Implantation of inflatable penile prosthesis should be considered as a definitive treatment of erectile dysfunction. However, the sole procedure might not allow for optimal dimensional and functional outcomes. The aim of this study was to systematically review the literature and present the findings on the optimal choice of perioperative methods, surgical techniques, and pharmacotherapy to improve penile length, curvature, and erectile function. Fifteen studies and 697 men were included. Nine studies focused on intraoperative techniques only, while 6 described intra- and postoperative methods. Regarding the outcomes, curvature of the penis was reported in 12 studies, penile length in 5 studies, penile girth in 2 studies, and the International Index of Erectile Function-5 (IIEF-5) score in 7 studies. According to this systematic review, extreme angulation can be reduced using plaque/corporal incisions and grafting with collagen fleece, as well as "scratch" technique with postoperative vacuum therapy. Also, among patients with preoperative curvature of approximately 30°-40°, penile plication, corporoplasty, tunica expansion procedure, manual, and at-home modeling can provide good results. In addition, corporal incisions plus grafting, as well as postoperative vacuum therapy might be the most beneficial in terms of length improvement. Importantly, penile implant in combination with the sealing, daily, and early prosthesis activation proved to improve length. Moreover, postoperative vacuum therapy has also been shown to greatly increase penile circumference. Finally, penile implant in combination with the sealing, corporal incisions plus grafting, "scratch" technique, vacuum therapy, and phosphodiesterase-5 inhibitor are all associated with major improvements in sexual function.
Asian journal of andrology. 2024 Dec 27 [Epub ahead of print]
Jan Łaszkiewicz, Ettore De Berardinis, Wojciech Krajewski, Łukasz Nowak, Tomasz Szydełko, Dalila Carino, Vincenzo Asero, Roberta Corvino, Carlo Maria Scornajenghi, Gabriele Savarese, Gabriele Bignante, Felice Crocetto, Matteo Ferro, Bernardo Rocco, Maria Chiara Sighinolfi, Shufeng Li, Chiyuan Amy Zhang, Satvir Basran, Anthony Mulloy, Frank Glover, Michael Scott, Albert Sangji Ha, Michael L Eisenberg, Francesco Del Giudice
University Center of Excellence in Urology, Wroclaw Medical University, Wroclaw 50-556, Poland., Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome 00161, Italy., University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw 50-556, Poland., Department of Urology, Rush University, Chicago, IL 60612, USA., Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples 80131, Italy., Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan 20141, Italy., Department of Life Sciences, University of Milan, Milan 20122, Italy., Urologic Unit, ASST Santi Paolo and Carlo, Milan 20142, Italy., Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA.