Humans ; Male ; Penile Erection ; Penile Implantation ; Penile Induration/surgery* ; Penile Prosthesis

The global population is collectively getting older, and age is directly correlated with erectile dysfunction (ED). With the advent of effective oral agents and wide availability of the Internet, a larger portion of the population is becoming aware of the different treatment options for men with ED. The penile prosthesis is a definitive and effective treatment for ED which has been available for just over half a century.
Erectile Dysfunction/surgery* ; Humans ; Male ; Penile Implantation ; Penile Prosthesis

PURPOSE: We investigated erectile and ejaculatory function after penile prosthesis implantation. MATERIALS AND METHODS: A total of 121 patients were enrolled in the surgery group (SG) and 120 patients in the nonsurgery group (NSG). All subjects were evaluated by use of the following questionnaires: the erection function and intercourse satisfaction domains of the International Index of Erectile Function (IIEF) and the ejaculation domain of the Male Sexual Health Questionnaire (MSHQ-EjD). Comparisons were made between the SG and the NSG, by prosthesis types, and of postoperative periods and complication rates for each prosthesis type. RESULTS: Differences in the erection function and intercourse satisfaction domains of the International Index of Erectile Function (IIEF-EF and IIEF-IS) between before and after treatment were significantly higher in the SG group than in the NSG group (p=0.02, 0.03, respectively). When comparing prosthesis types, differences in the erection confidence and intercourse satisfaction items between before and after surgery were significantly higher in the SG group (p=0.03, 0.04, respectively). In the comparison of each prosthesis type by postoperative period, differences in the IIEF-EF and IIEF-IS between before and after surgery were not statistically significant but the MSHQ-EjD domain after surgery was significantly lower in cases of >5 years (p=0.02, 0.03, respectively). CONCLUSIONS: Subjective symptoms such as erectile confidence and erectile function were improved more in the SG group than in the NSG group, especially in the inflatable group. It appeared that there was no significant difference in improvement in ejaculatory function depending on the treatment method, but that ejaculatory function decreased as time passed.
Ejaculation ; Humans ; Male ; Penile Erection ; Penile Implantation ; Penile Prosthesis ; Postoperative Period ; Prostheses and Implants ; Reproductive Health

PURPOSE: Cavernosal smooth-muscle relaxation is essential for penile erection Reduction or dysfunction of the muscle fibers can be related to impaired relaxation of cavernosal smooth muscle. Our study was aimed at seeing the changes in penile smooth muscle and collagen tissue in patients with erectile dysfunction. PATIENTS AND METHODS: Twelve impotent patients (study group; mean age 56.3 years) and five penile cancer patients (control group; mean age 57.6 years) were included. The cause of the impotence was Peyronie's disease, diabetes, and unknown in four patients each. Cavernosal tissues were obtained at the time of penile prosthesis implantation and fixed immediately in 10% Formalin. After staining with Masson's trichrome, analysis of smooth muscle fibers was performed using ImagePro. RESULTS: The smooth muscle ratio was 75.1+/-8.19% (SD) in the control group, 37.7+/-12.2 in Peyronie's disease, 37.1+/-18.4% in the patients with diabetes, and 52.2+/-10.6% in the group with no known underlying disease. There was a statistically significant difference in the smooth muscle ratio between the study and control group, but among the study groups, no significant difference was noted. CONCLUSIONS: Altered content of smooth muscle may contribute to the pathophysiology of erectile dysfunction.
Collagen* ; Erectile Dysfunction* ; Formaldehyde ; Humans ; Male ; Muscle, Smooth* ; Penile Erection ; Penile Implantation ; Penile Induration ; Penile Neoplasms ; Penis ; Relaxation

There has been remarkable progress in the treatment of erectile dysfunction during last decade. We have analyzed 2,000 patients with erectile dysfunction who had been treated with a variety of treatment modalities during last 10 years to identify the annual changes in the proportion of the respective treatment modality. The most remarkable change was seen in the proportion of patients treated by vasoactive pharmacotherapy The proportion was 12.0% on 1984, which was gradually increased in time, and reached to 82.1% on 1994. Another remarkable change was found in the proportion of patients treated by surgery, especially vascular surgery : The proportion of patients treated by penile prosthesis implantation on 1985 and vein ligation on 1986 was 64.0% and 14.3%, respectively ; whereas, it was decreased to 1.8 % and 0% on 1994, respectively. In conclusion, we could find remarkable change of trend in the primary treatment modality for erectile dysfunction from invasive and costly surgical treatment to less invasive and cheap vasoactive pharmacotherapy. Nowadays, intracavernous self-injection of vasoactive agents plays a primary role in the treatment of impotence. Penile prosthesis implantation remains as the last treatment modality for erectile dysfunction. However, vascular surgery is rarely being performed nowadays because of its poor long-term outcome.
Drug Therapy ; Erectile Dysfunction* ; Humans ; Ligation ; Male ; Penile Implantation ; Veins

Penile necrosis is a rare, serious complication of penile prosthesis implantation. Severas factors, including systemic disease, compressive dressing, hematoma, edema, indwelling urethral catheter, and local infection may contribute to the complication. We report two cases of penile necrosis caused by hematoma and compressive dressings applied to control the bleeding.
Bandages ; Edema ; Hematoma ; Hemorrhage ; Necrosis ; Penile Implantation ; Penile Prosthesis* ; Urinary Catheters

PURPOSE: Due to the increasing numbers of radical prostatectomies (RP) performed for prostate cancer, a substantial and increasing number of patients suffer from postoperative urinary incontinence and erectile dysfunction (ED). The objective of our study was to see whether an inflatable penile prosthesis implantation could control urinary incontinence for patients with the dual problems of ED and incontinence. MATERIALS AND METHODS: From March 2010 through May 2015, 25 post-RP patients were referred to our clinic with ED or incontinence. The degree of incontinence was classified according to the International Consultation on Incontinence Questionnaire-Short Form. Inflatable penile prostheses were implanted in all 25 patients. RESULTS: For one month after implantation, partial or full inflation was performed progressively to control urine leakage. Of 18 patients, 13 patients were categorized with mild or moderate stress incontinence. All 13 patients obtained control of incontinence with partial inflation (30% to 60%) and all reported satisfactory outcomes. Five out of the 18 patients were categorized with severe total incontinence. Three of the 5 patients could tolerate incontinence with full inflation on and off. Thirteen patients out of the total of 18 (72.2%) had their incontinence controlled by an inflating penile prosthesis. CONCLUSIONS: An inflatable penile prosthesis is highly recommended as an initial procedure, especially in patients with the dual problems of ED and incontinence.
Erectile Dysfunction ; Humans ; Inflation, Economic ; Male ; Penile Implantation ; Penile Prosthesis* ; Prostatectomy ; Prostatic Neoplasms ; Urinary Incontinence*

Forty eight patients with erectile failure were treated with penile prosthesis between December 1983 and March 1987 and following results were obtained. 1. The range of patient age was 23 to 75 years and the fifth decade(33.3%) was most common, followed by the fourth decade(25%) and the sixth decade(18.8%). 2. The etiology of erectile failure was spinal cord injury(31.3%), vasculogenic(27.1%), diabetes mellitus(22.9%) and radical cystectomy(8.3%). 3. The type of penile prosthesis was AMS malleable 600(62.5%), Jonas silicone silver(31.3%) and AMS Hydroflex(6.3%). The length of penile prosthesis was in the range of 13 to 21 cm and in 37 cases(77.1%) it was between 16 and 18 cm. The diameter of penile prosthesis was 9.5 mm(50%) and 11 - 11.5 mm(47.9%). 4. There were 4 cases of early complication ; prolonged pain in 2 cases and voiding difficulty in 2 cases were treated conservatively. There was 1 case of late complication ; the glans erosion in paraplegic patient. 5. Forty seven cases(97.9%) are now enjoying their sexual lives with penile prosthesis at follow-up of more than 3 months up to more than 3 years. From the above results, the implantation of penile prosthesis is a safe and effective method in the treatment of erectile failures.
Follow-Up Studies* ; Humans ; Penile Implantation* ; Penile Prosthesis* ; Silicones ; Spinal Cord

OBJECTIVESTo introduce the method and experience of three-piece inflatable penile prosthesis for treatment of erectile dysfunction (ED).

METHODSBoth AMS700CX/CXM and MENTOR ALPHA I three-piece inflatable prosthesis were used for 48 cases of ED.

RESULTSThere were no rejection, mechanical problems, urethral injury and penile skin necrosis after surgery. All patients had satisfaction of sexual life. Only one case had trauma of tunica albuginea (2.08%) and the implantation had to be cancelled. There were 2 cases of post-operative infection (4.17%), 10 cases of prepuce edema(20.8%), 8 cases of penile pain(16.67%). The effective rate was 97.9% and satisfaction rate was almost 100%.

CONCLUSIONSThree-piece inflatable penile prosthesis was more compatible to human physiology. It is natural, easy to hide and use, and it caused little trauma in surgery with high rate of successful implantation and patient satisfaction. It was indicated for all kinds of ED, especially suitable for refractory and drug incurable ED patients.

Adolescent ; Adult ; Aged ; Erectile Dysfunction ; therapy ; Humans ; Male ; Middle Aged ; Penile Implantation ; Penile Prosthesis

OBJECTIVETo study the effect and complications of augmentation phalloplasty by implanting autogenous tunica vaginalis grafts into the bilateral albuginea of the penile corpus.

METHODSFive mongrel dogs underwent augmentation phalloplasty with bilateral autogenous tunica vaginalis grafts. The increase in the volume of the corpora cavernosa was achieved by applying autogenous tunica vaginalis grafts to longitudinal openings made bilaterally in the albuginea along the whole length of the penile cavernous corpora. The perimeter of the penile cavernous corpora was measured in the flaccid state and during erection and dynamic infusion cavernosometry (DIC) was conducted for each dog before and after the operation. Histology of the penis was examined using hematoxylin and eosin stains.

RESULTSThe average increase in the perimeter of the penile cavernous corpora was 21. 1% in the erectile state but unobvious in the flaccid state 3 months after surgery. There were no statistically significant differences in cavernosometric parameters before and after the operation, and neither were there any other severe postoperative complications. The grafts had mild inflammatory reaction and fibrosis with apparent reformation of the tunica albuginea over the patch site.

CONCLUSIONThe augmentation phalloplasty technique with bilateral autogenous tunica vaginalis grafts was proved to be effective and reliable with few complications, particularly conspicuous in increasing the volume of the erectile tissues during erection.

Animals ; Dogs ; Male ; Penile Diseases ; surgery ; Penile Implantation ; Penis ; surgery ; Testis ; transplantation