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Giordano A, Smarrazzo F, Cilio S, Califano G, Collà Ruvolo C, Verze P. History of penile implants: from implants made of bone to modern inflatable penile implants. Int J Impot Res 2023; 35:601-608. [PMID: 37085736 DOI: 10.1038/s41443-023-00695-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/23/2023]
Abstract
Penile prostheses are implantable devices used to definitively treat erectile dysfunction when previous forms of treatment have failed. The first example of a penile implant dates to 1935, when a rib was inserted in a neo-phallus reconstructed after a traumatic amputation. Since then, alternative artificial devices were adopted as penile prosthetic implants. The evolution of prosthetic devices had a dramatic thrust in 1973 when the first inflatable penile prosthesis was worldwide presented. Thanks to advances in device materials, design, surgical implant techniques, and perioperative management, nowadays inflatable penile prostheses are one of the most adopted definitive therapy for patients with drug-refractory erectile dysfunction or refusing alternative forms of treatments. Moreover, the clinical indications for inflatable penile prosthesis have also expanded, including female-to-male transmen or men underwent penile reconstruction due to congenital aphallia or traumatic or surgical penile amputation. In order to summarise the process behind the development and evolution of penile prosthesis, we aimed at performing a historical review of the currently available literature to provide an easy and comprehensive overview of the topic. The understanding of the historical process behind the evolution of inflatable penile prostheses will drive further innovation to increase efficiency and the rate of patients satisfaction.
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Affiliation(s)
- Alessandro Giordano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Francesco Smarrazzo
- Urology Unit, Department of Medicine, Surgery, Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Simone Cilio
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy.
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Claudia Collà Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Paolo Verze
- Urology Unit, Department of Medicine, Surgery, Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
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Berrettini A, Paraboschi I, Di Grazia M, Gnech M, Mantica G, Minoli DG, De Marco EA, Manzoni G, Capece M, Palmieri A, Ralph D, Mirone V. A Unique Case of Inflatable Penile Prosthesis (IPP) Implantation and Mesh Phalloplasty in a Patient Born with Congenital Fusiform Megalourethra. Res Rep Urol 2023; 15:85-89. [PMID: 36814907 PMCID: PMC9939796 DOI: 10.2147/rru.s387042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
We present the first case of a patient born with congenital fusiform megalourethra who underwent the successful placement of an inflatable penile prosthesis (IPP) and mesh phalloplasty due to primary erectile dysfunction (ED). After an extensive psychosexual assessment and a preoperative MRI scan, an IPP was successfully implanted. The procedure was carried out through a penoscrotal approach, which offered excellent exposure to the crura and the proximal ends of the corpora cavernosa. Following the incision and the dilatation of both corpora cavernosa, the penile cylinders were inserted and a mesh phalloplasty was performed, to replace the erectile tissues lacking in the distal corpora cavernosa. After reservoir and pump placement, the device was tested, and no mechanical issues were recorded. The postoperative course was uneventful, and, at the 2-year follow-up, the patient reported highly satisfactory results, with valid functional erections.
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Affiliation(s)
- Alfredo Berrettini
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Irene Paraboschi
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy,Correspondence: Irene Paraboschi, Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milano, Italy, Tel +393313229495, Email
| | - Massimo Di Grazia
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Michele Gnech
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Guglielmo Mantica
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Dario Guido Minoli
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Erika Adalgisa De Marco
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Gianantonio Manzoni
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Marco Capece
- Department of Urology, Azienda Ospedaliera Universitaria “Federico II”, Napoli, Italy
| | - Alessandro Palmieri
- Department of Urology, Azienda Ospedaliera Universitaria “Federico II”, Napoli, Italy
| | - David Ralph
- Department of Urology, Azienda Ospedaliera Universitaria “Federico II”, Napoli, Italy
| | - Vincenzo Mirone
- Department of Urology, Azienda Ospedaliera Universitaria “Federico II”, Napoli, Italy
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Quesada-Olarte J, Nelwan D, Fernandez-Crespo R, Parker J, Carrion RE. “Pumpology”: Evolution of the Penile Implant Pump and What Is on the Horizon. CURRENT SEXUAL HEALTH REPORTS 2022. [DOI: 10.1007/s11930-022-00348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Fernandez-Crespo RE, Buscaino K, Carrion R. "Pumpology": the Realistic Issues Associated with Pump Placement in Prosthetic Surgery. Curr Urol Rep 2021; 22:10. [PMID: 33420939 DOI: 10.1007/s11934-020-01027-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW The goal of this paper was to discuss the issues and/or overt complications associated with the 3-piece inflatable penile prosthesis (3-IPP) pump. We also addressed how to resolve such issues with or without surgical intervention. RECENT FINDINGS Numerous modifications of the 3-IPP pump have been introduced with multiple techniques to place the pump. These are largely dependent on the approach to place the 3-IPP. Pump issues may inevitably occur, and there are numerous special maneuvers that can be performed to resolve pump issues. It is important for urologists to know maneuvers for pump malfunctions to prevent unnecessary surgical procedures and pump revision. Several studies are reviewed regarding pump issues and patient satisfaction; however, a more structured prospective research project is warranted to further evaluate these issues.
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Affiliation(s)
- Raul E Fernandez-Crespo
- Tampa General Hospital, 1 Tampa General Circle, Tampa, FL, 33606, USA. .,Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA.
| | - Kristina Buscaino
- Tampa General Hospital, 1 Tampa General Circle, Tampa, FL, 33606, USA.,Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Rafael Carrion
- Tampa General Hospital, 1 Tampa General Circle, Tampa, FL, 33606, USA.,Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
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Abstract
PURPOSE OF REVIEW The inflatable penile prosthesis (IPP) was introduced in 1973. Since that time, the fundamental design of the IPP has not changed, but numerous improvements to the device, surgery, and peri-operative management have resulted in a modern IPP with excellent reliability, infection control, safety profile, and user experience. RECENT FINDINGS We describe important modifications to the IPP and review available data assessing the impact of these changes. We also discuss possible changes to the IPP that would result in continued improvement. Since its introduction in 1973, changes to the penile prosthesis have resulted in significant improvements in reliability, infection control, safety, and user experience. Design changes are anticipated to continue, resulting in a better and more versatile penile prosthesis.
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Chung E. Translating Penile Erectile Hydraulics to Clinical Application in Inflatable Penile Prosthesis Implant. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0107-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chung E. Penile prosthesis implant: scientific advances and technological innovations over the last four decades. Transl Androl Urol 2017; 6:37-45. [PMID: 28217449 PMCID: PMC5313299 DOI: 10.21037/tau.2016.12.06] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Despite introduction of oral phosphodiesterase type 5 inhibitors and intracavernosal vasoactive agents, penile prosthesis implant remains a relevant and desired option with sales of penile prostheses continue to stay high, as many men became refractory to medical therapy and/or seeking a more effective and permanent therapy. There are two types of penile prosthesis implants: inflatable and non-inflatable types, and the inflatable penile implants can be subdivided into single-, two- and three-piece devices. Non-inflatable penile prosthesis (non-IPP) may be referred to as semi-rigid rod or malleable prosthesis. IPP is considered a superior option to malleable prosthesis as it produces penile rigidity and flaccidity that closely replicates a normal penile erectile function. Since the introduction of IPP by Scott in 1973, surgical landscape for penile prosthesis implantation has changed dramatically. Advances in prosthesis design, device technologies and surgical techniques have made penile prosthesis implant a more natural, durable and reliable device. The following article reviews the scientific advances and technological innovation in modern penile prosthesis implants over the last four decades.
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Affiliation(s)
- Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia;; AndroUrology Centre, St Andrew's War Memorial Hospital, Brisbane, QLD, Australia
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Trost L, Hellstrom WJG. History, Contemporary Outcomes, and Future of Penile Prostheses: A Review of the Literature. Sex Med Rev 2015; 1:150-163. [PMID: 27784554 DOI: 10.1002/smrj.8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Since their introduction, penile prostheses have consistently remained a superior treatment option for men with erectile dysfunction (ED) refractory to conservative measures. Ongoing enhancements to prosthetic design, materials, and surgical techniques have resulted in improved outcomes. AIM To review available literature on notable historical advancements and improvements of the penile prosthesis, summarize contemporary outcomes of recent devices, and discuss possible future directions of the penile prosthesis. METHODS A PubMed search was performed of all articles published from 1960 to present relating to penile prosthesis. Priority was given to series with 12 months of follow-up or greater, larger series, and studies reporting on outcomes of more recent prosthetic models. MAIN OUTCOME MEASURES Main outcomes included historical review of improvements leading to, and contemporary series reporting on rates of mechanical failures, infections, and satisfaction with penile prostheses. RESULTS Penile prostheses have undergone numerous enhancements since initial reports of synthetic materials utilized in the 1950s. Among others, recent notable device enhancements include Parylene coating, Bioflex® material, InhibizoneTM antibacterial impregnation, hydrophilic coating, lockout valves, and easy release pump mechanisms, all of which have improved mechanical reliability, reduced infection rates, and/or improved patient satisfaction with penile prostheses. Contemporary series of 3-piece penile prostheses report mechanical survival of 81-94%, 68-89%, and 57-76% at 5, 10, and 15 years, respectively. Infection rates of current devices are 1-2% in first-time, low-risk populations, and 2-3% for higher risk groups, with patient and partner satisfaction at 92-100% and 91-95%, respectively. Two-piece and malleable devices are associated with slightly higher mechanical reliability and decreased patient satisfaction. Minimal data currently exist on the outcomes of selected patient populations, including Peyronie's disease and corporal fibrosis. CONCLUSIONS Penile prostheses are associated with excellent, long-term outcomes and remain the gold-standard treatment for men with refractory ED. Additional research with prospective studies utilizing objective measures and standardized questionnaires is required. Trost L and Hellstrom WJG. History, contemporary outcomes, and future of penile prostheses: A review of the literature. Sex Med Rev 2013;1:150-163.
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Affiliation(s)
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
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Garber BB, Bickell M. Delayed postoperative hematoma formation after inflatable penile prosthesis implantation. J Sex Med 2014; 12:265-9. [PMID: 25349141 DOI: 10.1111/jsm.12728] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Infrequent but serious postoperative complications following inflatable penile prosthesis (IPP) insertion include infection, malfunction, and bleeding. Although prior publications report methods to reduce immediate postoperative bleeding, there is little in the literature concerning the etiology, diagnosis, imaging, and management of delayed bleeding after IPP insertion. AIM The aim of the study was to review cases of delayed postoperative bleeding following IPP insertion in a large single-surgeon series. METHODS We carried out a retrospective chart review of 600 patients implanted with a Coloplast Titan IPP with One-Touch Release pump by a single surgeon, and analyzed cases of delayed postoperative bleeding. MAIN OUTCOME MEASURE The main outcome measure was an analysis of the incidence, causes, diagnostic methods, treatment, and final outcome of these cases. RESULTS Three out of 600 consecutive patients (0.5%) developed a delayed (defined as >5 days postoperative) hematoma following IPP insertion. All patients presented postoperatively with a swollen surgical site, and all were evaluated with a pelvic computed tomography scan to completely define the extent of the hematoma. Two patients developed a delayed hematoma because of excessive physical activity; the remaining patient bled because of premature administration of enoxaparin sodium (Lovenox) by his cardiologist. All three patients were successfully treated with hospital admission, intravenous antibiotics, wound exploration, hematoma evacuation, and antibiotic washout. All three IPPs were successfully salvaged; none developed peri-prosthetic infection. CONCLUSIONS The incidence of delayed postoperative hematoma following IPP surgery was 0.5% in our series of 600 cases. All cases were successfully managed with intravenous antibiotics, hematoma evacuation, and antibiotic washout. Because of the low incidence of this complication, definitive statements concerning prevention and management cannot be made. However, we now recommend avoiding postoperative anticoagulants for at least 5 days if possible, and avoiding vigorous physical activity for at least 3 weeks.
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Affiliation(s)
- Bruce B Garber
- Department of Urology, Drexel University College of Medicine, Philadelphia, PA, USA
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Lindeborg L, Fode M, Fahrenkrug L, Sønksen J. Satisfaction and complications with the Titan® one-touch release penile implant. Scand J Urol 2013; 48:105-9. [PMID: 23834377 DOI: 10.3109/21681805.2013.808695] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to assess complication rates and patient satisfaction with Coloplast Titan® one-touch release (OTR) inflatable penile implants inserted at one university hospital centre between November 2008 and April 2011. MATERIAL AND METHODS Overall, 33 patients with organic erectile dysfunction underwent penile implant surgery during the study period. The Titan OTR inflatable penile implants were inserted using a penoscrotal approach. Patient and partner satisfaction was assessed with the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. RESULTS One implant was removed because of infection, and three patients underwent revision surgery due to problems with autoinflation, deflation, and a displaced reservoir, respectively. In all cases the problems were solved and the implants were salvaged. Further complications included one patient with haematoma and sustained scrotal pain, one patient with meatal stenosis, and four patients with infections not related to the implant. In total, 30 EDITS questionnaires were administered and 26 (87%) were completed. Twenty-two patients (85%) reported being satisfied with the implant and two (8%) were dissatisfied. Twenty-four patients (92%) would recommend a penile implant to someone with a similar medical condition. Eighteen patients (72%) believed that their partner was satisfied with the implant. Nineteen patients (76%) felt that the process of achieving an erection with the implant was natural. CONCLUSION Although it is important to inform patients about potential problems such as infection, pain and mechanical failure, the results show that inflatable penile implants are a good treatment choice for erectile dysfunction when conservative measures have failed.
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Mandava SH, Serefoglu EC, Freier MT, Wilson SK, Hellstrom WJ. Infection Retardant Coated Inflatable Penile Prostheses Decrease the Incidence of Infection: A Systematic Review and Meta-Analysis. J Urol 2012; 188:1855-60. [DOI: 10.1016/j.juro.2012.07.022] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Sree Harsha Mandava
- Department of Urology, Tulane University, New Orleans, Louisiana, and Institute for Urologic Excellence (SKW), Indio, California
| | - Ege Can Serefoglu
- Department of Urology, Tulane University, New Orleans, Louisiana, and Institute for Urologic Excellence (SKW), Indio, California
| | - Matthew T. Freier
- Department of Urology, Tulane University, New Orleans, Louisiana, and Institute for Urologic Excellence (SKW), Indio, California
| | - Steven K. Wilson
- Department of Urology, Tulane University, New Orleans, Louisiana, and Institute for Urologic Excellence (SKW), Indio, California
| | - Wayne J.G. Hellstrom
- Department of Urology, Tulane University, New Orleans, Louisiana, and Institute for Urologic Excellence (SKW), Indio, California
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Ohl DA, Brock G, Ralph D, Bogache W, Jones L, Munarriz R, Levine L, Ritenour C. Prospective evaluation of patient satisfaction, and surgeon and patient trainer assessment of the Coloplast titan one touch release three-piece inflatable penile prosthesis. J Sex Med 2012; 9:2467-74. [PMID: 22759540 DOI: 10.1111/j.1743-6109.2012.02819.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION A single-armed, prospective, multicenter international study evaluated the redesigned Coloplast Titan One Touch Release (OTR) pump inflatable penile prosthesis. The OTR pump has a unique release valve that permits deflation of the implant with one squeeze of opposing touch pads. AIMS To assess the impact of a new penile prosthesis design, the Titan OTR, on patient ease of operation. Furthermore, to assess patient satisfaction, surgeon acceptance, and the ease with which patients were trained in device operation in the clinic setting. METHODS A total of 113 eligible patients from eight centers were recruited from men presenting with erectile dysfunction without prior prosthetic implantation. The subjects had a mean age of 61 years, and had a number of comorbidities, including diabetes (31.9%), hypertension (34.5%), and Peyronie's disease (23.9%). All underwent implantation of the study device. MAIN OUTCOME MEASURES Questionnaires were used to capture patient satisfaction as well as physician feedback on ease of implantation and patient education. A paired analysis was completed for patient satisfaction at 6 (N = 96) and 12 (N = 90) months. RESULTS Overall satisfaction with the device was 90.6% and 90.0% at 6 and 12 months, respectively. The primary end point, ease of deflation, was seen in 70.8% and 73.3% at these two time points, with the 12-month value statistically better than historical controls. Physicians overwhelmingly reported straightforward/simple intraoperative product preparation (97.3%) and equivalent or easier training compared with their previous pump of choice (96.4%). Adverse events for all subjects (N = 113) included removal of the device in four cases (3.5%) for infection and one case for chronic pain (0.8%). CONCLUSIONS The Titan OTR represents an advance in penile prosthetic technology that is well accepted by patients and physicians. The study design allowed for realistic evaluation of the new technology aimed at enhancing clinical outcomes.
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Affiliation(s)
- Dana A Ohl
- Division of Sexual and Reproductive Medicine, Department of Urology, University of Michigan, Ann Arbor, MI, USA.
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