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Published on: March 15, 2024
Inflatable penile prosthesis placement in men with Peyronie's disease and drug-resistant erectile dysfunction: A
Laurence A Levine1, Jonas Benson, Christopher Hoover
1Department of Urology, Rush University Medical Center, Chicago, IL, USA. drlevine@hotmail.com
Introduction:
Erectile dysfunction (ED) frequently accompanies Peyronie's disease (PD) and changes the therapeutic approach.
Aim:
To evaluate a single-center experience with inflatable penile prostheses (IPP) in men with medication refractory ED and PD.
Methods:
Ninety men underwent placement of an IPP with straightening maneuvers as necessary to address their deformity and ED.
Main Outcome Measures:
Preoperative assessment included International Index of Erectile Function-erectile function domain (IIEF-EF) and duplex ultrasound to confirm ED and measure erect deformity. Postoperative assessment included a modified Erectile Dysfunction Index of Treatment Satisfaction (EDITS) questionnaire, as well as office visits at 1, 6, and every 12 months thereafter.
Results:
Complete chart review was performed with mean follow-up of 49 months. Mean preoperative IIEF-EF score was 11. Full rigidity was not obtained in any patient during duplex ultrasound. Mean curvature at maximum erection was 53°. There were seven mechanical failures requiring device replacement, two revision surgeries for pump or reservoir malposition, one infected device, and two corporoplasties for distal tunica erosion. Postoperative office assessment revealed a functionally straight (i.e., <20°) erect penis and a properly positioned as well as operational device in all patients. The modified EDITS questionnaire was returned by 56 (62%). Overall, 84% of patients were satisfied with their outcome, yet only 73% were satisfied with their straightness. Patient perceived postoperative curvature correction stabilized quickly and was complete by 3 months in 84% of patients. Satisfaction with ease of inflation, deflation, and concealability was 84%, 71%, and 91%, respectively. Coital activity was reported by 91% of men in this group.
Conclusion:
In men with PD and ED, IPP placement allowed reliable and satisfactory coitus for the great majority of men. Mechanical failure was 7%. Men with PD undergoing IPP placement should be counseled regarding potential penile length loss and residual curvature, neither of which appeared to interfere with coitus but may reduce satisfaction.
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