Penile Prosthesis: Difference between revisions
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=== Classification === | === Classification === | ||
* '''<span style="color:#ff0000"> | * '''<span style="color:#ff0000">Non-inflatable''' | ||
* | *#'''<span style="color:#ff0000">Malleable''' | ||
* | *#'''<span style="color:#ff0000">Positional''' | ||
*'''<span style="color:#ff0000">Inflatable''' | *'''<span style="color:#ff0000">Inflatable''' | ||
* | *#'''<span style="color:#ff0000">2-piece''' | ||
* | *#'''<span style="color:#ff0000">3-piece''' (see [https://www.mdpi.com/2673-4397/3/1/1 Figure]) | ||
*At the present time in the US, 70% of patients are implanted with 3-piece inflatable devices, 20% are implanted with 2-piece devices, and 10% are implanted with semirigid rods. | *At the present time in the US, 70% of patients are implanted with 3-piece inflatable devices, 20% are implanted with 2-piece devices, and 10% are implanted with semirigid rods. | ||
=== | === Non-inflatable === | ||
* Paired, solid cylinders that fill each corpus cavernosum | * Also known as semirigid rods | ||
*Paired, solid cylinders that fill each corpus cavernosum | |||
* '''Subdivided into malleable vs. positional devices''' | * '''Subdivided into malleable vs. positional devices''' | ||
** A malleable device has a central core that allows a patient to position the penis upward for sexual intercourse and downward at other times. | ** A malleable device has a central core that allows a patient to position the penis upward for sexual intercourse and downward at other times. | ||
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*** '''<span style="color:#ff0000">The reservoir is typically placed in the space of Retzius.</span>''' | *** '''<span style="color:#ff0000">The reservoir is typically placed in the space of Retzius.</span>''' | ||
**** '''<span style="color:#ff0000">Submuscular reservoir placement with a flat reservoir or a separate incision should always be performed in all patients after previous surgery involving the space of Retzius (robotic prostatectomy, radical cystectomy, and abdominoperineal resection and in patients with history of pelvic fracture with bladder rupture and pelvic surgery)</span>''' | **** '''<span style="color:#ff0000">Submuscular reservoir placement with a flat reservoir or a separate incision should always be performed in all patients after previous surgery involving the space of Retzius (robotic prostatectomy, radical cystectomy, and abdominoperineal resection and in patients with history of pelvic fracture with bladder rupture and pelvic surgery)</span>''' | ||
****See [https://www.nature.com/articles/nrurol.2015.270/figures/1 Figure] for submuscular reservoir placement | |||
** '''Closure''' | ** '''Closure''' | ||
*** '''A closed-suction drain should be used if the surgeon is not satisfied with hemostasis''' | *** '''A closed-suction drain should be used if the surgeon is not satisfied with hemostasis''' | ||
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== Adverse Events == | == Adverse Events == | ||
=== UrologySchool.com Summary === | |||
* '''<span style="color:#ff0000">Intra-operative''' | |||
*# '''<span style="color:#ff0000">Risks of general anesthesia''' | |||
*# '''<span style="color:#ff0000">Bleeding''' | |||
*# '''<span style="color:#ff0000">Infection''' | |||
*# '''<span style="color:#ff0000">Injury to adjacent structure/organ''' | |||
*#*'''<span style="color:#ff0000">Corpora cavernosa perforation''' | |||
*#*'''<span style="color:#ff0000">Urethral perforation''' | |||
* '''<span style="color:#ff0000">Early post-operative''' | |||
*# '''<span style="color:#ff0000">Infection''' | |||
*# '''<span style="color:#ff0000">Scrotal hematoma''' | |||
* '''<span style="color:#ff0000">Late post-operative''' | |||
*# '''<span style="color:#ff0000">Infection''' | |||
*# '''<span style="color:#ff0000">Device malfunction''' | |||
*# '''<span style="color:#ff0000">Device erosion''' | |||
*# '''<span style="color:#ff0000">Penile shortening''' | |||
*# '''<span style="color:#ff0000">S-shaped penile deformity''' | |||
*# '''<span style="color:#ff0000">Poor glans support''' | |||
=== Intraoperative === | === Intraoperative === | ||
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==== Infections ==== | ==== Infections ==== | ||
===== | ===== Epidemiology ===== | ||
*'''<span style="color:#ff0000">Incidence: overall infection rates following initial penile prosthesis insertion range from 1-3%</span>''' | *'''<span style="color:#ff0000">Incidence: overall infection rates following initial penile prosthesis insertion range from 1-3%</span>''' | ||
**'''Rate is significantly higher (7-18%) for revision surgery''' | **'''Rate is significantly higher (7-18%) for revision surgery''' | ||
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****'''Cylinder erosion into the urethra''' | ****'''Cylinder erosion into the urethra''' | ||
==== Device | ==== Device Malfunction ==== | ||
* '''Most common types of malfunction in a three-piece prosthetic device include''' | * '''Most common types of malfunction in a three-piece prosthetic device include''' | ||
*#'''Cracks in the silicone tubing''' | *#'''Cracks in the silicone tubing''' | ||
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*** '''After the device has been in place for >2 years: complete replacement is indicated''' | *** '''After the device has been in place for >2 years: complete replacement is indicated''' | ||
==== Erosion ==== | ==== Device Erosion ==== | ||
* '''Typically occurs months or years after implantation''' | * '''Typically occurs months or years after implantation''' | ||
* '''Can manifest in several different locations.''' | * '''Can manifest in several different locations.''' | ||
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* Wein AJ, Kavoussi LR, Partin AW, Peters CA (eds): CAMPBELL-WALSH UROLOGY, ed 11. Philadelphia, Elsevier, 2015, chap 30 | * Wein AJ, Kavoussi LR, Partin AW, Peters CA (eds): CAMPBELL-WALSH UROLOGY, ed 11. Philadelphia, Elsevier, 2015, chap 30 | ||
*Goodstein, Taylor, and Lawrence C. Jenkins. "A narrative review on malleable and inflatable penile implants: choosing the right implant for the right patient." ''International Journal of Impotence Research'' 35.7 (2023): 623-628. | |||
*Trost, Landon, Philip Wanzek, and George Bailey. "A practical overview of considerations for penile prosthesis placement." ''Nature Reviews Urology'' 13.1 (2016): 33-46. | |||