Have phosphodiesterase‐5 inhibitors changed the indications for penile implants?

Abstract

OBJECTIVE To evaluate the indications for penile prosthesis implantation in the treatment of erectile dysfunction (ED) before and after the introduction of sildenafil. PATIENTS AND METHODS Penile prosthesis implantation was indicated in 144 men with ED at our institution between 1992 and 2007; 83 (55.6%) accepted the procedure, 55 (38.2%) refused it and six (4.2%) accepted but eventually had no surgery. Sixty‐seven patients were operated primarily, and the remainder were referred cases with complications after or dissatisfaction with primary operations done elsewhere. Thirty‐two were operated before the introduction of sildenafil (BS) and 35 after (AS). RESULTS In the BS group the most frequent aetiology was vascular disease, with 11(34%) vs two (6%) in the AS group. The most frequent aetiology in the AS group was previous radical pelvic surgery (radical prostatectomy, sigmoidectomy, etc.) with 17 (49%) vs none in the BS group. There were no significant differences in complication rates in both groups. Satisfaction rates in patients with malleable and inflatable devices were 36 (86%) and 17 (85%), respectively. CONCLUSIONS After the introduction of oral therapy for ED there were some changes in the aetiology of refractory ED; ED after radical prostatectomy is gaining acceptance as the main reason for a penile implant.

Penile Implant Utilization Following Treatment for Prostate Cancer: Analysis of the SEER-Medicare Database

“…Improvement in erectile function was achieved in 45–67%, and successful intercourse was feasible in only 40–55% [5]. Interestingly, Cortes‐Gonzalez and Glina found that the proportion of men who underwent radical pelvic surgery that went on to penile implant surgery actually increased after the introduction of PDE5i, and the proportion of men who had ED caused by vascular diseases decreased [33]. Stanley et al.…”

Sex: the new postcode lottery

“…1,[4][5][6] The introduction of PDE-5i revolutionised the management of ED. [7][8][9] Initially, PDE-5i reduced the number of men requiring penile prosthesis implantation. However, this trend has reversed recently, probably as a result of ED being marketed as a curable condition and more men seeking medical treatment.…”

“…However, this trend has reversed recently, probably as a result of ED being marketed as a curable condition and more men seeking medical treatment. [7][8][9] PDE-5i have also changed the indications for penile prosthesis as successful medical management of vascular ED, resulting in more prostheses being implanted following pelvic surgery. 8 Nevertheless, a small group of men will still require a prosthesis after failure of all other options.…”

“…[7][8][9] PDE-5i have also changed the indications for penile prosthesis as successful medical management of vascular ED, resulting in more prostheses being implanted following pelvic surgery. 8 Nevertheless, a small group of men will still require a prosthesis after failure of all other options. 9 Penile prosthesis implantation is associated with very high satisfaction rates of over 80% and this has been reproduced consistently in the literature.…”

Bulbocavernosus reflex testing: a preliminary study on the prognostic factors for potency and response to sildenafil citrate after bilateral nerve-sparing radical prostatectomy

“…Erectile function can be preserved after radical prostatectomy, depending upon previous potency status, the patient's age, tumor stage, and preservation of the neurovascular bundles (NVB) [2]. At best, the probability for potency recovery after bilateral NS-RRP in a referral center, in a patient younger than 60 years, having adequate erections preoperatively is 76%, while other studies, however, have reported much lower probabilities [3][4][5][6]. In accordance, despite the operative effort for bilateral anatomic preservation of the NVB, postoperative adequate erectile function cannot be guaranteed [2].…”