BERKELEY, CA (UroToday.com) - When treating erectile dysfunction, the placement of penile prostheses has allowed patients to achieve dependable spontaneity for sexual activity and thus has been associated with high patient satisfaction rates.
Among the current available prostheses, the placement of a three-piece inflatable penile prosthesis carries the highest rates of satisfaction and is considered the gold standard. When compared with two-piece or semi-rigid implants, it gives the most natural and physiological feeling of erection, best firmness and expansion in girth, most flaccidity when deflated, and best concealment within the body. Nevertheless, the three-piece prosthesis is the most expensive amongst all the available implants, and since many authorities and insurance companies worldwide do not cover the costs of all types of penile prostheses, many patients choose to downgrade their options to cheaper implants that are less ideal.
When cost is not considered, a semi-rigid implant is considered for patients who have poor manual dexterity, or those who are significantly obese. It is also considered for patients who require having an adequate body to the penile shaft so as to hold an external urinary drainage device with or without erectile dysfunction. In patients with spinal cord injury, caution should be exercised when a semi-rigid prosthesis is used for this reason since many lack penile sensation and are thus more prone to erosion. Sometimes the surgeon wishes to avoid placing a reservoir inside its usual location behind the pelvic bone, in the space of Retzius, due to complex anatomical issues (e.g. patients with previous extensive abdominal surgery, kidney transplant, or peritoneal dialysis). In this case, the reservoir can be placed outside of its usual location or a two-piece inflatable implant can be considered since it is superior to the semi-rigid implant.
Written by:
Tariq F. Al-Shaiji, MB ChB, FRCSC as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology
Toronto Western Hospital, South Elevator Fell Pavilion 8-306
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Three-piece inflatable penile prosthesis: Surgical techniques and pitfalls - Abstract
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