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Technological advances in penile implants: past, present, future (2023)
Emily May, Meg Hanley, John J. Mulcahy and Martin S. Gross
Attempts to “cure” erectile dysfunction (ED) are as old as recorded history. The history of penile prosthetic devices dates back over 500 years when a French military surgeon designed the first known wooden prosthesis to support micturition. There have since been a great many technological advancements in penile prosthetics. Penile implants for the improvement of sexual function date to the twentieth century. Like all human endeavors, penile prosthesis innovations have progressed via trial and error. This review aims to provide an overview of penile prostheses for the treatment of ED since their introduction in 1936. More specifically, we aim to highlight important advances in penile prosthesis development and discuss dead ends that were abandoned. Highlights include two-piece inflatables, three-piece inflatables, and malleable/semirigid, along with modifications and updates to each basic design that improved both insertion and usability. Dead ends include innovative ideas that were lost to history due to a variety of factors. We also look to the future and discuss expected advances, including remotely activated devices and prostheses designed for special populations, including transgender men.
INTRODUCTION
Erectile dysfunction (ED) is a problem as old as humanity. Attempts to “cure” ED date back similarly far and are documented by many civilizations. The Old Testament, the poetry of Ovid, and ancient Hindu writings all contain references to male impotence. Designs preserved on ancient Greek cups depict ED, as do paintings in Egyptian tombs [1, 2]. Early attempts to cure ED are equally well documented; prayers, visits to and from religious/ community leaders, and recipes for tinctures and potions all make an appearance [2]
True surgical success with the treatment of ED dates to the twentieth century when injuries resulting from the World Wars inspired a wave of new breakthroughs. Penile prosthetic devices have since been innovated and improved by trial and error. The modern era of penile implants dates to 1973, with the introduction of the inflatable (IPP) and semirigid penile prostheses [3]. The debut of these devices resulted in an explosion of technological innovation and refinement that continues into the present day. Many dead ends in penile implant development have simultaneously occurred in the last five decades. In this review, we explore the most important advances in penile prosthesis placement as well as the ideas that were ultimately lost to history. Lastly, we look to the future for potential advancements in penile prosthetics.
*PAST
*TODAY
*FUTURE
CONCLUSION
While there has been stepwise improvement in penile prosthesis over the last 50 years, the ideal device does not yet exist. Such a device would mimic a natural erection, be easy to use, free of malfunction, and without risk of erosion or infection. Limitations to devices include palpable components, an erection that does not mimic the feel of a natural erection, and the need for device manipulation to achieve an erection. New technologies will need to show an advantage over existing technologies. It is possible that the ideal device is not a device at all, and that future regenerative therapies such as stem cell therapy, gene therapy, and advanced pharmaceuticals that restore and/or enhance native erectile function will compete with penile prostheses. For now, however, penile prostheses are marvels of technological achievement with a long and storied history.
Emily May, Meg Hanley, John J. Mulcahy and Martin S. Gross
Attempts to “cure” erectile dysfunction (ED) are as old as recorded history. The history of penile prosthetic devices dates back over 500 years when a French military surgeon designed the first known wooden prosthesis to support micturition. There have since been a great many technological advancements in penile prosthetics. Penile implants for the improvement of sexual function date to the twentieth century. Like all human endeavors, penile prosthesis innovations have progressed via trial and error. This review aims to provide an overview of penile prostheses for the treatment of ED since their introduction in 1936. More specifically, we aim to highlight important advances in penile prosthesis development and discuss dead ends that were abandoned. Highlights include two-piece inflatables, three-piece inflatables, and malleable/semirigid, along with modifications and updates to each basic design that improved both insertion and usability. Dead ends include innovative ideas that were lost to history due to a variety of factors. We also look to the future and discuss expected advances, including remotely activated devices and prostheses designed for special populations, including transgender men.
INTRODUCTION
Erectile dysfunction (ED) is a problem as old as humanity. Attempts to “cure” ED date back similarly far and are documented by many civilizations. The Old Testament, the poetry of Ovid, and ancient Hindu writings all contain references to male impotence. Designs preserved on ancient Greek cups depict ED, as do paintings in Egyptian tombs [1, 2]. Early attempts to cure ED are equally well documented; prayers, visits to and from religious/ community leaders, and recipes for tinctures and potions all make an appearance [2]
True surgical success with the treatment of ED dates to the twentieth century when injuries resulting from the World Wars inspired a wave of new breakthroughs. Penile prosthetic devices have since been innovated and improved by trial and error. The modern era of penile implants dates to 1973, with the introduction of the inflatable (IPP) and semirigid penile prostheses [3]. The debut of these devices resulted in an explosion of technological innovation and refinement that continues into the present day. Many dead ends in penile implant development have simultaneously occurred in the last five decades. In this review, we explore the most important advances in penile prosthesis placement as well as the ideas that were ultimately lost to history. Lastly, we look to the future for potential advancements in penile prosthetics.
*PAST
*TODAY
*FUTURE
CONCLUSION
While there has been stepwise improvement in penile prosthesis over the last 50 years, the ideal device does not yet exist. Such a device would mimic a natural erection, be easy to use, free of malfunction, and without risk of erosion or infection. Limitations to devices include palpable components, an erection that does not mimic the feel of a natural erection, and the need for device manipulation to achieve an erection. New technologies will need to show an advantage over existing technologies. It is possible that the ideal device is not a device at all, and that future regenerative therapies such as stem cell therapy, gene therapy, and advanced pharmaceuticals that restore and/or enhance native erectile function will compete with penile prostheses. For now, however, penile prostheses are marvels of technological achievement with a long and storied history.
