Abstract
The prevalence of impotence in diabetes mellitus ranges as high as 75%. The implantation of an inflatable penile prosthesis (IPP) is frequently carried out to restore erectile function. However, clinical studies have demonstrated that severe post-implantation penile pain during erection is a common complication in diabetic men. A biomechanical model of the penis/prosthesis complex is developed, based on cross-sectional anatomy, to simulate the internal stress distribution due to interaction of the prosthesis with both normal and diabetic penile tissues. The material properties of the model components are adopted from experimental data. The model is solved by using commercial finite-element software for a characteristic inflation loading of the penile prosthesis. Elevated structural stresses during erection are found in the dorsal aspect of the tunica albuginea (normal 5.1–31.5 kPa, diabetic 5.1–70 kPa post-implantation). Following IPP implantation, stresses in the diabetic penis are almost as twice as high as those in the normal one and can cause a painful sensation owing to nerve stimulation or to ischaemia in regions of compressed vascular tissue.
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References
Bankroft, J., andGutierrez, P. (1996): ‘Erectile dysfunction in men with and without diabetes mellitus: A comparative study’,Diabet. Med.,13, p. 84–89
Bitsch, M., Kromann-Andersen, B., Schou, J., andSjontoft, E. (1990): ‘The elasticity and tensile strength of the tunica albuginea’,J. Urol.,143, pp. 642
Brock, G., Hsu, G. L., Nunes, L., Von Heyden, B., andLue, T. (1997): ‘The anatomy of the tunica albuginea in the normal penis and Peyronie's disease’,J. Urol.,157, pp. 276–281
Brownlee, M., Cerami, A., andVlassara, H. (1988): ‘Advanced glycosylation end products in tissue and the biochemical basis of diabetic complications’,N. Engl. J. Med.,318, pp. 1315–1321
Buchhauser, K. (1990): ‘Erectile dysfunction’ (Planegg, Hanns Gebele GmbH)
Culcha, M., Alici, B., Acar, O., Multu, N., andGakalp, A. (1998): ‘The relationship between Diabetes Mellitus, impotence and veno-occlusive dysfunction in Peyronie's disease patients’,Urol. Int.,60, pp. 101–104
Dalton, J. R. (1983): ‘Basic clinical urology’ (Harper and Row, Philadelphia)
Gefen, A., Megido-Ravid, M., Azariah, M., Itzchak, Y., andArcan, M. (1998): ‘Integrating a photoelastic device into Open MRI for soft tissue mechanics studies’, Proc. 11th Int. Conf. on Experimental mechanics, Oxford, UK, pp. 829–833
Gefen, A., Elad, D., andShiner, R. J. (1999): ‘Analysis of stress distribution in the alveolar septa of normal and simulated emphysematic lungs’,J. Biomech.32, pp. 891–897
Gray, H. (1995): ‘Gray's anatomy,’ (Churchill Livingstone, Edinburgh)
Gregory, J. G., Parra, R. O., andPurcell, M. H. (1988a): ‘Impotence: an historic perspective’,Am. Soc. Artif. Intern. Organs,34, pp. 987–991
Gregory, J. G., Parra, R. O., andPurcell, M. H. (1988b): ‘Diagnosis and treatment of erectile dysfunction’,Am. Soc. Artif. Int. Organs,34, pp. 991–993
Hakim, L. S., andGoldstein, I. (1996): ‘Diabetic sexual dysfunction’,Endocrin. Metab. Clin. North. Am.,25, pp. 379–400
How, T. V. (1992): ‘Mechanical properties of arteries and arterial grafts’,inHastings, G. W. (Ed.): ‘Cardiovascular biomaterials’ (Springer-Verlag, London), pp. 1–35
Hsu, G. L., Brock, G., Martinez-Pineiro, L., von Heyden, B., Lue, T., andTanagho, E. A. (1994): ‘Anatomy and strength of the tunica albuginea: its relevance to penile prosthesis extrusion’,J. Urol.,151, pp. 1205–1208
Krane, R. J., Goldstein, I., andDe Tejada, I. S. (1989): ‘Impotence’,N. Engl. J. Med.,321, pp. 1648–1659
Mersdorf, A., Goldsmith, P. C., Diederichs, W., Padula, C. A., Lue, T. F., Fishman, I. J., andTanagho, E. A. (1991): ‘Ultrastructural changes in impotent penile tissue: A comparison of 65 patients’,J. Urol.,145, pp. 749–758
Moncada, I., Hernandez, J. J., Hernandez, L., Lafuente, J., Lledo, E., Rodriguez, E., andSaenz De Tejada, I. (1998): ‘Buckling of cylinders may cause prolonged penile pain after prosthesis implantation: A case control study using magnetic resonance imaging of the penis’,J. Urol.,160, pp. 67–71
Nehra, A., Azadzoi, K. M., Moreland, R. B., Pabby, A., Siroky, M. B., Krane, R. J., andGoldstein, I. (1998): ‘Cavernosal expandability is an erectile tissue mechanical property which predicts trabecular histology in an animal model of vasculogenic erectile dysfunction’,J. Urol.,159, pp. 2229–2236
Pescatory, E. S. andGoldstein, I. (1993): ‘Intraluminal device pressures in 3-piece inflatable penile prostheses: the “pathophysiology” of mechanical malfunction’,J. Urol.,149, pp. 295–300
Pescatory, E. S., Jatzichristou, D. G., Namburi, S., andGoldstein, I. (1994): ‘A positive intracavernous injection test implies veno-occlusive but not necessarily normal arterial function: A hemodynamic study’,J. Urol.,151, pp. 1209–1216
Quesada, E. T., andLight, J. K. (1998): ‘The AMS 700 inflatable prosthesis: Long-term experience with the controlled expansion cylinders’,J. Urol.,149, pp. 46–48
Seeley, R. R., Stephens, T. D., andTate, P. (1995): ‘Anatomy and physiology’ (Mosby, St. Louis)
Smueli, J., andZengerich, E. (1991): ‘Penile prostheses implantation as a treatment of impotence’,The Family Physician,19, pp. 183–188
Sugihara, T., Martin, C. J., andHilderbrandt, J. (1971): ‘Lengthtension properties of alveolar wall in man’,J. Appl. Physiol.,30, pp. 875–878
Timm G. W. (1988): ‘Mechanical penile prostheses’,Am. Soc. Artif. Intern. Org.,34, pp. 996–998
Udelson, D., Nehra, A., Hatzichristou, D. G., Azadzoi, K., Moreland, R. B., Krane, R. J., Saenz de Tejada, I., andGoldstein, I. (1998): ‘Engineering analysis of penile hemodynamic and structural-dynamic relationships: Part II—Clinical implications of penile buckling’,Int. J. Impot. Res.10, 25–35
Venegas, J. G., Sullivan, M. P., Yalla, S. B., andVickers, M. A. (1995): ‘Assessment and modeling of the physical components of human corporovenous function’,Am. J. Physiol.,269, pp. 12109–2123
Wilson, S. K., andDelk, J. R. 2nd (1996): ‘Prevention and treatment of complications of inflatable penile prosthesis surgery: A review article’,Arch. Esp. Urol.,49, pp. 306–311
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Gefen, A., Chen, J. & Elad, D. Stresses in the normal and diabetic human penis following implantation of an inflatable prosthesis. Med. Biol. Eng. Comput. 37, 625–631 (1999). https://doi.org/10.1007/BF02513358
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DOI: https://doi.org/10.1007/BF02513358