Long-Term Follow-Up After Penile Prosthesis Implantation—Survival and Quality of Life Outcomes

Abstract

Introduction Hydraulic penile prostheses have shown an overall good mechanical reliability up to 10 years after surgery; however, few data have been published on very long-term follow-up. Aim We looked at long-term (≥15 years) complications, including functional and quality of life (QoL) outcomes, after 3-piece inflatable penile prosthesis (IPP) implantation in patients with erectile dysfunction (ED). Methods Data regarding 149 patients submitting to IPP placement before 2001 were analyzed. All patients were implanted with AMS CX and Ultrex Plus 3-piece prostheses. Main Outcome Measure Patients were reassessed to evaluate rates of complications and functional outcomes. The validated questionnaire Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) was used to assess patient QoL. Kaplan-Meier analysis estimated the probability of prosthesis survival (defined as working device/not-explanted). Results Median follow-up of 51 patients was 206 months (interquartile range [IQR], 145–257). The etiology of ED was vasculogenic (n = 20; 39%), Peyronie’s disease (n = 15; 29%), pelvic surgery (n = 4; 7.8%), organic other than vasculogenic (n = 3; 5.9%), or other (n = 9; 18%). Throughout the follow-up, 24 patients (49%) experienced complications: mechanical failure (n = 19; 79%), pain (n = 3; 12%), orgasmic dysfunctions (n = 1; 4.5%), or device infection (n = 1; 4.5%). The estimated IPP survival was 53% (95% CI, 36–67) at 20-year follow-up. Baseline characteristics (age, Charlson comorbidity index, body mass index, and erectile dysfunction etiology) were not significantly associated with the risk of IPP failure over time by Cox regression analysis. At 20-year follow-up, 41% (95% CI, 19–49) of the patients were still using the device. Among them, QoLSPP median domain scores were high: functional 22/25 (IQR, 20–23), relational 17/20 (IQR, 15–18), personal 14/15 (IQR, 12–15), and social 14/15 (IQR, 11–15). Clinical Implications The longevity of the device and long-term satisfaction rates should be comprehensively discussed during patient consultation for IPP surgery. Strengths & Limitations To our knowledge, this is the first study reporting long-term QoL outcomes using a dedicated questionnaire for penile prostheses. The low response rate for the telephone interviews, the retrospective design of the study, and the relatively small number of patients are the main limitations. Conclusion Long-term follow-up data after IPP placement showed that almost half of the devices still worked properly 20 years after the original penile implant, as 60% of patients were still using the device with high satisfaction and adequate QoL outcomes. Both patients and physicians should be aware of the expected life and outcomes of IPP implants.

Does two-piece PPI provide improvement in patient-partner quality of life?

“…There are many studies in the literature that evaluate QoL of male patients with penile prostheses, but findings evaluating QoL of female partners could not be observed in these studies (8,22,23). In this study, partners' QoL was not at a healthy level before PPI.…”

“…Ure et al evaluated patients' QoL with SF 36 scale and observed that it was significantly increased after PPI compared to the preoperative period (7). However, in studies about patient QoL who underwent PPI, partner QoL was not mentioned much (8). In the current study, patients that did not respond to first-line and second-line treatments, and therefore underwent two-piece PPI were evaluated.…”

“…Studies have repeatedly shown that PPI positively affects patients' QoL, perceived quality of the couple relationship, partner satisfaction, body image, the relationship with the outside world, and the satisfaction with the implant function (22,23). In addition, in a study where the patient follow-up period was at least 15 years, it was found that 60% of the patients still used penile prostheses, satisfaction was high, and the QoL results were sufficient (8). In this study, patient QoL was not at a healthy level before PPI.…”

Enhanced recovery strategies after penile implantation: a narrative review

“…Annual IPP implantation cases rose in the US from 17,540 in 2000 to 22,420 in 2009, and the numbers continue to climb (7). Improvements in prosthetic design and surgical implantation techniques have resulted in longer device functional capacity and quality of life scores among patients, making this procedure popular and increasingly common (8). Still, post-operative pain continues to be a significant issue among patients undergoing IPP surgery, effecting up to 11.9% of patients at 5-year follow-up (9).…”

8-year post operative survival after penile prothesis implantation: Less than expected perioperative risk.

“…Long term function of the prosthesis, i.e., for up to 15 years along with the outcome of post-hospital syndrome have been investigated in past studies (12), (13). However, the mortality rate of patients based on the risks imposed by anaesthesia, along with the risks involved during the perioperative period has not been extensively studied by past literature (10).…”