We treated 138 patients with severe Peyronie's disease by insertion of an inflatable penile prosthesis and manual modeling of the erect penis. This novel technique was successful in 118 patients (86%) in achieving a straight, rigid erection. In 11 patients (8%) penile modeling did not result in satisfactory straightening and relaxing plaque incisions were performed. Complications of penile modeling included urethral perforation in 4 patients (3%). Infection of the prosthesis occurred postoperatively in 4 patients (3%). At a mean followup of 32 months (range 9 to 84) 124 patients (90%) were actually using the penile prostheses and none reported penile shortening or impairment of glandular sensation. We suggest that penile modeling over an inflatable penile prosthesis is an important new technique for the patient with severe Peyronie's disease.

No abstract

Introduction Long-term revision-free survival, greater than 10 years has never been reported for inflatable penile prostheses. We conducted a historical prospective study to estimate 10 and 15 years survival of first time (virgin) implantations in 2,384 patients with four different models. Aim Evaluation of 10- and 15-year mechanical and overall revision-free survival of inflatable penile prostheses. Main Outcome Measures Kaplan–Meier product limit method, and comparison using the log rank test, were used to estimate the 10- and 15-year revision-free survival. Methods Data were obtained from medical records and patient interviews, entered into a computerized database, and analyzed by a third party. Information included implant type, date, revision history with date, and reason. Fourteen different inflatables were examined. Mentor Alpha 1, Mentor Alpha NB, AMS 700 CX, and AMS 700 Ultrex had usage for an extended period of time. Because of failure times being confounded as a result of prior implants, only virgin implants were examined. Results For the entire series, estimated 10-year revision-free survival for all reasons was 68.5% and the 15-year revision-free survival was 59.7%. Freedom from mechanical breakage at 10 years was 79.4%; 15 years was 71.2%. Recent mechanically enhanced models did even better. In 1992, Mentor Alpha added pump reinforcement to forestall mechanical breakage. This improved 10-year survival from 65.3% to 88.6% (P  = 0.0001). In January 2001, AMS CX added a parylene coating to the cylinders that increased 3-year mechanical survival from 88.4 to 97.9% (P  = 0.0002). Conclusions This is the first report on long-term reliability of inflatable penile prostheses. We estimated 60% of these virgin implants would survive 15 or more years without revision or extraction. Newer enhanced models are currently available, and our tracking predicts even better long-term survival for these devices.

Early results of combining complete implant removal and modified salvage protocol indicate a markedly decreased incidence of infection in patients with a penile prosthesis undergoing revision for noninfectious reasons.