Clinical Recommendations From the European Society for Sexual Medicine Exploring Partner Expectations, Satisfaction in Male and Phalloplasty Cohorts, the Impact of Penile Length, Girth and Implant Type, Reservoir Placement, and the Influence of Comorbidities and Social Circumstances

Abstract

Introduction: To date, several aspects of inflatable penile prosthesis (IPP) surgical procedure have been poorly studied. Aim: The aim of this study was to review the evidence associated with IPP implantation and provide clinical recommendations on behalf of the European Society for Sexual Medicine (ESSM). Overall, 130 peer-reviewed studies and systematic reviews, which were published from 2007À2018 in the English language, were included. Methods: MEDLINE and EMBASE were searched for randomized clinical trials, meta-analyses, and open-label prospective and retrospective studies. Main Outcome Measure: The panel provided statements exploring patients and partner expectations, satisfaction in male and phalloplasty cohorts, the impact of penile length, girth and implant type, reservoir placement, the influence of comorbidities, and social circumstances. Levels of evidence were provided according to the Oxford 2011 criteria and graded as for the Oxford Centre for Evidence-Based Medicine recommendations. Results: In the preoperative setting, it is fundamental to identify and interact with difficult patients with the intention of enhancing the surgeon's ability to establish the surgeon-patient relationship, reduce physical and legal risk, as well as enhancing patient satisfaction. To address this need, the mnemonic Compulsive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, and Psychiatric ("CURSED") has been suggested to identify patients who are at high risk of dissatisfaction. The current recommendations suggest improving glycemic control in patients with diabetes. Available evidence suggests evaluating transplant recipients with the criteria of Barry, consisting of stable graft function for >6 months, avoidance of intra-abdominal reservoir placement, and lowdose immunosuppression. HIV status does not represent a contraindication for surgery. Smoking, peripheral vascular disease, and hypertension may be associated with an increased risk of revision surgery. Patients with

The woman and the penile prosthetic implant. Primary or secondary role? Personal experiences on 355 implanted patients

“…In the past, the Literature addressed women sexual satisfaction in a generic way when reporting the satisfaction shown by women in relation to the penile prostheses of their partners. Another problem begins to be observed in women with sexual dysfunction already existing before the resolution of the erectile dysfunction of their partners, who got used to the ED of their partners and after PPI begin to develop a high level of stress, as a result of the new requests and expectations made possible by the penile prosthetic implant (17). It has sometimes emerged that the wife, no longer young, begins to fear that the husband may be interested and involved in extramarital relationships, not possible as long as an ED was present.…”

Penile implant infection factors: a contemporary narrative review of literature

“…Another review noted smoking as a risk factor for revision or removal surgery in penile prosthesis patients; while this study did not specifically look at infection rates relative to smoking, revisions/explantations are often treatments for infection so one could infer from this data that infection was likely involved (59). Of note, society recommendations generally lean toward smoking cessation before prosthesis implantation (60).…”

“…The European Society for Sexual Medicine notes diabetes as a risk factor and recommends optimizing glycemic control to normal A1C levels before surgery to decrease the rate of infection; in addition, they make recommendations on other topics listed above (60).…”

Preoperative Psychological Evaluation for Patients Referred for Penile Prosthesis Implantation

“…17 The assessment of the expectations of sexual partners of patients who are candidates for penile prosthesis implantation is also recommended by the European Society for Sexual Medicine. 11 Still, we could not find studies using preoperative structured psychological evaluation protocols.…”

“…Whatever the cause, the partner's involvement in the clinical assessments and discussing the patient's and their partner's expectations are crucial in choosing the best suitable treatment. 11 The levels of satisfaction among patients that underwent penile prosthesis implantation can be high, 12 calculated at 69e89% in the 1980s and 1990s, and reaching 100% in some studies published from 2000 onwards. 13 However, some patients remain dissatisfied with the surgical results due to reduction in penile size, expectations not met, prosthesis not allowing sexual intercourse, artificial or unnatural appearance, retarded ejaculation, prosthesis malfunction, and the difficulty to satisfy one's partner.…”