MEN'S HEALTH
[Inflatable Penile Prosthesis Illustration]
[AMS 700 Conceal Reservoir]
Photos by Boston Scientific (AMS) rep Tracey Silcox with permission
to use.
(continued from page 21)
disease (3) so I make sure lipid panels and other signs of vascular
disease are investigated. Poorly controlled diabetic patients can prog-
ress to having severe erectile dysfunction, so I make sure they are
well-connected with other physicians to manage their diabetic care.
Once all potential causes are addressed and the patient continues
to suffer from ED, I will discuss potential treatments, including the
risks and benefits of each one. In conjunction with the patient and
their partner, we come up with a stepwise plan to treat their ED.
Normally, we start with the least invasive approach, those being a
PDE-5 inhibitor, penile pump or penile injections.
Minimally invasive approaches unfortunately do not always
allow patients to have their optimal sexual activity again. When that
occurs, we can explore surgical options to treat their ED. Once a
patient understands that surgical approaches are inevitable, I make
a separate appointment for the sole purpose of counseling the pa-
tient and their partner about the risks and benefits of surgery, what
exactly the surgery is, and what life will be like after surgery. We
have penile prosthetic models in the office for patients to explore.
We give them information about these prostheses and answer all
questions. Currently, Coloplast and Boston Scientific (AMS) are
the two major manufacturers for the penile prosthesis products.
Which product is used is usually based on product availability at
that specific hospital and surgeon preferences depending on their
training and expertise.
If going forward with surgery, I explicitly explain the risks,
benefits and what they can realistically expect from the functionally
from their prosthesis. For patients with great dexterity and the desire
to get the most physiologically natural erection quality possible, I
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LOUISVILLE MEDICINE
recommend the three-piece penile prosthesis. It is made up of a
reservoir, a scrotal pump and cylinders that go into the corporal
body. When a patient would like to have sexual activity, he simply
needs to pump the scrotal pump which cycles the water from the
reservoir to the cylinders. Once done with intercourse, he can de-
flate the cylinders by pumping the scrotal pump and squeezing the
cylinders which then cycles the fluids back to the reservoir. Studies
have shown that patient and partner satisfaction rates were higher
with the three-piece inflatable penile prosthesis, as compared to
malleable model (4,5).
If such a mechanism is too complex for a patient to operate, the
two-piece malleable may be a better solution. It is made up of two
malleable cylinders located on each corporal body. For this penile
prosthesis, a patient simply needs to straighten the penis when he
wants to have sex. When done with sex, he brings the penis back to
a normal anatomical position. Although as mentioned previously,
the three-piece penile prosthetic is found to be most physiologic in
terms to giving the natural erection quality, a few other studies on
patient satisfaction survey showed that patients with the malleable
model were just as pleased with the prosthesis (6).
Infection rates are low at 1-3% (7,8). Patients may need revi-
sion down the road due to malfunction or erosion but fortunately
those rates are low, at 2-3% (9). Patients with history of MRSA or
uncontrolled diabetics may be at higher risk for infections, so I am
meticulous both in surgery and in counseling those patients about
potential complications.
Most recently, I operated on a patient suffering from a long his-
tory of diabetes and vascular disease who had undergone multiple
surgeries due to cancer. Despite all his agony, at his first follow