Outcome of penile prosthesis implantation for treating erectile dysfunction

Nine out of ten men fitted with a penile prosthesis were able to have sexual intercourse and eight out of ten were satisfied with the overall results, according to research published in the latest issue of BJU International.

The researchers, from St Peter's Hospital and The Institute of Urology in London, studied 447 men who had received 504 implants over a 25-year period.

Subjects ranged from 21 to 78 with an average age of 52 and were monitored for an average of just over four years.

"Not all men are able to take medication to help them overcome erection problems" explains lead author Andrea Minervini. "Implanting a penile prosthesis remains an effective treatment, particularly for patients with medical conditions that cause irreversible erectile dysfunction.

"This large-scale study provides valuable information on more than 500 procedures, which were carried out between 1975 and 2000 by my co-authors, surgeons David Ralph and John Pryor, using ten different penile prostheses."

Key findings include:

• The most common reasons for implants were diabetes (27 per cent) and vascular disease (26 per cent). Other reasons included radical pelvic surgery and spinal cord injuries.

• Patient satisfaction rates were high. 89 per cent of the men said that they were able to have sexual intercourse and 81 per cent were satisfied with the final results of their procedure.

• 71 per cent of patients were satisfied with the actual operation. Dissatisfaction was most likely to be caused by having the prosthesis removed because of problems such as infection or mechanical failure.
• 24 per cent of the men experienced post-operative complications. Minor complications included short-term urinary retention and superficial wound infections. Major complications included prosthesis infection and mechanical failure of the device.

• Complication rates varied depending on the type of prosthesis fitted and the nature of the patient's health problem. For example, men who had suffered pelvic trauma experienced a higher than average rate of prosthesis infection.

• 80 per cent of the procedures carried out were first implants. Of the remainder, just under half were revisions to procedures carried out by other organisations and the rest were for men who needed surgery more than once.

"Recent advances in treating erectile dysfunction mean that many men prefer less invasive alternatives to penile implants" says Andrea Minervini. "However penile prostheses still have an important role to play and continue to provide the 'gold standard' for patients with irreversible erectile dysfunction".