THE INSERTION OF A PENILE PROSTHESIS FOR ERECTILE DYSFUNCTION AND THE MANAGEMENT OF COMPLICATIONS: A REVIEW IN 447 PATIENTS

Objective To evaluate the long-term results of penile prosthesis surgery in the management of erectile dysfunction and to further analyse the management of the complications arising from inserting penile prostheses. Patients and methods In all, 447 men (mean age 52 years. range 21-78) had 504 penile prosthesis implanted between August 1975 and December 2000: 404 were primary ìmplants and 43 secondary: 393 were malleable, 81 were three-piece inflatable and 30 were inflatable self-contained devices. The outcome was assessed from the medical records with a mean (range) follow-up of 50 (1-297) months. In particular the complications arising from prosthesis insertion and the associated predisposing factors were analysed. The management and outcome of patients with complications was recorded. Results. Twenty-two patients were lost to follow-up and 26 (5.8%) had their prosthesis removed and not replaced. The success rate of the primary operation was 90.8% which decreased to 80.5% for the first revision and to 62.5% for second. Eight patients developed a penoscrotal haematoma and all were managed conservatively: 25 had a superficial wound infection but none rcquired removal of the prosthesis. Thirty-three had delayed deep infection and all required prosthesis rernoval. Of the prostheses which became infected. 17 (4.7%) were malleable, 10 (16.4%) were three-piece inflatable and 6 (24%) were self-contained. Thirteen patients went into urinary retention after surgery but all subsequentily passed a trial without catheter. Sìxteen developed erosion of the prosthesis and all had their prosthesis removed and replaced. After cavernosal erosion, 11 prostheses were malleable (4.4%), 4 were three-piece inflatable (6.6%) and one was self-contained (4%). There was no correlation between diabetes and the rate of prosthesis infection. Conclusions Most patients (84.7%) who undergo penile prosthetic surgery are extremely satisfied with the result. The surgery is associated with a low complication rate and a good long-term outcome. Diabetes does not predispose the patient to a higher risk of prosthesis-related infection. However. the type of prosthesis (self-contained or three-piece) is associated with a higher risk of infection. Penoscrotal haematoma with no evidence of infection may be managed without inserting a drain. Deep infection and cavernosal erosion should be treated by removing the prosthesis, whereas superficial infection is adequately managed with broad-spectrum antibiotics.