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Impact the implantation of prostheses with fewer diameters to erectile dysfunction surgical treatment outcomes

Background:

Penile prosthesis implantation to treat erectile dysfunction has been successfully used for several decades with prodigious evolution from autologous implants (rib) to high-tech 3-component implants. The effectiveness of treatment grew significantly and the number of complications decreased. However, since in some cases penile prosthesis implantation still remains the method of choice, we must find ways to avoid its complications. We mean unsatisfactory post-operative size of the penis from the patient’s point of view, cold gland syndrome and the lack of erection. These complications are caused by the destruction of the corpora cavernosa during the implantation of prostheses, as well as reducing the size of cavernous bodies before the operation as a result of impaired blood flow, which actually led to erectile dysfunction. We decided to develop a complex of measures designed to improve the results of penile prosthesis implantation and evaluate its effectiveness.

This complex included the following measures:

1. Preoperative:
А) Daily treatment with tadalafil 5 mg for 3 months before surgery;
B) Local negative pressure therapy (LNP - therapy) during the same period;
C) Hormone replacement therapy with testosterone (Nebido);

2. Intraoperative:
А) Implantation of prosthetic devices of smaller diameter in order to maintain the maximum of intact cavernous tissue.

3. Postoperative:
А) Daily treatment with tadalafil 5 mg for at least 6 months after surgery;
B) Hormone replacement therapy with testosterone (at least 6 months after surgery).

STUDY DESIGN

60 patients with ED of organic origin, refractory to medical treatment. The mean age was 57 + 8 years. 3 groups (20 patients in each).

1. In 1st (control) group single-component silicone penile prosthesis with a diameter of 12 mm were implanted. Tadalafil therapy, LNP- therapy and hormone replacement therapy with testosterone were not conducted.

2. In 2nd group single-component silicone penile prosthesis with a diameter of 8 mm were implanted. Preoperative tadalafil therapy and LNP - therapy were not carried.

Postoperative tadalafil therapy was undertaken starting with the 2nd month after surgery.

3. Patients in 3rd group received complex of all scheduled measures:

- LNP-therapy, tadalafil and HRT with testosterone before surgery;

- Tadalafil and testosterone therapy after surgery.

- One-component silicone penile prosthesis with a diameter of 8 mm were implanted.

RESULTS:

CONCLUSION:

Use of the proposed complex of measures can significantly improve the results penile prosthesis implantation.

Sukhikh. G.T., Apolikhina I.A., Mirkin Y. Central Researching Institute of Obstetrics and Gynecology, Moscow, Russia