What do couples think of penile implants? Two- and 3-piece inflatable devices have higher satisfaction rates than malleable implants, scientists report. But each type has its advantages and disadvantages for patients to consider.
Penile implantation is a “gold-standard” erectile dysfunction (ED) treatment for men who do not respond to (or can’t safely use) other therapies, such as PDE5 inhibitors, vacuum devices, intraurethral prostaglandin and prostaglandin injections.
Currently, three types of penile prostheses are available. All are surgically implanted after the removal of the corpora cavernosa – spongy tissue that typically fills with blood to form an erection.
Malleable implants are semi-rigid rods that can be manually raised to create an erection as desired.
Inflatable implants use fluid to form an erection. Most inflatable implants are 3-piece devices that include cylinders, a fluid reservoir, and a pump that activates and de-activates the erection. Men who are at high-risk for reservoir complications may choose a 2-piece device, in which the fluid is housed with the cylinders.
In a recent Journal of Sexual Medicine study, researchers investigated couples’ satisfaction rates for both types of inflatable devices and malleable implants. They also looked at implant complications and mechanical reliability.
The retrospective study involved 883 men (average age 58 years) who had undergone implant procedures for the treatment of ED. Three hundred forty-nine men had malleable implants, 26 had 2-piece inflatable implants, and 508 had the 3-piece inflatable type.
Couples’ satisfaction was assessed with the modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire, with female partners (average age 43 years) also completing another validated questionnaire. The men’s medical records were also reviewed. The average follow-up period was 68 months.
Satisfaction rates for all 3 groups were at least 90%, with higher rates in the 2-piece and 3-piece inflatable implant groups (96.1% and 99.2%, respectively) compared to the malleable implant group (90.3%). Almost 8% of the patients with malleable implants were dissatisfied enough to have their implant replaced with a 3-piece version. Only one patient chose to replace a 3-piece implant with a malleable version.
Seven percent of all patients experienced complications within 30 days of surgery. Edema, hematoma, and mild infection were most frequently reported. Eight percent of the men had complications after the 30-day mark. Penile corporal perforation was the most common reason for revision surgery in the malleable group, affecting 2.6% of the men. In the 3-piece group, 5.5% of the men had a device malfunction requiring revision surgery.
Implant brands did not seem to affect satisfaction rates. Having a complication was the only risk factor that predicted dissatisfaction.
It’s important for patients to know about their implant options and what they might expect from each type of implant, the authors noted.
“Prosthesis choice should be customized to individual patient’s expectations/conditions and be tailored accordingly,” they wrote.
The Journal of Sexual Medicine
Çayan, Selahittin, MD, FECSM, et al.
“Comparison of Long-Term Results and Couples’ Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation”
(Full-text. Published online: May 30, 2019)