Erectile Function Significant Enough for Penetration During Sexual Intercourse After Removal of Inflatable Penile Prosthesis

Abstract

Introduction Fifty-two-year-old male with history of multiple insults to his erectile tissue, including insertion and removal of penile implant, presents with significant partial erectile function, substantial enough for anal penetration during sexual intercourse. Aim Erectile function rigid enough for anal penetration, let alone any erectile function after removal of an inflatable penile prosthesis (IPP), is rare. This article, to our knowledge, is the first case of a patient who has undergone multiple insults to his erectile tissue, including an episode of ischemic priapism followed by implantation and removal of an IPP, who presents with erectile function sufficient enough for coitus. Main Outcome Measures Outcome measured via standardized patient questionnaires and penile Doppler following injection of Trimix. Method An objective measure of the patient’s erectile function was performed via penile Doppler. Results Penile Doppler after 10-mcg injection of Trimix revealed numerous perforating vessels from the corpora spongiosum providing blood flow to the corpora cavernosa. The patient obtained approximately 60–70% rigid erection. Conclusions To our knowledge, and after thorough review of the literature, we could not find any reports of erectile function significant enough to take part in sexual intercourse and penetration after removal of a three-piece IPP. The implant usually disrupts the normal anatomy which allows for cavernosal arterial vasodilation and increased blood flow into the corpora. Following dilation of the corpora the cylinders are inserted and inflated, and the smooth muscle that makes up the corpora cavernosum is compressed against the wall of the tunica albuginea. Theoretically, the remaining smooth muscle tissue may retain some of its physiologic function, adding some additional girth to the penis with an already activated IPP during sexual intercourse.

Treatment of Penile Prosthesis Implant’s Infection

“…For several reasons, including technical ones, many propose the implantation of a new prosthesis at the time of explant surgery (“concomitant implant after explant”). A penis uninhabited by the cylinder will lead to fibrosis formation and shortening of the penis (by up to 4–5 cm) [22]; in these circumstances, re-implant surgery is technically demanding, and the use of a vacuum device after explant may help in obtaining good results and reducing fibrosis and the shortening of the penis. Although technically harder, delayed re-implant surgery currently remains safer than immediate re-implant surgery.…”