Clinical Outcome/Patient and Partner Satisfaction after Penile Implant Surgery
Erectile dysfunction (ED) is a common condition which affects more than half of men between 40 and 70 years of age. According to EAU Guidelines on male sexual dysfunction implantation of a penile prosthesis is a valid therapeutic option for treatment of ED. We conducted a retrospective single centre study to analyse the mechanical reliability, complication rate, quality of life and patient satisfaction of the implantation of an inflatable penile prosthesis (IPP).
Data were collected of 126 patients with erectile dysfunction who underwent primary implantation of an inflatable penile prostheses during a 5-year period. The surgical approach was either penoscrotal or infrapubic. We classified the patients in five aetiological groups: vasculogenic, post-prostatectomie, peyronies disease, diabetes and others. At least one year after implant surgery a structured telephone interview concerning patient and partner satisfaction was conducted.
Mechanical failure occurred in 7.14%. The three major complaints were loss of penile length (18.53%), post-operative pain (11.9%) and altered sensation (8.73%). Three patients (2.28%) received prolonged antibiotic therapy for possible signs of infection (no explantation required) and one patient (0.79%) underwent revision surgery for an imminent erosion. The occurrence of floppy glans syndrome was significant higher with the infrapubic approach. In total, 15 patients (11.9%) had revision surgery for various reasons. One year or more after surgery, there were high patient and partner satisfaction rates, respectively 83.2% and 85.4%. We found the highest satisfaction rates in the vasculogenic and post-prostatectomy group. There was a significant lower satisfaction rate for the AMS-Ultrex (25%) comparing to the Coloplast Titan (91%) and AMS-LGX (80%). The average time to activation of the prosthesis after surgery was 6 weeks and more than 50% had sexual intercourse within 4 weeks after activation. 72.41% of the patients had an orgasm during their first sexual intercourse. The average quality of life on a scale from 0 to 5 was 2 before and 3.5 after surgery.
We found very high patient and partner satisfaction rates and an increase of the general quality of life. These rates can be negatively influenced by the occurrence of postoperative penile length shortening, pain and floppy glans syndrome. We prefer the penoscrotal approach for insertion because of significant lower floppy glans syndrome. Sexual life can restart after an average of 6 weeks after surgery and the prosthesis has minimal effect on reaching an orgasm.