Draft:Inflatable Penile Prosthesis
 | Review waiting, please be patient.
This may take 4 weeks or more, since drafts are reviewed in no specific order. There are 2,356 pending submissions waiting for review.
Where to get help
How to improve a draft
You can also browse Wikipedia:Featured articles and Wikipedia:Good articles to find examples of Wikipedia's best writing on topics similar to your proposed article. Improving your odds of a speedy review To improve your odds of a faster review, tag your draft with relevant WikiProject tags using the button below. This will let reviewers know a new draft has been submitted in their area of interest. For instance, if you wrote about a female astronomer, you would want to add the Biography, Astronomy, and Women scientists tags. Editor resources
Reviewer tools
|
Inflatable penile prosthesis (IPP), also called an inflatable penile implant, is a surgically implanted medical device used primarily to treat erectile dysfunction (ED). It is one of the two principal categories of penile prosthesis, the other being the malleable or semi-rigid penile implant.[1]
An IPP produces penile rigidity by transferring fluid into cylinders surgically implanted within the corpora cavernosa. Modern inflatable prostheses are generally available as two-piece or three-piece systems. Three-piece devices contain a pair of intracavernosal cylinders, a manually operated pump placed in the scrotum, and a separate fluid reservoir, typically placed within the pelvis or abdominal wall.[1]
Penile prosthesis implantation is generally considered for patients with erectile dysfunction who have not responded to, cannot use, or do not wish to continue less invasive therapies such as phosphodiesterase type 5 inhibitors, intracavernosal injections, or vacuum erection devices.[2] Inflatable prostheses may also be used in selected patients with erectile dysfunction associated with Peyronie's disease, pelvic surgery, neurological disease, trauma, or other causes.
Design and function
[edit]Modern inflatable penile prostheses use a closed hydraulic system. When the user operates the pump, fluid is transferred into cylinders positioned inside the corpora cavernosa, increasing penile rigidity. Activating the deflation mechanism allows fluid to leave the cylinders and return to the reservoir or other fluid-storage component.[1]
In a three-piece inflatable penile prosthesis, the system consists of:
- two inflatable cylinders implanted in the corpora cavernosa;
- a pump and deflation mechanism positioned within the scrotum; and
- a separate fluid reservoir.
A two-piece inflatable prosthesis combines the fluid-storage mechanism with the cylinders and pump and therefore does not require placement of a separate abdominal or pelvic reservoir. Three-piece implants are commonly used because they can provide substantial rigidity when inflated while permitting the penis to become comparatively soft when deflated.[1]
Unlike a physiological erection, activation of an inflatable prosthesis primarily changes the rigidity of the corpora cavernosa. It does not itself produce sexual desire, ejaculation, orgasm, or engorgement of the glans penis, although these functions may remain intact depending on the patient's underlying condition.
History
[edit]Attempts to restore penile rigidity using implanted materials predate modern inflatable devices. Early prosthetic techniques used cartilage, bone, acrylic materials, and later silicone-based implants.[3] Development of modern penile prosthetic surgery accelerated during the twentieth century as biocompatible materials and intracavernosal implantation techniques improved.[4]
The modern inflatable penile prosthesis was introduced in the early 1970s by F. Brantley Scott, William E. Bradley, and Gerald W. Timm. Their hydraulic device incorporated paired inflatable cylinders, a fluid reservoir, and a pumping mechanism and established the basic architecture from which contemporary three-piece prostheses developed.[5]
Subsequent changes in cylinder materials, pump and valve design, reservoir construction, antibiotic or hydrophilic surface treatments, and surgical technique have improved device reliability and reduced some complications associated with earlier prostheses.[4][1]
Surgical techniques have also continued to evolve. In 2008, urologist Paul Perito described a minimally invasive modification of the infrapubic approach for inflatable penile prosthesis placement.[6] Perito Urology subsequently used the term Perito Implant for its version of the minimally invasive infrapubic technique.
Medical use
[edit]The principal indication for inflatable penile prosthesis implantation is erectile dysfunction for which other therapies have been unsuccessful, contraindicated, poorly tolerated, or rejected by the patient after counseling.[2]
Causes of erectile dysfunction treated with penile prostheses can include vascular disease, diabetes mellitus, neurological disorders, pelvic trauma, erectile dysfunction following treatment for prostate cancer, and severe structural disease of the penis. Implantation may also be performed in patients with both erectile dysfunction and Peyronie's disease; placement of the prosthesis can restore rigidity while additional surgical maneuvers may be used when clinically significant curvature remains.
Because implantation permanently alters the erectile tissue of the corpora cavernosa, patients are ordinarily counseled regarding the irreversible nature of the operation, expected function of the device, possible changes in perceived penile length, and the potential need for future revision surgery.[2]
Outcomes
[edit]Published studies generally report high patient satisfaction following inflatable penile prosthesis implantation, although reported rates vary according to patient population, device, surgical technique, follow-up period, and method of measurement.[7]
In a series of 504 penile prosthesis procedures reported by Minervini and colleagues, 81% of patients were satisfied overall, with higher satisfaction reported among recipients of inflatable devices.[8] Outcomes are influenced by appropriate patient selection, preoperative expectations, surgical technique, complications, and device function.
Complications
[edit]Complications of inflatable penile prosthesis implantation include infection, bleeding or hematoma, injury to surrounding structures, erosion or extrusion of prosthetic components, device migration, mechanical failure, pain, and dissatisfaction with cosmetic or functional outcomes.[9]
Infection is a particularly important complication because treatment may require removal or replacement of some or all components of the prosthesis. Strategies intended to reduce infection include perioperative antimicrobial prophylaxis, improved sterile technique, antibiotic-impregnated or hydrophilic device coatings, and attention to patient-specific risk factors.[10]
Mechanical failure can involve the cylinders, pump, tubing, valves, or reservoir and may require revision or replacement surgery. Device durability has generally improved as prosthesis design and materials have evolved.[1]
Surgical approaches
[edit]Inflatable penile prostheses can be implanted through several surgical approaches. The two most commonly described approaches are the penoscrotal and infrapubic approaches; a subcoronal approach is also used in selected cases.[11] Selection of an approach depends on factors including surgeon experience, patient anatomy, previous pelvic or penile surgery, and whether additional reconstructive procedures are required.[12]
Penoscrotal approach
[edit]The penoscrotal approach uses an incision at or near the junction of the penis and scrotum. It provides direct access to the corpora cavernosa as well as the scrotum, facilitating dilation of the corpora, insertion of the prosthetic cylinders, and positioning and fixation of the pump within the scrotum.[13]
The approach provides broad exposure of both the proximal and distal corpora and permits direct placement of the scrotal pump. For three-piece prostheses, however, the fluid reservoir is commonly introduced from the penoscrotal incision into a retropubic or alternative reservoir location without the same direct visualization available through an infrapubic incision.[11] Dissection within the scrotum can also produce postoperative scrotal edema or hematoma, which may delay initial manipulation or cycling of the pump.[11]
The penoscrotal approach is widely used and has historically been the more common surgical access for inflatable penile prosthesis implantation.[11]
Infrapubic approach
[edit]The infrapubic approach uses an incision above the base of the penis near the penopubic junction. The corpora cavernosa are approached from above, allowing placement of the cylinders while also providing relatively direct access to the region used for reservoir placement in a three-piece prosthesis.[14]
Because the initial incision does not enter the scrotum, the approach can reduce surgical dissection of scrotal tissues. The pump is instead passed into a subdartos pouch in the scrotum from the infrapubic incision. Reported advantages include direct visualization during reservoir placement, reduced postoperative scrotal swelling, shorter operative times in some series, and the possibility of earlier device activation.[14][11]
Technical concerns associated with the infrapubic approach include its proximity to the dorsal penile nerves, more limited exposure of the distal corpora, and potentially more difficult pump positioning. These issues can be particularly relevant in patients with obesity, altered anatomy, or previous surgery.[14][11] Injury to the dorsal nerves has historically been considered a potential risk of the infrapubic approach, although clinically significant sensory injury has been uncommon in published comparative studies.[12]
Several modifications of the infrapubic technique have been developed. In 2008, urologist Paul Perito published a minimally invasive infrapubic technique intended to reduce incision and corporotomy size and streamline placement of the cylinders, reservoir, and scrotal pump.[6] The technique became one of several refinements of the infrapubic approach described in subsequent prosthetic urology literature.[11]
Comparison of infrapubic and penoscrotal approaches
[edit]Studies comparing infrapubic and penoscrotal implantation have generally not demonstrated a consistent overall advantage of one approach in major clinical outcomes. A 2018 systematic review found both approaches to be effective and associated with high patient satisfaction. It found no evidence that either incision reduced prosthetic infection rates and concluded that selection should take into account patient anatomy, surgical history, and surgeon experience.[12]
A later critical review similarly found no significant differences between the two approaches in prosthesis size, achieved penile length, patient satisfaction, infection, or urethral injury. The infrapubic approach was associated in the reviewed literature with shorter operative times and earlier device use, while carrying a potential, though uncommon, risk of injury to the dorsal penile nerves.[11]
Individual comparative studies have also reported shorter operative times with minimally invasive infrapubic implantation without demonstrating substantial differences in safety or functional outcomes.[15]
Consequently, surgical approach is generally considered a technical choice rather than an independent determinant of prosthesis success, and outcomes are influenced by factors including patient selection, surgical anatomy, operative technique, and surgeon experience.[12][11]
Other approaches
[edit]A subcoronal approach uses an incision below the glans penis followed by degloving of the penile shaft. It provides extensive exposure of the corpora and can facilitate simultaneous reconstructive procedures, such as correction of penile curvature. Comparative evidence for this approach is more limited than for infrapubic and penoscrotal implantation.[11]
Historically, suprapubic, perineal, and other incisions have also been used for penile prosthesis implantation, but these approaches are substantially less common in contemporary inflatable prosthesis surgery.[11]
See also
[edit]References
[edit]- 1 2 3 4 5 6 Wang, Vinson M.; Levine, Laurence A. (2022). "Safety and Efficacy of Inflatable Penile Prostheses for the Treatment of Erectile Dysfunction: Evidence to Date". Medical Devices: Evidence and Research. 15: 27–36. doi:10.2147/MDER.S251364. PMC 8844936. PMID 35177941.
- 1 2 3 Burnett, Arthur L.; Nehra, Ajay; Breau, Rodney H.; et al. (2018). "Erectile Dysfunction: AUA Guideline". The Journal of Urology. 200 (3): 633–641. doi:10.1016/j.juro.2018.05.004. PMID 29746858.
- ↑ Le, Brian (2015). "Evolution of penile prosthetic devices". Korean Journal of Urology. 56 (3): 179–186. doi:10.4111/kju.2015.56.3.179. PMC 4355428. PMID 25763121.
- 1 2 Henry, Gerard D. (2009). "Historical Review of Penile Prosthesis Design and Surgical Techniques: Part 1 of a Three-Part Review Series on Penile Prosthetic Surgery". The Journal of Sexual Medicine. 6 (3): 675–681. doi:10.1111/j.1743-6109.2008.01145.x. PMID 19207278.
- ↑ Scott, F. Brantley; Bradley, William E.; Timm, Gerald W. (1973). "Management of erectile impotence. Use of implantable inflatable prosthesis". Urology. 2 (1): 80–82. doi:10.1016/0090-4295(73)90224-0. PMID 4766860.
- 1 2 Perito, Paul E. (2008). "Minimally invasive infrapubic inflatable penile implant". The Journal of Sexual Medicine. 5 (1): 27–30. doi:10.1111/j.1743-6109.2007.00682.x. PMID 18173764.
- ↑ Bettocchi, Carlo; Palumbo, Fabrizio; Spilotros, Marco; et al. (2010). "Patient and partner satisfaction after AMS inflatable penile prosthesis implant". The Journal of Sexual Medicine. 7 (1): 304–309. doi:10.1111/j.1743-6109.2009.01499.x. PMID 19758282.
- ↑ Minervini, Andrea; Ralph, David J.; Pryor, John P. (2006). "Outcome of penile prosthesis implantation for treating erectile dysfunction: experience with 504 procedures". BJU International. 97 (1): 129–133. doi:10.1111/j.1464-410X.2005.05907.x. PMID 16336342.
- ↑ Moukhtar Hammad, Muhammed A.; Barham, David W.; Sanford, Daniel I.; et al. (2023). "Maximizing outcomes in penile prosthetic surgery: exploring strategies to prevent and manage infectious and non-infectious complications". International Journal of Impotence Research. 35 (7): 613–619. doi:10.1038/s41443-023-00773-7. PMC 10622320. PMID 37828138.
- ↑ Selph, J. Patrick; Carson, Culley C. (2011). "Penile prosthesis infection: approaches to prevention and treatment". Urologic Clinics of North America. 38 (2): 227–235. doi:10.1016/j.ucl.2011.02.007. PMID 21621089.
- 1 2 3 4 5 6 7 8 9 10 11 Romero Otero, Javier; Manfredi, Celeste; Wilson, Steven K. (2022). "The good, the bad, and the ugly about surgical approaches for inflatable penile prosthesis implantation". International Journal of Impotence Research. 34 (2): 128–137. doi:10.1038/s41443-020-0319-4. PMID 32488210.
- 1 2 3 4 Palmisano, Franco; Boeri, Luca; Cristini, Cristiano; Antonini, Gabriele; et al. (2018). "Comparison of Infrapubic vs Penoscrotal Approaches for 3-Piece Inflatable Penile Prosthesis Placement: Do We Have a Winner?". Sexual Medicine Reviews. 6 (4): 631–639. doi:10.1016/j.sxmr.2018.03.007. PMID 29730314.
- ↑ Gupta, Nikhil K.; Ring, Josh; Trost, Landon; Wilson, Steven K.; Köhler, Tobias S. (2017). "The penoscrotal surgical approach for inflatable penile prosthesis placement". Translational Andrology and Urology. 6 (4): 628–638. doi:10.21037/tau.2017.07.32. PMC 5583046. PMID 28904895.
- 1 2 3 Jayadevan, Rajiv; Eleswarapu, Sriram V.; Mills, Jesse N. (2020). "Infrapubic approach for placement of inflatable penile prosthesis: contemporary review of technique and implications". International Journal of Impotence Research. 32 (1): 10–17. doi:10.1038/s41443-019-0193-0. PMID 31537910.
- ↑ Grande, Pietro; Antonini, Gabriele; Cristini, Cristiano; De Berardinis, Ettore; et al. (2018). "Penoscrotal versus minimally invasive infrapubic approach for inflatable penile prosthesis placement: a single-center matched-pair analysis". World Journal of Urology. 36 (7): 1167–1174. doi:10.1007/s00345-018-2249-z. PMID 29492584.