madman
Super Moderator
Abstract
Purpose of Review The goal of this paper is to understand the reasons behind penile length and girth issues after penile prosthesis surgery and review the literature for current strategies employed to decrease these issues.
Recent Findings Measurement inconsistencies triggering further studies have shown there is a real loss of penile length and girth after prosthesis surgery. There have been varying hypotheses of why this happens, and numerous approaches have been proposed to help combat this in the preoperative, intraoperative, and postoperative settings.
Summary Erectile dysfunction prevalence is expected to increase; therefore it is important for urologists to understand the treatment options, including prosthesis surgery. Numerous techniques have been hypothesized and studied in smaller settings in the preoperative, intraoperative, and postoperative settings with regard to prosthetics surgery. However, larger studies are still needed to confirm these findings in order to help to counsel and educate patients preoperatively in addition to employing tactics to help minimize penile shortening.
Introduction
In 2015, the 4th International Consultation on Sexual Medicine defined erectile dysfunction (ED) as a consistent or recurrent inability to attain and/or maintain penile erections sufficient for sexual satisfaction [1]. In the United States, this is commonly seen in men as they age and associated with increased medical comorbidities [2]. The prevalence of ED is expected to increase worldwide, with 322 million men being affected by 2025, an increase of 111% from 1995 [3], which will increase the number of patients with ED seen by urologists.
There are various non-surgical and surgical treatments for ED. Nonsurgical include lifestyle modifications, vacuum erection devices (VED), phosphodiesterase type 5 inhibitors (PDE-5I), intraurethral alprostadil, and intracavernosal injections (ICI) [4]. Surgical options are indicated in patients who failed, are not candidates for, or cannot tolerate non-surgical management. Surgical treatment is with a penile prosthesis, which generally has a high satisfaction rate of above 90%. Satisfaction is typically measured by erectile function, penile length, partner satisfaction, and cosmetic outcome [5]. However, perceived loss of penile length after the surgical intervention has been of great concern to both patients and urologists. In this article, we review the current literature in regard to measurement inconsistencies, reasons for length and girth problems, and strategies employed to help decrease these problems.
*Measurement Inconsistencies
*Reasons for Length and Girth Issues
*Strategies Used to Enhance Penile Length and Girth
-Preoperative Strategies
-Intraoperative Strategies
-Postoperative Strategies
Conclusion
Erectile dysfunction prevalence is expected to increase worldwide, especially as men are living a longer lifespan. In addition to a longer lifespan, these men will likely present with more medical comorbidities, making the treatment of ED more challenging. There is a perceived and actual reduction in penile length and girth, which continues to be a valid concern among patients and treating urologists. Fortunately, there have been numerous strategies employed in the preoperative, intraoperative, and postoperative settings. Deciding on which strategies and which combinations of strategies to use will vary from patient to patient while also taking into consideration the experience of the surgeon. Although most of these techniques are novel, they have shown promising results in smaller studies. However, in order to be able to incorporate the techniques and strategies into the urologist repertoire, there still needs to be large, multi-institutional, prospective, randomized controlled studies to prove the effectiveness and provide better guidance for future urology practice patterns.
Purpose of Review The goal of this paper is to understand the reasons behind penile length and girth issues after penile prosthesis surgery and review the literature for current strategies employed to decrease these issues.
Recent Findings Measurement inconsistencies triggering further studies have shown there is a real loss of penile length and girth after prosthesis surgery. There have been varying hypotheses of why this happens, and numerous approaches have been proposed to help combat this in the preoperative, intraoperative, and postoperative settings.
Summary Erectile dysfunction prevalence is expected to increase; therefore it is important for urologists to understand the treatment options, including prosthesis surgery. Numerous techniques have been hypothesized and studied in smaller settings in the preoperative, intraoperative, and postoperative settings with regard to prosthetics surgery. However, larger studies are still needed to confirm these findings in order to help to counsel and educate patients preoperatively in addition to employing tactics to help minimize penile shortening.
Introduction
In 2015, the 4th International Consultation on Sexual Medicine defined erectile dysfunction (ED) as a consistent or recurrent inability to attain and/or maintain penile erections sufficient for sexual satisfaction [1]. In the United States, this is commonly seen in men as they age and associated with increased medical comorbidities [2]. The prevalence of ED is expected to increase worldwide, with 322 million men being affected by 2025, an increase of 111% from 1995 [3], which will increase the number of patients with ED seen by urologists.
There are various non-surgical and surgical treatments for ED. Nonsurgical include lifestyle modifications, vacuum erection devices (VED), phosphodiesterase type 5 inhibitors (PDE-5I), intraurethral alprostadil, and intracavernosal injections (ICI) [4]. Surgical options are indicated in patients who failed, are not candidates for, or cannot tolerate non-surgical management. Surgical treatment is with a penile prosthesis, which generally has a high satisfaction rate of above 90%. Satisfaction is typically measured by erectile function, penile length, partner satisfaction, and cosmetic outcome [5]. However, perceived loss of penile length after the surgical intervention has been of great concern to both patients and urologists. In this article, we review the current literature in regard to measurement inconsistencies, reasons for length and girth problems, and strategies employed to help decrease these problems.
*Measurement Inconsistencies
*Reasons for Length and Girth Issues
*Strategies Used to Enhance Penile Length and Girth
-Preoperative Strategies
-Intraoperative Strategies
-Postoperative Strategies
Conclusion
Erectile dysfunction prevalence is expected to increase worldwide, especially as men are living a longer lifespan. In addition to a longer lifespan, these men will likely present with more medical comorbidities, making the treatment of ED more challenging. There is a perceived and actual reduction in penile length and girth, which continues to be a valid concern among patients and treating urologists. Fortunately, there have been numerous strategies employed in the preoperative, intraoperative, and postoperative settings. Deciding on which strategies and which combinations of strategies to use will vary from patient to patient while also taking into consideration the experience of the surgeon. Although most of these techniques are novel, they have shown promising results in smaller studies. However, in order to be able to incorporate the techniques and strategies into the urologist repertoire, there still needs to be large, multi-institutional, prospective, randomized controlled studies to prove the effectiveness and provide better guidance for future urology practice patterns.
