Three-dimensional mapping and comparative analysis of the distal human corpus cavernosum and the inflatable penile prosthesis

Penile implants: a look into the future

Inflatable penile prosthesis (IPP) has been around since the 1970’s as a durable and one-time cure for erectile dysfunction (ED). For the past 40 years, many changes have been made to make the device better and currently IPP boasts a high percentage of long-term patient satisfaction. The next paradigm shift in IPP treatment for ED is upon us. Funding for ED related medications and devices has been a hot topic in health policy over the last 10 years. This suggests that the device must improve and patient advocacy and education must increase for IPP to remain as a viable solution for ED. In this paper, we conduct a literature search for innovations in IPP and argue that IPP must constantly improve to compete with oral, injectable, shockwave, and potentially gene therapies.

A history of penile implants

Erectile dysfunction (ED) has long been described by physicians and patients, with treatments for ED proposed starting in the 8^th century BC. In the last 50 years, however, there have been many advances in medical and surgical management of ED, notably the introduction of the inflatable penile prosthesis (IPP) in 1973 and phosphodiesterase type 5 inhibitors (PDE5Is) in 1998. Here we review the evolution of the IPP from 1973 through the current day. The 3-piece device was first described in 1973 by Dr. F. Brantley Scott, who helped found American Medical Systems (AMS) to market and sell the device. In 1983, Mentor (now Coloplast) started marketing a competing device. AMS and Mentor have made multiple modifications to the device over the years, which have increased rigidity, durability and patient satisfaction, and have decreased surgical variability, post-operative infection and spontaneous inflation. Today, the IPP is a safe and effective option for many men who have failed medical therapies, with high satisfaction from both patients and partners.

Comprehensive assessment of cavernosography with 320-row dynamic volume CT versus conventional cavernosography in erectile dysfunction patients caused by venous leakage

The present study aims to investigate and compare the diagnostic and prognostic value of cavernosography with 320-row dynamic volume computed tomography (DVCT) versus conventional cavernosography in men with erectile dysfunction (ED) caused by venous leakage. A total of 174 patients diagnosed with ED were enrolled and received cavernosography with 320-row DVCT (DVCT group) and conventional cavernosography scans (control group) respectively. The diagnosis, complications, and prognosis of patients were evaluated. The DVCT group provided high-resolution images with less processing and testing time, as well as lowered radiological agent and contrast agent compared with the control group. In the DVCT group, 89 patients who were diagnosed with venous ED had six various venous leakage, namely superficial venous leakage, profundus venous leakage, the mixed type, cavernosal venous leakage, crural venous leakage, and also venous leakage between the penis and urethra cavernosum (9, 21, 32, 6, 18, and 3 cases respectively). Similarly, 74 patients out of the 81 who suffered from venous ED were classified to have superficial venous leakage (11), profundus venous leakage (14), the mixed type venous leakage (26), and middle venous leakage (23). Six out of 25 patients in the DVCT group, had improvements in ED while the remaining 19 achieved full erectile function recovery with no penile fibrosis and erectile pain. Cavernosography with 320-row DVCT is a reliable system that can be used to diagnose ED caused by venous leakage. This is especially useful in accurately determining the type of venous and allows for a better prognosis and direction of treatment.

Technological Improvements in Three-Piece Inflatable Penile Prosthesis Design over the Past 40 Years

INTRODUCTION

The advent of the penile prosthesis revolutionized the treatment of erectile dysfunction (ED), resulting in near-complete treatment efficacy and high patient satisfaction rates. While several types of penile prosthesis are available, the inflatable penile prosthesis (IPP) is the most commonly used device in the United States.

AIMS

To describe the key modifications to IPPs from the two major manufacturers-American Medical Systems (AMS) and Coloplast-since the invention of the IPP, and to relate these changes to improvements in prosthesis function and patient outcomes based on available literature.

METHODS

Review and evaluation of the literature between 1973 and present describing modifications in IPP design and the influence of these modifications on IPP durability and patient-related factors.

MAIN OUTCOME MEASURES

Data describing the impact of iterative improvements in three-piece IPP design on device function, durability, and patient outcomes.

RESULTS

There were progressive improvements in IPP technology from both major manufacturers not only on the durability of the prosthesis but also on patient outcomes, with fewer device failures and lower infection rates. Notable improvements include incorporation of kink-resistant tubing, changes in the weave or addition of shear- and infection-resistant coatings to cylinder layers, pump and tubing connection modifications, the addition of rear tip extenders, and the incorporation of lockout valves to prevent autoinflation.

CONCLUSIONS

Numerous incremental modifications to the IPP from both major manufacturers since its invention have increased its durability and improved patient outcomes.