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Comment on: Comparative analysis of inflatable penile prosthesis in patients with vasculogenic erectile dysfunction versus post-radical prostatectomy erectile dysfunction

International Journal of Impotence Research volume 32, page 638 (2020)Cite this article

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It is a great pleasure to comment on the current paper: “Comparative analysis of inflatable penile prosthesis in patients with vasculogenic erectile dysfunction versus post-radical prostatectomy erectile dysfunction”. This head to head comparative study highlights a frequently underestimated fact, namely that different etiological factors are responsible for development of vasculogenic erectile dysfunction (ED) and ED due to radical prostatectomy (RRP) [1].

Are these differences all about the reservoir placement (RP)? Or are there other crucial factors? 24.1% of the IPPs in the RP group and 39% in the vasculogenic group were two-piece systems. This shows that there is an avoidance of RP in general. In this clinical situation ectopic high submuscular RP can be a useful option. The worst-case scenario after ectopic RP is a visible or palpable reservoir [2]. A recent study by Osmonov et al. has confirmed that ectopic RP leads to fewer complications while achieving comparable satisfaction [3]. Another difference that was verified is a significant difference in the size of the implanted cylinders with longer cylinders in the vasculogenic group. This reflects that while there are equal vasculogenic mechanisms of the ED in both groups of patients, but probably diverging neurogenic mechanisms [4]. These findings should be taken into consideration during preoperative counseling. In addition, vacuum devices could be recommended in order to avoid penile shortening prior to IPP placement. This study is a first step towards understanding that different etiological factors in the development of corporal fibrosis and severe ED may lead to different clinical outcomes.

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References

  1. Atienza Merino G. Penile prosthesis for the treatment of erectile dysfunction. Actas Urol Esp. 2006;30:159–69.

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  2. Karpman E, Sadeghi-Nejad H, Henry G, Khera M, Morey AF. Current opinions on alternative reservoir placement for inflatable penile prosthesis among members of the Sexual Medicine Society of North America. J Sex Med. 2013;10:2115–20.

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  1. Urology University Medical Center Schleswig Holstein, Campus Kiel, Kiel, Germany

    Daniar Osmonov

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  1. Daniar Osmonov
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Correspondence to Daniar Osmonov.

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Osmonov, D. Comment on: Comparative analysis of inflatable penile prosthesis in patients with vasculogenic erectile dysfunction versus post-radical prostatectomy erectile dysfunction. Int J Impot Res 32, 638 (2020). https://doi.org/10.1038/s41443-020-0276-y

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