Sizing Penile Prosthesis Length as per the Erect Penile Length: Experience from Cases of Unresolved Ischemic Priapism

Abstract

Introduction: Among the reasons for patient dissatisfaction following penile prosthesis implantation (PPI) is decreased length, possibly due to implantation as per the flaccid stretched length, which is shorter than the erect length. Aim of Study: To examine safety of sizing implant length as per the erect state, and its efficacy in enhancing patient satisfaction, by evaluating outcome of implantation in patients with refractory ischemic priapism operated upon early enough before fibrosis sets in. Patients and Methods: Patients for the study were recruited in the past 2 years. Nineteen post-priapism patients comprised the study group (SG), and 21 non-priabitic cases comprised the control group (CG) who were treated for ED refractory to oral medication and intr-cavernosal injection. PPI was performed as per the erect length for the SG and the flaccid stretched length for the CG. At final follow up (46 ± 12.4 months), subjective patient's impression of length compared to his recall of erect pre-ED/pre-priapism length was recorded as either "almost the same", "shorter" or "longer", and patient's satisfaction with length was recorded on a 5-point Lickert scale. Complications were reported. Results: In the CG all patients reported a shorter length (100%), in contrast to 5.3% in the SG .Satisfaction with length was 57.1 % higher in the SG compared to CG (mean satisfaction 5, and 2.1 ± 0.96 respectively, p=0.048). None of the cases in either groups encountered anterior or posterior perforation/extrusion) or persistent pain beyond 2 months postoperatively. Clinical Implications : Penile prosthesis implantation as per the erect length and not the flaccid stretched length may be safe and effective in preserving length. Conclusion: Penile prosthesis implantation in the erect state post-priapism was safe and offered higher satisfaction with length, and it is therefore safe and favorable to implant prostheses as per the erect length in other cases.