Malleable and inflatable penile implants

[madman]

A penile prosthesis/implant is an excellent option for men with erectile dysfunction refractory to medical treatment or with contraindications to medical management. In this narrative review, we discuss the different types of penile prostheses and the considerations for patient and device selection to maximize satisfaction. There are three main prosthesis types to choose from: three-piece inflatable devices, two-piece inflatable devices, and malleable/semirigid devices. The three-piece devices are the gold standard in advanced economy countries but require reservoir placement and manual dexterity, which can be limiting to some patients. The two-piece inflatable devices are a good option for patients who have standard-sized penises, lack significant penile pathology, have limited dexterity issues, or should avoid reservoir placement due to potential complications. The malleable devices are popular in countries where insurance coverage is limited but are increasingly used in advanced economy countries for length conservation in specific patient populations. Finally, not every patient needs an implant, and assessing partner sexual function is an important consideration for patient–partner satisfaction. Surgeons need to be familiar with the strengths and limitations of each device and the patient characteristics that will yield the best outcome from penile prosthesis surgery.




*REVIEW OF DEVICES


*PATIENT COUNSELING FOR ALL DEVICES


*CONSIDERATIONS FOR CHOOSING A THREE-PIECE INFLATABLE PENILE PROSTHESIS


*CONSIDERATIONS FOR CHOOSING A TWO-PIECE INFLATABLE PENILE PROSTHESIS


*CONSIDERATIONS FOR CHOOSING A NONINFLATABLE PROSTHESIS


*WHEN TO ADVISE AGAINST PENILE PROTHESIS SURGERY




CONCLUSION

A penile prosthesis is an excellent option for men with ED refractory to medical treatment or with contraindications to medical management. There are three main prosthesis types to choose from: malleable/semirigid devices, three-piece inflatable devices, and two-piece inflatable devices. The three-piece devices are the gold standard in advanced economy countries and especially for patients with PD; however, three-piece devices require reservoir placement and patient dexterity, which can be limiting in certain situations. A two-piece device is a good option for patients who have standard-sized penises, lack significant penile pathology, or should avoid reservoir placement due to potential complications. The malleable devices are popular where insurance coverage is limited but are becoming increasingly popular in the United States for length preservation in specific patient populations. Finally, not every patient needs an implant, and assessing partner sexual function is an important consideration for postoperative patient–partner satisfaction.

 

[madman]

Fig. 1 Images of different penile prostheses. Boston Scientific: a AMS 700, b Ambicor, c Tactra, d Spectra. Coloplast: e Titan, f Titan Touch, g Genesis. Rigicon: h Infla10 series, i Rigi10.

 

[madman]

Fig. 2 Algorithm to reference for assistance with selecting the appropriate prosthetic device for a given patient.

 

[madman]

Table 1. Penile prostheses available in the United States and specific considerations for each.

 

[madman]

Table 2. Devices to consider based on existing patient characteristics.

 

[madman]

Five Decades of Experience with the Development of Penile Prosthesis

https://www.vjsm.info/videos/legend-series/five-decades-of-experience-with-the-development-of-penile-prosthesis

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