Penile implant
A penile implant is an implanted device intended for the treatment of erectile dysfunction, Peyronie's disease, ischemic priapism, deformity and any traumatic injury of the penis, and for phalloplasty or metoidioplasty, including in gender-affirming surgery. Men also opt for penile implants for aesthetic purposes. Men's satisfaction and sexual function is influenced by discomfort over genital size which leads to seek surgical and non-surgical solutions for penis alteration.[1] Although there are many distinct types of implants, most fall into one of two categories: malleable and inflatable transplants.[2]
Penile implant
Penile prosthesis
Urology
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Outcomes[edit]
Satisfaction[edit]
The overall satisfaction rate with penile implants reaches over 90%.[6] Both self- and partner-reported satisfaction rates are evaluated to assess the outcomes. It has been shown that implantation of inflatable penile prosthesis brings more patient and partner satisfaction than medication therapy with PDE5 inhibitors or intracavernosal injections.[21] Satisfaction rates are reported to be higher with inflatable rather than malleable implants, but there are no differences between two-piece and three-piece devices.[27][28] The most frequent reasons for dissatisfaction are reduced penis length and girth, failed expectations and difficulties with device use.[21][27] Thus, it is vital to provide patients and their partners with detailed preoperative counselling and instructions.
Progress in procedure[edit]
Dilation of the corpora cavernosa, typically with Hegar sounds, before inserting the device has been a common part of implantation procedures. This dilation destroys erectile tissue. It has been shown that a tissue-sparing technique, i.e. without dilation, correlates with superior outcomes – some remaining natural erectile response can be preserved, and post-operative pain is reduced as well.[29][30]
Complications[edit]
The most common complication associated with penile implant placement appears to be infections with reported rates of 1–3%.[27] Both surgical site and device infections are reported. When the infection involves the penile implant itself, implant removal is required and irrigation of the cavities with antiseptic solutions. In this scenario, placement of a new implant is needed to avoid further tissue fibrosis and shortening of the penis. The rate of repeat surgeries or device replacements ranges from 6% to 13%.[23] Other reported complications include perforation of the corpus cavernosum and urethra (0.1–3%), commonly occurring in patients with previous fibrosis, prosthesis erosion or extrusion, change in glans shape, hematoma, shortening of penis length, and device malfunction. Due to continuous improvement of surgical techniques and modifications of implants, complication rates have dramatically decreased over time.
To overcome post-operative penile shortening and to increase the perceived length of the penis and patient satisfaction, ventral and dorsal phalloplasty procedures in combination with penile implants have been described.[21] Modified glanulopexy has been proposed to prevent supersonic transporter deformity and glandular hypermobility which are possible complications of penile implants.[31]
Sliding techniques in which the penis is cut and elongated with penile implants have been performed in cases of severe penile shortening. However, these techniques had higher rates of complications and are currently avoided.