Penile prosthesis in the medically complex patient: a narrative review

Translational Andrology and Urology, 2023 · DOI: 10.21037/tau-23-71 · Published: December 21, 2023

Simple Explanation

Penile prosthesis surgery is a common and effective treatment for erectile dysfunction, but it can be challenging in medically complex patients. This review discusses potential problems and solutions. The article covers common comorbidities like spinal cord injury, diabetes, cardiovascular disease, organ transplants, and previous pelvic surgery, focusing on preoperative planning and management. Preoperative assessment and experienced surgeons are crucial for safe prosthetic surgery in complex cases, using various surgical techniques to manage potential problems.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Narrative Review

Key Findings

1
Patients with spinal cord injuries may benefit from penile implants for both ED and urinary symptoms, but require careful consideration of dexterity and sensation.
2
Diabetic patients may have a higher risk of infection after penile implant surgery, emphasizing the importance of good blood sugar control preoperatively.
3
Patients with cardiovascular disease require careful preoperative cardiac risk stratification and management of antiplatelet/anticoagulant medications.

Research Summary

Penile implant surgery is a safe and effective treatment for erectile dysfunction but requires careful consideration in medically complex patients. Preoperative diagnostics and counseling are crucial for making informed treatment decisions, especially in patients with comorbidities. Experienced surgeons should be skilled in various techniques to manage perioperative problems, such as reservoir placement in patients with previous pelvic surgery.

Practical Implications

Preoperative Assessment

Comprehensive evaluation of patients with comorbidities to optimize surgical outcomes.

Surgical Technique Adaptation

Tailoring surgical approaches based on patient-specific factors, such as previous surgeries or medical conditions.

Infection Prevention

Strict adherence to infection control protocols, particularly in high-risk patients like those with diabetes or organ transplants.

Study Limitations

1
Limited evidence in some areas necessitates consideration of all publication dates.
2
Conflicting and limited results regarding penile implant surgery in organ transplant patients.
3
Data regarding penile implant surgery and peripheral vascular disease or hypertension is limited.

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