Vacuum Preparation, Optimization of Cylinder Length and Postoperative Daily Inflation Reduces Complaints of Shortened Penile Length Following Implantation of Inflatable Penile Prosthesis

Tom Sellers, Martin Dineen, Emad A. Salem, Steven K. Wilson

Daytona Beach, USA.
Indio, CA, USA.
Zagazig University, Zagazig, Egypt.

DOI: 10.4236/asm.2013.31003                

Abstract

Introduction: The inflatable penile prosthesis (IPP) has been used to treat erectile dysfunction for 40 years. Loss of penile length following IPP remains the single biggest patient complaint. We describe a preoperative and postoperative patient preparation protocol to assist in setting realistic patient expectations and decreasing the complaint of reduced penile length. Materials & Methods: 750 Patients are instructed to use a vacuum erection device for 10 minutes each day for up to 2 months prior to IPP implant. After two months, maximization of cylinder length is accomplished regardless of IPP manufacturer. Cylinders are left partially inflated in the post-operative period and daily inflation for 3 months immediately upon patient tolerance. The average implanted cylinder length has increased dramatically with the preoperative vacuum usage when compared to the authors’ previous implantations and when compared to the national average of implanted cylinders obtained from one manufacturer. Results: Preoperative use of the vacuum device has allowed maximization of cylinder length. After the vacuum program, patients tend to experience less pain following implantation allowing earlier device instruction cycling and use. The average implanted cylinder length continued to increase annually for the first 5 years as the protocol evolved and seems to have remained stable for the last five years. Conclusions: Preoperative vacuum usage and postoperative capsule management has nearly eliminated patient complaints of reduced penile length. We believe this to be the result of larger size cylinders being implanted when compared to our previous implantations absent of the patient participation protocol.

Keywords

Inflatable Penile Prosthesis; Vacuum Device; Satisfaction

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	A. Rajpurkar and C. Dhabuwala, “Comparison of Satisfaction Rates and Erectile Function in Patients Treated with Sildenafil, Intercavernosus Prostaglandin E, and Penile Implant Surgery for Erectile Dysfunction in Urology Practice,” Journal of Urology, Vol. 170, 2003, pp. 159-165. doi:10.1097/01.ju.0000072524.82345.6d
[2]	S. K. Wilson, J. R. Delk, E. Salem and M. A. Cleves, “Long-Term Survival of Inflatable Penile Prosthesis: Single Surgical Group Experience with 2384 First-Time Implants Spanning Two Decades,” The Journal of Sexual Medicine, Vol. 4, No. 4, 2007, pp. 1074-1079. doi:10.1111/j.1743-6109.2007.00540.x
[3]	S. K. Wilson and J. R. Delk, “Inflatable Penile Implant Infection: Predisposing Factors and Treatment Suggestions,” Journal of Urology, Vol. 153, 1995, pp. 659-663. doi:10.1016/S0022-5347(01)67678-X
[4]	S. K. Wilson, J. Zumbe, G. D. Henry, et al., “Infection Reduction Using Antibiotic Coated Inflatable Penile Prosthesis,” Journal of Urology, Vol. 70, No. 2, 2007, pp. 337-340. doi:10.1016/j.urology.2007.03.058
[5]	F. Montorsi, P. Rigatti, G. Carmignani, B. Campo, G. Ordesi, P. Silvestre, B. Giamusso, G. Morgia and A. Graziottin, “AMS Three-Piece Inflatable Implants for Erectile Dysfunction: A Long-Term Multi-Institutional Study in 200 Consecutive Patients,” European Urology, Vol. 37, No. 1, 2000, pp. 50-55. doi:10.1159/000020099
[6]	F. Borges, L. Hakim and C. Kline, “Surgical Technique to Maintain Penile Length after Insertion of an Inflatable Penile Prosthesis,” The Journal of Sexual Medicine, Vol. 3, No. 3, 2006, pp. 550-553. doi:10.1111/j.1743-6109.2006.00232.x
[7]	D. K. Montague, “Ultrex Cylinders: Problems with Uncontrolled Lengthening (The S-Shaped Deformity),” Journal of Urology, Vol. 155, No. 1, 1996, pp. 138-140.
[8]	J. J. Mulcahy, “Prevention and Correction of Penile Implant Problems,” AUA Update Series, Lesson 27, 1994, pp. 214-218.
[9]	S. K. Wilson, M. A. Cleves and J. R. Delk II, “Long-Term Follow-Up of a Treatment for Peyronie’s Disease: Modeling the Penis over an Inflatable Penile Prosthesis,” Journal of Urology, Vol. 165, 2001, pp. 825-831. doi:10.1016/S0022-5347(05)66537-8
[10]	S. K. Wilson, M. A. Cleves and J. R. Delk, “Long-Term Results with Hydroflex and Dynaflex Penile Prostheses: Device Survival Comparison to Multi-component Inflatables,” Journal of Urology, Vol. 155, 1996, pp. 1621-1625. doi:10.1016/S0022-5347(01)66145-7
[11]	S. K. Wilson, J. R. Delk II, J. J. Mulcahy, M. Cleves and E. A. Salem, “Upsizing of Inflatable Penile Implant Cylinders in Patients with Corporal Fibrosis,” The Journal of Sexual Medicine, Vol. 3, No. 4, 2006, pp. 736-742. doi:10.1111/j.1743-6109.2006.00263.x