Inflatable penile prostheses yield positive outcomes in Peyronie's patients

Chicago-For men with erectile dysfunction and Peyronie’s disease, implantation of a modern inflatable penile prosthesis with manual penile remodeling appears to provide satisfactory penile straightening without an increased risk of revision surgery, according to the findings of a recent retrospective study.

The investigation evaluated clinical outcomes, post-implant sexual characteristics, and overall patient satisfaction of 138 patients with concomitant erectile dysfunction (ED) and Peyronie’s disease (PD) who underwent inflatable penile prosthesis (IPP) implantation at St. Joseph’s Health Care London in London, Ontario, during a 5-year period from January 2006 to November 2010. All men had preoperative penile Duplex ultrasound, and those with curvature >90 degrees were excluded. Two different IPPs were used; 88 men received the AMS 700CX (American Medical Systems, Minnetonka, MN), and the remaining 50 patients were implanted with the Titan (Coloplast, Minneapolis). The two IPP groups were similar in their demographic and preoperative characteristics.

Surgical outcomes were determined from medical record review, and patient satisfaction was evaluated by telephone survey conducted by an independent interviewer. After a mean overall follow-up of 3+ years

(AMS 700CX, 41 months; Titan, 35 months), 96% of men had an intact IPP and reported being sexually active. In Kaplan-Meier analysis of the 5-year rate of survival from mechanical failure, there was a trend favoring the AMS 700CX device over the Titan IPP (91% vs. 87%), but the difference between groups was not statistically significant. There were no significant differences between the two IPP groups in rates of infection, erosion, or patient satisfaction regarding curvature outcome and IPP strength/rigidity for sexual activity. In addition, more than 85% of men in both device groups said they would undergo the surgery again and would recommend it to others with PD and ED, reported Eric Chung, MD, who presented the findings at the 2012 World Meeting on Sexual Medicine in Chicago.

“Although implantation of an IPP with simultaneous manual penile remodeling can both treat the underlying ED and correct penile deformity and/or curvature, in the past it has been associated with an increased risk of device mechanical failure and malfunction. However, there have been significant advances in prosthesis technology in terms of mechanical reliability and durability of the device and also the quality of the artificial erection,” said Dr. Chung, urologic surgeon at Princess Alexandra Hospital, Brisbane, Australia.

“Our results indicate that surgical and ­clinical outcomes, including patient satisfaction, have been excellent when implanting either of these IPPs with manual penile remodeling.”

When he conducted the research, Dr. Chung was the fellow for senior author Gerald Brock, MD, professor of surgery (urology), University of Western Ontario, London.

6% of patients underwent revision surgery

Of the 138 patients in the series, eight men (6%) had IPP revision surgery for reasons of mechanical malfunction (seven patients) or personal dissatisfaction with recycling of the device (one patient). There was no significant correlation between IPP cylinder size and mechanical failure. There was a trend for the mechanical failure rate to be higher in men with penile curvature >60 degrees versus those with lesser curvature, but the difference between groups did not reach statistical significance.

Three men had the IPP removed after the implantation (between 11 days and 3 years). One patient had immediate salvage per the Mulcahy protocol; one had delayed IPP implantation; and the third decided against further implant surgery.

Analysis of outcomes in men with preoperative curvature ≤60 degrees showed all reported excellent improvement in penile curvature, as defined as <10-15 degrees residual curvature. Of the 18 men (13%) dissatisfied with their outcome, the main concern was decrease in perceived penile length.

Dr. Brock is a consultant to and receives honoraria and research/grant funds from American Medical Systems and Coloplast.UT