Current Management of Penile Implant Infections, Device Reliability, and Optimizing Cosmetic Outcome
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Penile implants hold a major position in the treatment algorithm for patients with erectile dysfunction who find medications and vacuum erection devices ineffective or unsatisfactory. As with any surgical procedure, adverse events may occur. The infection rate associated with implant placement has been lowered to the range of 1 % or less due to multifactorial improvements including no-touch techniques, the use of antibiotic-coated devices, and improved quality measures in the operating room. Urologists have been proactive in employing techniques and procedures which minimize loss of erectile length, hence enhancing patient satisfaction. Flat reservoirs have been developed and techniques of placing these to avoid problems in the space of Retzius have reduced complication rates as well. Device reliability has improved to the point that penile implants are among the most durable mechanical surgical products that contribute to patient and partner satisfaction, which is by far the greatest among all the treatments of erectile dysfunction.
KeywordsPenile implant infection Penile enlargement Penile implant reservoir placement Satisfaction with penile implants Penile implant reliability Penile implant complications
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Conflict of Interest
Dr. Andrew Kramer, Dr. Justin L. Parker, Dr. Paul E. Perito, Dr. Richard Bryson, and Dr. Meagan Dunne each declare no potential conflicts of interest.
Dr. John J. Mulcahy received honoraria, payment for the development of educational presentations including service on speakers’ bureaus, and travel/accommodations expenses covered or reimbursed from AMS and Coloplast.
Dr. William O. Brant is consultant for and has had travel/accommodations expenses covered or reimbursed from AMS and Coloplast. Dr. Brant receives royalties from Smith’s Urology and UpToDate. Dr. Brant has received grants from AMS and The Joe W. and Dorothy Dorsett Brown Foundation. Dr. Brant gave expert testimony on behalf of COPIC Medical Insurance.
Dr. Jeremy B. Myers is a board member for International Volunteers in Urology.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 3.•Darouiche RO, Wall MJ, Kamal MF, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical site antisepsis. N Engl J Med. 2010;362:18–26. This study shows that a chlorhexidine-alcohol skin prep is 40% more effective in reducing surgical site infection when compared with the standard povidone-iodine prep.PubMedCrossRefGoogle Scholar
- 4.••Eid F. No-touch technique. J Sex Med. 2011;8:5–8. Dr Eid’s compulsive no-skin-touch implantation technique series has perhaps the lowest infection rate for penile implant placement on record. This reinforces the concept that infectious organisms are introduced via the wound and not by hematogenous spread.PubMedCrossRefGoogle Scholar
- 8.Richardson B, Caire A, Hellstrom W. Retrospective long-term analysis of Titan hydrophilic coating: positive reduction of infection compared to non-coated device. J Sex Med. 2010;7:28.Google Scholar
- 10.•Köhler TS, Modder JK, Dupree JM, Bush NC, McVary KT. Malleable implant substitution for the management of penile prosthesis pump erosion: a pilot study. J Sex Med. 2009;6:1474–8. The less complicated approach of placing semirigid spacer rods only following salvage irrigations is to be recommended especially where there is severe inflammation in the scrotum.PubMedCrossRefGoogle Scholar
- 14.••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;03:14–8. For the motivated patient who has a strong desire to maintain as much erectile length as possible after implant placement this regimen is effective and strongly recommended.CrossRefGoogle Scholar
- 20.•Hakky TS, Suber J, Henry G, Smith D, Bradley P, Martinez D, et al. Penile enhancement procedures with simultaneous penile prosthesis placement. Adv Urol. 2012;2012:314612. This ventral phalloplasty is a simple procedure which usually adds little time and morbidity to the implant procedure and can enhance patient satisfaction significantly.PubMedCentralPubMedCrossRefGoogle Scholar
- 30.••Chung E, Solomon M, Deyoung L, Brock GB. Comparison between AMS 700 CX and Coloplast Titan Inflatable Penile Prosthesis for Peyronie's disease treatment and remodeling: clinical outcomes and patient satisfaction. J Sex Med. 2013;10(11):2855–60. This study demonstrates that the mechanical reliability and patient satisfaction with the 3-piece inflatable penile implant is similar with both vendors products.Google Scholar
- 33.Menard J, Tremeaux JC, Faix A, Pierrevelcin J, Staerman F. Erectile function and sexual satisfaction before and after penile prosthesis implantation in radical prostatectomy patients: a comparison with patients with vasculogenic erectile dysfunction. J Sex Med. 2011;8(12):3479–86.PubMedCrossRefGoogle Scholar
- 43.Enemchukwu EA, Kaufman MR, Whittam BM, Milam DF. Comparative revision rates of inflatable penile prostheses using Woven Dacron(R) Fabric cylinders. J Urol 2013.Google Scholar