PENILE PROSTHESIS OUTCOME

IN IRAQI PATIENTS
By
Jihad Anad Khalef
Supervised by
Dr.Adil Hefdhi &Dr.Nowfal Alfahad

Anatomy

Physiology

Erectile dysfunction
Definition
Worldwide estimates of ED prevalence range from

2% in men younger than 40 yr to 86% in men 80

yr

RISK FACTORS FOR ERECTILE DYSFUNCTION

Age
Psychogenic
Neural causes (including peripheral nerve injury)
Hormonal causes
Vascular causes. E.g IHD (DM, hypertension,

hyperlipidemia and smoking)

IMPACTS OF ERECTILE DYSFUNCTION:

Economical
Relationship and cultural

Diagnosis of ED
History
Physical exam.
General test, e.g. s. testerone, lipid profile, HbA1c
Specific test

Specific tests
NPT
Doppler study plus Caverject inj.
Arteriography
cavernosography/cavernometry
Bulbocavenosal latency

TREATMENT
First-line treatment

PDE5 inhibitors (e.g., sildenafil, tadalafil,

vardenafil)
Vacuum erection devices
Second-line treatment
Intracavernous injection therapy
Intraurethral alprostadil
Third-line treatment

Penile prosthesis
Semirigid penile prostheses;

Malleable penile prostheses;

mechanechal
Inflatable penile prostheses
2 pieces
3 pieces

Semirigid prosthesis

Malleable penile prostheses

Composed of two rod-like cylinders that are

implanted into the corpora cavernosa

Have a wire-made core for changing the
positioning of the penis from a downward or
upward position (for concealing) to a straight
position for intercourse.
The first malleable penile prosthesis had a silicone
body with a twisted silver wire core
Later, American Medical Systems (AMS) started to
produce malleable prostheses which have a steel
wire core covered by polyester and a silicone outer
part constituting the rod

 The diameter of the AMS 600MTM model is either

9.5 or 11.5 mm
The AMS 650TM model comes in either 11 or 13
mm.
Both come in lengths from 12 to 20 cm,
Lengths can be adjusted by using the proximal tip
extender

Mechanically positional penile prosthesis

Type

Advantages

Disadvantages

Semirigid

Ease of use in men with

limited dexterity
Less expensive
Shorter surgical procedure
Less likely to have
mechanical failure

Remains firm when not erect

More difficult to conceal
Higher risk of erosion, especially
in spinal cord.
Higher risk with repeated
cystoscopy

Inflatable

More natural appearing

flaccid penis
More histologic erection
Easier to conceal

Requires some manual dexterity

to pump
Possibility of mechanical
breakdown
Requires pump and reservoir
placement

TECHNIQUES
Penoscrotal approach;

Subcoronal approach

Infrapubic approach

Perineal approach

COMPLICATIONS
Intraoperative complications

Corporeal crossover
Perforation
Postoperative complications
Erosion
Glans deformity
Infection
Penile necrosis

Patients and methods

We retrospectively reviewed medical records for

17 patients from December 2012 to June 2014 in

Ghazi alhariri surgical
The aim of the study to identify the outcome,
complication and satisfaction in men who
complain sever ED that treated by MPP.
The inclusion criteria for MPP as follows:
(i) Severe erectile dysfunction (SED);
(ii) Failure or intolerance of medical management;
and
(iii)
The confirmation of organic ED by special
evaluation, such as Doppler ultrasound.

 Admission 2-3 preop.

Hair removal
Skin wash: alcohol, hibitane and povidone
Prophylactic antibiotics
Consent
Foley's catheter insertion
Penoscrotal incision
Dilatation
MPP insertion
Skin closure
dressing

Dilatation

Prosthesis preparation

Prosthesis insertion

Fellow up

Satisfaction by visual scale

Modified scale is used

Satisfied
Partially satisfied
Non satisfied

 Data analysis by SPSS 21 & Microsoft excel 2010

Chi square
P value <0.05 significant

Results
PPI was performed in 17 men at our center in the

period between December 2012 to June 2014

Mean age (43.9 11. 5) Range (25-62) year, P
value (1.2) statistically non-significant
According to following table 4 causes are
vasculogenic (52.9%), DM (29.4%), trauma
(11.7%), pyeronies (5.9%)
Causes
Vascular
DM
Trauma
Pyeronies

No.
9
5
2
1

%
52.9
29.4
11.7
5.9

 One of the cases which is severely uncontrolled

DM has right prosthesis removed after a month

and the other remain intact infection (5.9%).
Two cases have erosion for corpora and removed
(11.7%).
11 of patients undergo pain post op. Treated
successfully by the NSAID.

 For satisfaction, we compare the result in 3

grades; (modified satisfaction scale)

Three of them were failed (one of the unmarried),
from other 14 patients have ( one unmarried) . so
we grade satisfaction to 13 patients with their
partner.
From the married persons completely satisfied
4(30.7%) of them, 1 (7.6%) unsatisfied, 8(61.5%)
of them partially satisfied
For 13 patients who are doing intercourse, 3
partners partially satisfied and 10 are completely
satisfied

Discussion
In our study One of the cases which is severely

uncontrolled DM has right prosthesis removed

after a month and the other remain intact infection
(5.9%).
Two cases have erosion for corpora and removed
(11.7%).
11 of the patients (62%) undergo pain post op.
( Treated successfully by the NSAID.
From the married persons (13) completely satisfied
4 (30.7%) of them, 1 (7.6%) unsatisfied, 8 (61.5%)
of them partially satisfied

 Study in university of Sao Paulo Medical School,

Sao Paulo, Brazil 2010

A total of 24.5% of men had immediate
postoperative pain, 7.9% had local infection, and
8.6% had other complications, One hundred
twenty patients (86.3%) rated their level of
satisfaction as good, excellent or very good, which
was similar to the percentage of partners. The
mean follow-up was 40 months

 Another study by N. Salama31

In all, 70% of the patients and 57% of the partners

were satisfied with the prosthesis. There was an

increase in frequency of intercourse, sexual desire,
and ability to achieve orgasm

 study done by Kim Yong dong et.al, 32 on A total of

48 patients with an SCI, who underwent malleable

penile prosthesis (AMS 600) insertion from 1990 to
2004
eight patients (16.7%). Wound infections in four
(8.3%). Two patients were treated with conservative
management, where erosion in two patients (4.2%),
uncontrolled penile pain owing to the excessive
prosthesis length in one patient (2.1%), and
supersonic transport (SST) deformity in one patient
(2.1%). The overall patient satisfaction rate was
79.2%.

Recommendation
I recommend to use a malleable penile prosthesis
as a safe and effective procedure for the sever ED
in males, but still it needs long term follow up.
Also, I recommend trying an inflatable prosthesis
and make a comparative study between them.

THANK YOU