Prior to the introduction of effective penile implants 50 years ago there was no treatment of organic erectile dysfunction (ED). Most patients with this disorder were thought to have a situational or psychologic basis for this malady, and were told that their days of penetrative sexual activity were over. Michael Small and Hernan Carrion placed the first silicone semirigid rod implant bearing their names in September 1972, and Brantley Scott placed the first inflatable penile implant in March of 1973. Nocturnal penile tumescence monitoring and other tests, which became popular in this era, revealed that most cases of ED had a physical basis with a deficiency of penile hemodynamics. Sales of both types of penile implants, hydraulic and semirigid rod, grew exponentially each year, The semirigid rods initially outsold the inflatables due to simplicity of insertion and cost, but the superior rigidity and flaccidity of the inflatables soon made them the favored device. Early repair rates of the implants, especially the inflatables were high, in the range of 50% at 5 years after insertion. Sales of penile implants plummeted abruptly in 1998 to about one third of the previous year’s numbers with the anticipation of Viagra’s introduction. Men believed that this wonder drug would solve their ED problems, but it became evident that this medication was only effective in about two thirds of cases. Patients with ED following radical prostatectomy and those with diabetes mellitus are particularly refractory to this medical therapy. Patients with a scarred penis and curved erections associated with Peyronie’s Disease are many times better suited for penile implant placement to remedy their ED. Patients who have failed medical therapy or in whom it is contraindicated or psychologically unattractive are also well served with penile implant placement.
Since the introduction of the PDE-5 inhibitors 25 years ago, when penile implant sales were relatively low, there has been a gradual annual growth in the number of devices implanted, as ED awareness through marketing and the effectiveness and reliability of these implants have improved. Today over 60,000 penile implants are placed annually worldwide, far surpassing the number of the previous pre -Viagra peak in 1996. About one half of these are sold in the USA, in the range of 30,000. South Korean sales of about 8000 come in at number 2. With a South Korean population of about 52 million that’s almost twice the per capita implant placement rate of the USA. In other countries sales are in the range of 1000 or less annually. Even China and India, both of whom have populations in the 1.5 billion range, have sales well under 1000 per year each. Contrast penile implant sales with those of other prosthetic devices. Orthopedic artificial joint replacements are performed in well over 1 million cases per year in the USA. Breast augmentation occurs over 300,000 times annually in the USA. Breast implant procedures are not covered by insurance, but are relatively low in cost, in the range of $5000. Patients needing joint replacement are usually in considerable pain and these surgeries are usually covered by medical insurance or the health system. A recent study of patients over age 65, who had undergone radical prostatectomy and who had failed medical therapy for ED, found that only about 2% elected to have a penile implant placed for their ED. Declining interest in sexual activity with age, lack of a partner interested in sexual activity, the presence of other comorbidities precluding participating in intercourse, and cost to the patient are features which may account for the relatively low numbers for penile prostheses placed compared to breast and orthopedic joint devices.
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