaction of patients (pts) after 2-pieces inflatable penile prosthesis (IPP). Aim of the study: to evaluate safety, reliability and post-operative patient’s satisfaction after implantation of two-pieces IPP. Materials and Methods: This retrospective multicentric analysis concerns a group of 42 patients undergone 2-pieces IPP implantation from November 2005 to November 2013, in four Centers of proven experience. As a first step, a detailed review of all clinical reports was performed. Secondly, every patient was asked to fill the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) specifically modified, in order to assess their own satisfaction after surgery and, its impact on patient’s quality of sexual life. Results: 42 pts were evaluated (AMS-Ambicor: 28; Coloplast- Excell: 14); mean age, at time of operation: 60,7 years; mean follow up: 27,6 months; etiology of ED: vascular 23,8%, diabetes 19%, La Peyronie D. 7,1%, consequence of radical prostatectomy 31%, consequence of other pelvic surgery 11,9%, spinal trauma 7%. Mean operative time: 117 ± 58 min, mean postoperative hospital stay 3 ± 1,6 days. Post operative short-term complications: 4 pts (9,5%). Post operative long-term complications: 4 pts (9,5%). Long-term functional results (Questionnaire): 71% of pts (30) reported regular use of the prosthesis, at least 1 time/week, the satisfaction was good in 42% of pts (18), quite good in 33,3% (14), quite bad in 2,4% (1), very bad in 7,1% (3), 6 pts (14,4%) didn’t answer. Conclusions: 2 pieces IPP appears to be associated with a low complication rate and good satisfaction of pts especially in the elderly. It also assures satisfactory rates of aesthetics and functional results.

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