Penile prosthesis in the medically complex patient: a narrative review

Area of Science:

• Urology
• Andrology
• Surgical Innovation

Background:

• Penile prosthesis implantation is a standard treatment for erectile dysfunction.
• Medically complex patients present unique challenges for penile prosthesis surgery.
• Risk-benefit analysis is crucial for patient selection and surgical planning.

Purpose of the Study:

• To review challenges and strategies for penile prosthesis surgery in medically complex patients.
• To outline preoperative work-up and management for specific comorbidities.
• To discuss intraoperative and postoperative complication avoidance.

Main Methods:

• A narrative review of relevant literature was conducted.
• Literature search performed in January 2023 using PubMed.
• Inclusion of non-English and non-full text articles was excluded.

Main Results:

• Comorbidities like spinal cord injury, diabetes, and cardiovascular disease require thorough preoperative evaluation and counseling.
• Organ transplant recipients may face challenges with reservoir placement.
• Prior pelvic surgery necessitates consideration for ectopic reservoir placement to prevent complications.

Conclusions:

• Robust preoperative diagnostics are essential for successful penile prosthesis surgery.
• High-volume surgeons with diverse techniques are recommended for complex cases.
• Individualized surgical planning mitigates risks in medically complex patients.