madman
Super Moderator
Complications and troubleshooting in primary penile prosthetic surgery—a review (2023)
Eileen R. Byrne, Garrett N. Ungerer, Matthew J. Ziegelmann and Tobias S. Kohler
Penile implant surgery is the gold standard to treat erectile dysfunction with success rates of over 90%. The first penile implants were developed in the early 1900s. Since then, several types of implants have been developed including malleable implants, two-piece inflatable implants, and three-piece inflatable implants. The three-piece inflatable penile prosthesis, which was introduced in 1973, is the most widely used type of penile implant in the United States. Penile implant surgery has undergone numerous advancements over the years, improving outcomes and patient satisfaction. However, as with any surgical procedure, there are risks and complications associated with penile implant surgery. It is important for surgeons to understand these potential complications and to have strategies in place to manage and prevent them to achieve the best possible outcomes for their patients.
INTRODUCTION
Penile prosthetic surgery is the gold standard treatment for erectile dysfunction in the setting of poor response to oral and/or injectable medications or for patients who prefer a definitive therapy [1, 2]. Various types of rigid and semi-rigid rods were originally described dating back to the early 1900s [3, 4]. The inflatable penile prosthesis was introduced into clinical practice in 1973 [5]. There have been numerous advances in device technology over the last several decades meant to enhance the ease of placement, device longevity, and “naturalness” of the erection [6]. Concurrently, there have been numerous innovations in operative technique and complications management that have been introduced by surgeons looking to optimize long-term outcomes including patient satisfaction [7, 8].
Regardless of the surgeon's expertise, experience, and good luck, intraoperative and postoperative complications will arise. Put another way, as a person with brilliant insight once commented, “If you don’t have complications, then you aren’t operating enough”. This adage has been passed down in part to inject humor and humility for those of us who experience complications, but it very much rings true for penile prosthetics. By understanding the potential risks and complications associated with penile implant surgery and feeling confident and prepared to take these issues on as they arise, prosthetic surgeons can achieve the best possible outcomes for their patients. Herein, we seek to provide a review of penile prosthetic complications, discuss specific management strategies, and offer suggestions for preventing common complications that may arise. In an effort to keep this review article concise, we will focus on the three-piece device and will not specifically address adjunctive measures for Peyronie’s disease, techniques and complications unique to revision surgery, and applications for gender affirmation surgery. The reader is referred to a variety of comprehensive review articles on these and other pertinent prosthetic-related topics for further information [9–13].
*PREOPERATIVE CONSIDERATIONS
*INFECTION
*SUPERSONIC TRANSPORTER (SST) DEFORMITY
*CROSSOVER
*PERFORATION
*URETHRAL INJURY
*CORPORAL FIBROSIS TROUBLESHOOTING
*RESERVOIR COMPLICATIONS
*GLANS COMPLICATIONS
*PENOSCROTAL WEBBING
*PUMP AND TUBING PLACEMENT
*DEVICE INJURY
*ACQUIRED BURIED PENIS
CONCLUSIONS
Penile prosthesis placement remains a highly effective treatment of erectile dysfunction with excellent satisfaction rates, but surgeons often face anatomical challenges and intraoperative complications that must be successfully navigated to lead to successful outcomes. Good clinical judgment coupled with sound knowledge of various management strategies are critical to effectively handling the plethora of possible scenarios encountered intraoperatively. Inexperienced implanters should consider referring patients who are identified pre-operatively as having complex anatomy or other potential challenges to centers of excellence with highly experienced implant surgeons.
Eileen R. Byrne, Garrett N. Ungerer, Matthew J. Ziegelmann and Tobias S. Kohler
Penile implant surgery is the gold standard to treat erectile dysfunction with success rates of over 90%. The first penile implants were developed in the early 1900s. Since then, several types of implants have been developed including malleable implants, two-piece inflatable implants, and three-piece inflatable implants. The three-piece inflatable penile prosthesis, which was introduced in 1973, is the most widely used type of penile implant in the United States. Penile implant surgery has undergone numerous advancements over the years, improving outcomes and patient satisfaction. However, as with any surgical procedure, there are risks and complications associated with penile implant surgery. It is important for surgeons to understand these potential complications and to have strategies in place to manage and prevent them to achieve the best possible outcomes for their patients.
INTRODUCTION
Penile prosthetic surgery is the gold standard treatment for erectile dysfunction in the setting of poor response to oral and/or injectable medications or for patients who prefer a definitive therapy [1, 2]. Various types of rigid and semi-rigid rods were originally described dating back to the early 1900s [3, 4]. The inflatable penile prosthesis was introduced into clinical practice in 1973 [5]. There have been numerous advances in device technology over the last several decades meant to enhance the ease of placement, device longevity, and “naturalness” of the erection [6]. Concurrently, there have been numerous innovations in operative technique and complications management that have been introduced by surgeons looking to optimize long-term outcomes including patient satisfaction [7, 8].
Regardless of the surgeon's expertise, experience, and good luck, intraoperative and postoperative complications will arise. Put another way, as a person with brilliant insight once commented, “If you don’t have complications, then you aren’t operating enough”. This adage has been passed down in part to inject humor and humility for those of us who experience complications, but it very much rings true for penile prosthetics. By understanding the potential risks and complications associated with penile implant surgery and feeling confident and prepared to take these issues on as they arise, prosthetic surgeons can achieve the best possible outcomes for their patients. Herein, we seek to provide a review of penile prosthetic complications, discuss specific management strategies, and offer suggestions for preventing common complications that may arise. In an effort to keep this review article concise, we will focus on the three-piece device and will not specifically address adjunctive measures for Peyronie’s disease, techniques and complications unique to revision surgery, and applications for gender affirmation surgery. The reader is referred to a variety of comprehensive review articles on these and other pertinent prosthetic-related topics for further information [9–13].
*PREOPERATIVE CONSIDERATIONS
*INFECTION
*SUPERSONIC TRANSPORTER (SST) DEFORMITY
*CROSSOVER
*PERFORATION
*URETHRAL INJURY
*CORPORAL FIBROSIS TROUBLESHOOTING
*RESERVOIR COMPLICATIONS
*GLANS COMPLICATIONS
*PENOSCROTAL WEBBING
*PUMP AND TUBING PLACEMENT
*DEVICE INJURY
*ACQUIRED BURIED PENIS
CONCLUSIONS
Penile prosthesis placement remains a highly effective treatment of erectile dysfunction with excellent satisfaction rates, but surgeons often face anatomical challenges and intraoperative complications that must be successfully navigated to lead to successful outcomes. Good clinical judgment coupled with sound knowledge of various management strategies are critical to effectively handling the plethora of possible scenarios encountered intraoperatively. Inexperienced implanters should consider referring patients who are identified pre-operatively as having complex anatomy or other potential challenges to centers of excellence with highly experienced implant surgeons.
