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  • Review Article
  • Published:

A practical overview of considerations for penile prosthesis placement

Nature Reviews Urology volume 13, pages 33–46 (2016)Cite this article

Subjects

Key Points

  • Penile prostheses have high rates of long-term device survival, few complications, and high satisfaction in appropriately selected individuals; no data suggest superiority of any one approach or manufacturer

  • The indications for the preferential use of three-piece, two-piece, or malleable prosthetics are poorly defined, although three-piece devices are typically preferred over alternatives if clinically indicated

  • Important considerations for infection control include use of anti-infection-coated devices, perioperative antibiotics, alcohol-based surgical site scrub, and use of a no-touch technique

  • Penile prosthesis revision and salvage surgery (in both infected and noninfected prostheses) should incorporate washout protocols to reduce infection if a new device is to be placed

  • Placement of a penile prosthesis in men with corporal fibrosis or with Peyronie's disease might require adjunctive techniques

  • Intraoperative complications including proximal corporal perforation and crossover can be managed without aborting the procedure, whereas the optimal management of urethral perforation (particularly distal perforation) remains poorly defined

Abstract

Penile prostheses have remained the gold-standard therapy for medically refractory erectile dysfunction (ED) since their popularization. Advances in device design and surgical techniques have yielded improved rates of infection, satisfaction, and mechanical survival of devices. Operative techniques in penile prosthesis surgery include the use of adjunctive procedures (such as ventral phalloplasty and release of the suspensory ligament), management of penile fibrosis, and manoeuvres to correct Peyronie's-disease-related curvature. Complications include urethral and corporal perforation, crossover, infection, impending erosion, and/or supersonic transporter deformity. Long-term data regarding mechanical, overall, and infection-free survival demonstrate excellent results, and, given the consistently high satisfaction rates and limited alternatives for medically refractory ED, penile prostheses are likely to remain a relevant and important treatment strategy for the foreseeable future.

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Figure 1: Various locations for submuscular ectopic reservoir placement.
Figure 2: Traditional orthotopic reservoir placement.

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  1. Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, 55905, Minnesota, USA

    Landon Trost, Philip Wanzek & George Bailey

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  1. Landon Trost
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All authors researched data for and wrote the article. L.T. reviewed and edited the manuscript before submission.

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Correspondence to Landon Trost.

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Trost, L., Wanzek, P. & Bailey, G. A practical overview of considerations for penile prosthesis placement. Nat Rev Urol 13, 33–46 (2016). https://doi.org/10.1038/nrurol.2015.270

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