Penile prostheses: are they still relevant?

Abstract

and 270 VIPs. Currently our operating time is 2-2.5 h, depending on whether a pelvic lymphadenectomy is performed or not; the robotic RP time is 45 min less. Allowing for a theatre turn-over of 1-1.5 h, we can undertake three operations during a normal working day. Over 95% of the patients are discharged within 24 h; over the last month, half have gone home within 6 h of surgery.No patient has required an intraoperative transfusion. Six patients have had major complications, five requiring secondary surgical procedures (two port-site hernias, two pelvic haematomas and one repair of a small bowel injury). After 2 months, 90% of the patients are continent, and 60% of initially potent patients have had unassisted intercourse by the 6 month follow-up. Table 1 compares the operative variables during radical, laparoscopic RP and VIP.There appear to be two unresolved issues about robotic surgery, i.e. the cost of the procedure and the intensity of training. The da Vinci surgical system (Intuitive Surgical™, France) costs US $1.2 million, with a maintenance fee of $100 000/year after the first year. The average cost of disposables is $1500 per patient. These extra costs are balanced by the cost savings of decreased hospitalization, fewer blood transfusions, decreased theatre time and a lower complication rate. While it is notoriously difficult to calculate precise hospital costs in the USA, the best we can determine is that the robotic procedure still costs an average of $150 more than the open procedure. This has changed over the last few months, with costs actually favouring robotic surgery, as the operating times for VIP have become shorter than for open RP.

Should being aged over 70 years hinder penile prosthesis implantation?

“…Currently, penile implants play a welldefined role in the treatment of organic irreversible erectile dysfunction (ED). When pharmacological therapy, oral or locally administered, is ineffective or contraindicated, and when vacuum devices are unsatisfactory or unacceptable, implants have offered patients with ED a very predictable and reliable way of restoring sexual function [1].…”

Treating erectile dysfunction when PDE5 inhibitors fail

“…Pharmacotherapy often fails in patients with diabetes, radical prostatectomy, Peyronie's disease, and severe penile fibrosis. Penile prosthetic surgery has high long term mechanical reliability and patient satisfaction rates of more than 85% 29. One of the most serious complications is infection, although infection has decreased greatly since the introduction of antibiotic coated penile prostheses 30…”

Management of sildenafil treatment failures

“…Penile prosthetic surgery has high long-term mechanical reliability and patient satisfaction rates of more than 85% [83]. Recent modifications in penile prostheses have resulted in less mechanical malfunction rates, and antibiotic coating has reduced infection rates to less than 1% [83].…”

“…Penile prosthetic surgery has high long-term mechanical reliability and patient satisfaction rates of more than 85% [83]. Recent modifications in penile prostheses have resulted in less mechanical malfunction rates, and antibiotic coating has reduced infection rates to less than 1% [83]. As this alternative assumes the risks inherent of any surgical procedure requiring general or spinal anesthesia, as well as risks specific to this procedure, it is generally reserved for those who fail to respond to the less-invasive pharmacologic therapies or VEDs.…”