Penile Prosthetic Surgery in Neurologically Impaired Patients: Long-Term Followup

Abstract

The implantation of a penile prosthesis is a safe procedure for erectile dysfunction and/or urinary incontinence in neurologically impaired patients. Based on technical advances the complication rates significantly decreased during the years. The implantation of an inflatable 3-piece penile prosthesis in a neurologically impaired patient is a safe and viable procedure. Indications include the management of erectile dysfunction and problematic urinary collection.

Penile Prosthesis Surgery: A Review of Prosthetic Devices and Associated Complications

“…Resolution of urinary management problems and successful treatment of ED has been reported in 90.3% and 82.6% of neurologically impaired patients with urinary drainage problems or ED, respectively [35]. Perforation rates are significantly higher for the semirigid, as compared with the self-contained inflatable, prostheses.…”

Erectile Dysfunction in Paraplegic Males

“…In a relatively recent study a total number of 245 patients with SCL participated (Zermann et al, 2006). Apart from the restoration of erectile function, penile prosthesis implantation offered a wide enough penis in order to achieve a better fixation of a condom catheter.…”

Surgical Treatment of Erectile Dysfunction

“…Patients at younger age with normal manual dexterity or who wear firm clothing often choose a three-piece inflatable penile prosthesis because appearance in the flaccid position is better than other designs (Hellstrom WG, et al 2010). In addition, inflatable penile prosthesis should be the preferred option in patients with Peyronie's disease, history of previous implantation procedures or neurological disorders where considering interior tissue pressures are declined between uses and the risk of extrusion is diminished (Zermann DH, 2006). For some patients such as paraplegics, malleable prostheses can be chosen since inflatable ones have much higher malfunction rates.…”

“…If the problem is noted in the immediate postoperative period, it is wise to wait a few weeks and allow for complete healing and scar formation, which may result in glans fixation and resolution of the SST deformity (Carson C. 1999) Device extrusion may develop as an isolated finding or may be a sign of the device infection. Semirigid prosthesis are more prone to erosion, as the rate was reported as 18.1% for semirigid prostheses, 2.4% for self contained inflatable and 0% for 3-piece inflatable ones (Zermann et al 2006). Distal cylinder extrusion can be corrected by preparing a new cavity for the distal cylinder behind the back wall of the fibrotic sheath containing it (Mulcahy JJ.…”