Utility of magnetic resonance imaging in evaluating inflatable penile prosthesis malfunction and complaints

The introduction of oral pharmacotherapy dramatically changed practice patterns in erectile dysfunction. The direct effect was to decrease the numbers of patients seeking penile implants; an indirect effect has been the changing ratio of new, to re-do operations. Patients seeking replacement inflatable penile prosthesis (IPP) surgery pose challenges both in diagnosis and management; in very select cases preoperative MRI can be useful in the evaluation of the patient's complaint and in planning operative management. Imaging can supplement the physical exam; in certain cases imaging will reveal: crural herniation, corporal distortion, corporal fibrosis, and hardware migration. Inflatable penile prosthesis has a high rate of satisfaction for patients (89%) and partners (70%). The principal reasons for dissatisfaction are penile shortening, pain and frustration with reoperation. If pain is not due to infection, it may be secondary to malpositioning, improper sizing, cylinder cross-overs, or herniation. After one or more reoperations, penile distortion may occur secondary to tunica albugenia thinning or fibrosis. A series of cases will be presented to highlight the utility of MRI for IPP problems, define normal appearance and abnormal appearance of penile hardware. Careful collaboration between the Urologist and Radiologist in the review and final dictation of these cases is warranted to properly document problems and to plan device replacement/penile reconstruction.