Updated recommendations for penile implants

The aim of this study was to update recommendations on the use of penile implants for erectile dysfunction. Authors concluded that penile implants remain a safe and effective treatment option for erectile dysfunction not responding to other less invasive therapies.

Penile prosthetic devices are a treatment option for severe erectile dysfunction or erectile dysfunction not responding to drug therapy. It involves the surgical placement of an implant into the penis to enable penetrative sexual activity. Penile prostheses that are available for implantation include semi-rigid rods and inflatable devices. Advances in penile implants have led to devices being more effective and have reduced complication rates.

The International Consultation on Sexual Medicine has updated ten recommendations for penile implants based on recent evidence.

Penile implants should be considered as a second-line treatment for erectile dysfunction not responding to other therapies.

Physical examinations as well as medical and sexual histories should be considered before undergoing surgery. Patients should be well informed on alternative treatment options, possible side effects, and risk factors for surgery. Some risk factors include smoking, prior penile prosthesis surgery, and other medical conditions, such as diabetes. One study reported a 23% increased risk of infection for diabetic patients after penile prosthesis surgery.

High-quality evidence suggests that inflatable penile implants covered with an antibiotic film can reduce infection rates. One analysis of several studies reported significantly reduced infection rates from 2.32% to 0.89%. Semi-rigid rods are recommended for patients with reduced mobility in their hands.

Penile implants can be inserted through incision in the scrotum, the abdomen, or from the bottom of the penis. The incision site is dependent on the type of penile implant, the surgeon’s preference, and the patient’s medical history. The penile device should have minimal contact with the skin. The pubic hair may be shaved or clipped before surgery.

Follow-up care should be provided to assess for complications and treatment satisfaction. One study involving 185 patients reported 98% patient and 96% partner satisfaction rates after penile prosthesis surgery. Patients with Peyronie Disease (where scar tissue forms under the skin of the penis), previous prostate surgery, or obesity may have lower satisfaction rates.

A second revision surgery can increase the risk of infection. Measures should be taken to reduce infection rates during revision surgery. If a device becomes infected, all parts should be removed from the body.

Men with severe scarring after priapism (medical condition where the penis does not return to its flaccid state) should consider early penile implant surgery. One study reported increased rates of necessary revision surgeries when penile implantation was delayed (5 months) compared to immediate (7 days) in men with priapism.

Patients at risk of the device coming through the skin or tissue (known as erosion or extrusion) should undergo further surgery to reposition the device and prevent complications.

During penile prosthesis placement in patients with Peyronie Disease, surgeons should correct deformities such as curvatures. One study involving 46 patients reported that 39% of curvatures were corrected by the device alone and 61% required additional modeling.

Authors concluded that penile implants remain a safe and effective treatment option for erectile dysfunction not responding to other less invasive therapies.