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{{Short description|Medical device}}
{{Undisclosed paid|date=January 2021}}
{{Infobox medical intervention
{{Infobox medical intervention
| name = Penile implant
| name = Penile implant
| synonym = Penile prosthesis
| synonym = Penile prosthesis
| image = File:Penile Implant.png|thumb|
| image = Penile Implant.png
| caption = Penile implant
| caption = Penile implant
| alt =
| alt =
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| eMedicine =
| eMedicine =
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A '''penile implant''' is an [[Implant (Medicine)|implanted device]] intended for the treatment of [[erectile dysfunction]], [[Peyronie's disease]], ischemic [[priapism]], deformity and traumatic injury of the penis, and for [[phalloplasty]] in men or phalloplasty and [[metoidioplasty]] in [[Sex reassignment surgery (female-to-male)|female-to-male gender reassignment surgery]]. Although there are many distinct types of implants, most fall into one of two categories: malleable and inflatable.<ref>{{cite web|last1=Perito|first1=Paul|title=Penile Implants|url=https://peritourology.com/penile-implants/|website=PeritoUrology.com|publisher=Perito Urology|accessdate=12 November 2019}}</ref>


⚫
A '''penile implant''' is an [[Implant (Medicine)|implanted device]] intended for the treatment of [[erectile dysfunction]], [[Peyronie's disease]], ischemic [[priapism]], deformity and any traumatic injury of the penis, and for [[phalloplasty]] or [[metoidioplasty]], including in gender-affirming surgery. Men also opt for penile implants for aesthetic purposes. Men's satisfaction and sexual function is influenced by discomfort over genital size, which leads some to seek surgical and non-surgical solutions for penis alteration.<ref>{{Cite journal|last1=Littara|first1=Alessandro|last2=Melone|first2=Roberto|last3=Morales-Medina|first3=Julio Cesar|last4=Iannitti|first4=Tommaso|last5=Palmieri|first5=Beniamino|date=2019-04-19|title=Cosmetic penile enhancement surgery: a 3-year single-centre retrospective clinical evaluation of 355 cases|journal=Scientific Reports|volume=9|issue=1|page=6323|doi=10.1038/s41598-019-41652-w|issn=2045-2322|pmc=6474863|pmid=31004096|bibcode=2019NatSR...9.6323L}}</ref> Although there are many distinct types of implants, most fall into one of two categories: malleable and inflatable transplants.<ref name="peritourology.com penile-implants">{{cite web|last1=Perito|first1=Paul|title=Penile Implants|url=https://peritourology.com/penile-implants/|website=PeritoUrology.com|publisher=Perito Urology|access-date=12 November 2019}}{{self-published inline|date=December 2020}}</ref>
⚫
==History==
⚫
The first modern prosthetic reconstruction of a penis is attributed to NA Borgus, a German physician who performed the first surgical attempts in 1936 on soldiers with traumatic [[Penectomy|amputations of the penis]]. He used [[Costal cartilage|rib cartilages]] as prosthetic material and reconstructed the genitals for both [[Urination|micturition]] and [[Sexual intercourse|intercourse]] purposes.<ref name="History">{{cite journal |last1=Carrion |first1=Hernan |last2=Martinez |first2=Daniel |last3=Parker |first3=Justin |last4=Hakky |first4=Tariq |last5=Bickell |first5=Michael |last6=Boyle |first6=Alexander |last7=Weigand |first7=Luke |last8=Carrion |first8=Rafael |title=A History of the Penile Implant to 1974 |journal=Sexual Medicine Reviews |date=July 2016 |volume=4 |issue=3 |pages=285–293 |doi=10.1016/j.sxmr.2016.05.003 |pmid=27871961 }}</ref> Willard E. Goodwin and William Wallace Scott were the first to describe the placement of synthetic penile implants using [[Acrylic resin|acrylic]] prosthesis in 1952.<ref>{{cite journal |last1=Goodwin |first1=Willard E. |last2=Scott |first2=William Wallace |title=Phalloplasty |journal=Journal of Urology |date=December 1952 |volume=68 |issue=6 |pages=903–908 |doi=10.1016/S0022-5347(17)68301-0 |pmid=13000938 |url=https://www.sciencedirect.com/science/article/abs/pii/S0022534717683010 |accessdate=4 February 2020}}</ref> [[Silicone]]-based penile implants were developed by Harvey Lash and the first case series were published in 1964.<ref>{{cite journal |last1=LASH |first1=HARVEY |last2=ZIMMERMAN |first2=DONALD C. |last3=LOEFFLER |first3=ROBERT A. |title=Silicone Implantation |journal=Plastic and Reconstructive Surgery |date=July 1964 |volume=34 |issue=1 |pages=75–80 |doi=10.1097/00006534-196407000-00011 |pmid=14200523 |s2cid=43779571 |url=https://insights.ovid.com/crossref?an=00006534-196407000-00011 |accessdate=4 February 2020}}</ref> The development of a high-grade silicone that is currently used in penile implants is credited to [[NASA]].<ref name="Rodriguez">{{cite journal |last1=Rodriguez |first1=Katherine M. |last2=Pastuszak |first2=Alexander W. |title=A history of penile implants |journal=Translational Andrology and Urology |date=November 2017 |volume=6 |issue=S5 |pages=S851–S857 |doi=10.21037/tau.2017.04.02 |pmid=29238664 |pmc=5715175 }}</ref> The prototypes of the contemporary inflatable and malleable penile implants were presented in 1973 during the annual meeting of the [[American Urological Association]] by two groups of physicians from [[Baylor University]] (Gerald Timm, William E. Bradley and F. Brantley Scott) and [[University of Miami]] (Michael P. Small and Hernan M. Carrion).<ref name="History" /><ref name="Scott">{{cite journal |last1=Brantley Scott |first1=F. |last2=Bradley |first2=William E. |last3=Timm |first3=Gerald W. |title=Management of erectile impotence Use of implantable inflatable prosthesis |journal=Urology |date=July 1973 |volume=2 |issue=1 |pages=80–82 |doi=10.1016/0090-4295(73)90224-0 |pmid=4766860 }}</ref><ref>{{cite journal |last1=Small |first1=Michael P. |last2=Carrion |first2=Hernan M. |last3=Gordon |first3=Julian A. |title=Small-Carrion penile prosthesis |journal=Urology |date=April 1975 |volume=5 |issue=4 |pages=479–486 |doi=10.1016/0090-4295(75)90071-0 |pmid=1093303 }}</ref> Small and Carrion pioneered the popularization of semi-rigid penile implants with the introduction of Small-Carrion prosthesis ([[Mentor (company)|Mentor]], USA) in 1975. Brantley Scott described the initial device as composed of two inflatable cylindrical bodies made up of silicone, a reservoir containing [[Radiodensity |radiopaque]] fluid and two pumping units.<ref name="Scott" /> The first generation products were marketed through American Medical Systems (AMS; currently [[Boston Scientific]]), with which Brantley Scott was associated.<ref name="Rodriguez" /><ref>{{cite journal |last1=Carson |first1=Culley C |title=F. Brantley Scott: a visionary in the world of urology |journal=Trends in Urology & Men's Health |date=May 2018 |volume=9 |issue=3 |pages=32–33 |doi=10.1002/tre.639 |doi-access=free }}</ref> Many device updates have been released by AMS since the first generation implants. In 1983, Mentor (currently [[Coloplast]]) joined the market.<ref name="Rodriguez" /> In 2017, there were more than ten manufacturers of penile implants in the world, however only a few now remain in the market.<ref name="Chung">{{cite journal |last1=Chung |first1=Eric |title=Penile prosthesis implant: scientific advances and technological innovations over the last four decades |journal=Translational Andrology and Urology |date=February 2017 |volume=6 |issue=1 |pages=37–45 |doi=10.21037/tau.2016.12.06 |pmid=28217449 |pmc=5313299 }}</ref> The latest additions to the market are [[Zephyr Surgical Implants]] and [[Rigicon Innovative Urological Solutions]]<ref>https://www.nature.com/articles/s41443-020-0338-1</ref><ref>https://www.researchgate.net/publication/336218253_Future_considerations_in_prosthetic_urology</ref><ref>https://www.ajandrology.com/article.asp?issn=1008-682X;year=2020;volume=22;issue=1;spage=70;epage=75;aulast=Trost</ref>. [[Zephyr Surgical Implants]] along with penile implants for biological men, introduced the first line of inflatable and malleable penile implants designed for [[Sex reassignment surgery|sex reassignment]] for [[Trans man|trans men]].


⚫
== History ==
⚫
According to analysis of the 5% Medicare Public Use Files from 2001 to 2010 approximately 3% of patients diagnosed with erectile dysfunction opt for penile implantation.<ref>{{cite journal |last1=Lee |first1=Daniel J. |last2=Najari |first2=Bobby B. |last3=Davison |first3=Wesley L. |last4=Al Awamlh |first4=Bashir Al Hussein |last5=Zhao |first5=Fujun |last6=Paduch |first6=Darius A. |last7=Mulhall |first7=John P. |last8=Chughtai |first8=Bilal |last9=Lee |first9=Richard K. |title=Trends in the Utilization of Penile Prostheses in the Treatment of Erectile Dysfunction in the United States |journal=The Journal of Sexual Medicine |date=July 2015 |volume=12 |issue=7 |pages=1638–1645 |doi=10.1111/jsm.12921 |pmid=26096365 |url=https://www.jsm.jsexmed.org/article/S1743-6095(15)34145-X/fulltext |accessdate=5 February 2020}}</ref> Each year nearly 25,000 inflatable penile prostheses are implanted in the USA.<ref>{{cite journal |last1=Darouiche |first1=Rabih O. |last2=Bella |first2=Anthony J. |last3=Boone |first3=Timothy B. |last4=Brock |first4=Gerry |last5=Broderick |first5=Gregory A. |last6=Burnett |first6=Arthur L. |last7=Carrion |first7=Raphael |last8=Carson |first8=Culley |last9=Christine |first9=Brian |last10=Dhabuwala |first10=Chipriya B. |last11=Hakim |first11=Lawrence S. |last12=Henry |first12=Gerard |last13=Jones |first13=LeRoy A. |last14=Khera |first14=Mohit |last15=Montague |first15=Drogo K. |last16=Nehra |first16=Ajay |title=North American Consensus Document on Infection of Penile Prostheses |journal=Urology |date=October 2013 |volume=82 |issue=4 |pages=937–942 |doi=10.1016/j.urology.2013.05.048 |pmid=23958508 |url=https://www.goldjournal.net/article/S0090-4295(13)00822-4/fulltext|accessdate=19 April 2020}}</ref>
⚫
The first modern prosthetic reconstruction of a penis is attributed to NA Borgus, a German physician who performed the first surgical attempts in 1936 on soldiers with traumatic [[Penectomy|amputations of the penis]]. He used [[Costal cartilage|rib cartilages]] as prosthetic material and reconstructed the genitals for both [[Urination|micturition]] and [[Sexual intercourse|intercourse]] purposes.<ref name="History">{{cite journal |last1=Carrion |first1=Hernan |last2=Martinez |first2=Daniel |last3=Parker |first3=Justin |last4=Hakky |first4=Tariq |last5=Bickell |first5=Michael |last6=Boyle |first6=Alexander |last7=Weigand |first7=Luke |last8=Carrion |first8=Rafael |title=A History of the Penile Implant to 1974 |journal=Sexual Medicine Reviews |date=July 2016 |volume=4 |issue=3 |pages=285–293 |doi=10.1016/j.sxmr.2016.05.003 |pmid=27871961 }}</ref> Willard E. Goodwin and William Wallace Scott were the first to describe the placement of synthetic penile implants using [[Acrylic resin|acrylic]] prosthesis in 1952.<ref>{{cite journal |last1=Goodwin |first1=Willard E. |last2=Scott |first2=William Wallace |title=Phalloplasty |journal=Journal of Urology |date=December 1952 |volume=68 |issue=6 |pages=903–908 |doi=10.1016/S0022-5347(17)68301-0 |pmid=13000938 }}</ref> [[Silicone]]-based penile implants were developed by Harvey Lash and the first case series were published in 1964.<ref>{{cite journal |last1=Lash |first1=Harvey |last2=Zimmerman |first2=Donald C. |last3=Loeffler |first3=Robert A. |title=Silicone Implantation |journal=Plastic and Reconstructive Surgery |date=July 1964 |volume=34 |issue=1 |pages=75–80 |doi=10.1097/00006534-196407000-00011 |pmid=14200523 |s2cid=43779571 }}</ref> The development of a high-grade silicone that is currently used in penile implants is credited to [[NASA]].<ref name="Rodriguez">{{cite journal |last1=Rodriguez |first1=Katherine M. |last2=Pastuszak |first2=Alexander W. |title=A history of penile implants |journal=Translational Andrology and Urology |date=November 2017 |volume=6 |issue=S5 |pages=S851–S857 |doi=10.21037/tau.2017.04.02 |pmid=29238664 |pmc=5715175 |doi-access=free }}</ref> The prototypes of the contemporary inflatable and malleable penile implants were presented in 1973 during the annual meeting of the [[American Urological Association]] by two groups of physicians from [[Baylor University]] (Gerald Timm, William E. Bradley and F. Brantley Scott) and [[University of Miami]] (Michael P. Small and Hernan M. Carrion).<ref name="History" /><ref name="Scott">{{cite journal |last1=Brantley Scott |first1=F. |last2=Bradley |first2=William E. |last3=Timm |first3=Gerald W. |title=Management of erectile impotence Use of implantable inflatable prosthesis |journal=Urology |date=July 1973 |volume=2 |issue=1 |pages=80–82 |doi=10.1016/0090-4295(73)90224-0 |pmid=4766860 }}</ref><ref>{{cite journal |last1=Small |first1=Michael P. |last2=Carrion |first2=Hernan M. |last3=Gordon |first3=Julian A. |title=Small-Carrion penile prosthesis |journal=Urology |date=April 1975 |volume=5 |issue=4 |pages=479–486 |doi=10.1016/0090-4295(75)90071-0 |pmid=1093303 }}</ref> Small and Carrion pioneered the popularization of semi-rigid penile implants with the introduction of Small-Carrion prosthesis ([[Mentor (company)|Mentor]], USA) in 1975. Brantley Scott described the initial device as composed of two inflatable cylindrical bodies made up of silicone, a reservoir containing [[Radiodensity|radiopaque]] fluid and two pumping units.<ref name="Scott" /> The first generation products were marketed through American Medical Systems (AMS; currently [[Boston Scientific]]), with which Brantley Scott was associated.<ref name="Rodriguez" /><ref>{{cite journal |last1=Carson |first1=Culley C |title=F. Brantley Scott: a visionary in the world of urology |journal=Trends in Urology & Men's Health |date=May 2018 |volume=9 |issue=3 |pages=32–33 |doi=10.1002/tre.639 |doi-access=free }}</ref> Many device updates have been released by AMS since the first generation implants. In 1983, Mentor (currently [[Coloplast]]) joined the market.<ref name="Rodriguez" /> In 2017, there were more than ten manufacturers of penile implants in the world, however only a few now remain in the market.<ref name="Chung">{{cite journal |last1=Chung |first1=Eric |title=Penile prosthesis implant: scientific advances and technological innovations over the last four decades |journal=Translational Andrology and Urology |date=February 2017 |volume=6 |issue=1 |pages=37–45 |doi=10.21037/tau.2016.12.06 |pmid=28217449 |pmc=5313299 |doi-access=free }}</ref> The latest additions to the market are [[Zephyr Surgical Implants]] and [[Rigicon Innovative Urological Solutions]].<ref>{{cite journal |last1=Mulcahy |first1=John J. |last2=Köhler |first2=Tobias S. |last3=Wen |first3=Lexiaochuan |last4=Wilson |first4=Steven K. |title=Penile implant infection prevention part II: device coatings have changed the game |journal=International Journal of Impotence Research |date=7 August 2020 |volume=33 |issue=8 |pages=801–807 |doi=10.1038/s41443-020-0338-1 |pmid=32770140 |pmc=8776559 |s2cid=221019610 |doi-access=free }}</ref><ref>{{cite journal |last1=Trost |first1=Landon |title=Future considerations in prosthetic urology |journal=Asian Journal of Andrology |date=2020 |volume=22 |issue=1 |pages=70–75 |doi=10.4103/aja.aja_103_19 |pmid=31571642 |pmc=6958985 |doi-access=free }}</ref> Zephyr Surgical Implants, along with penile implants for biological men, introduced the first line of inflatable and malleable penile implants designed for [[Sex reassignment surgery|sex reassignment]] for [[Trans man|trans men]]. In recent years, Rigicon Innovative Urological Solutions, a US-based company, has made significant advancements in the field of penile implants. In 2017, they released the 'Rigi10,' a malleable implant that expanded the market's options. Following this, in 2019, they introduced both the 'Infla10' series, which includes the Infla10 AX, Infla10 X, and Infla10 models, and the 'Rigi10 Hydrophilic.' These inflatable and hydrophilic-coated malleable models respectively were important additions to the range of penile implant technologies available. These advancements have contributed to the diversity and progress in the development of penile implants, offering patients more varied and tailored treatment solutions.<ref>{{cite journal | doi=10.1038/s41443-023-00663-y | title=Celebrating 50 years of penile implants | year=2023 | last1=Wilson | first1=Steven K. | last2=Gross | first2=Martin S. | journal=International Journal of Impotence Research | volume=35 | issue=7 | pages=596–600 | pmid=36650316 | pmc=10622314 | s2cid=255971214 | doi-access=free }}</ref> <ref>{{cite journal | doi=10.1038/s41585-022-00607-z | title=The International Penile Prosthesis Implant Consensus Forum: Clinical recommendations and surgical principles on the inflatable 3-piece penile prosthesis implant | year=2022 | last1=Chung | first1=Eric | last2=Bettocchi | first2=Carlo | last3=Egydio | first3=Paulo | last4=Love | first4=Chris | last5=Osmonov | first5=Daniar | last6=Park | first6=Sean | last7=Ralph | first7=David | last8=Xin | first8=Zhong Cheng | last9=Brock | first9=Gerald | journal=Nature Reviews Urology | volume=19 | issue=9 | pages=534–546 | pmid=35711059 | s2cid=249680998 | doi-access=free }}</ref>

⚫
According to analysis of the 5% Medicare Public Use Files from 2001 to 2010 approximately 3% of patients diagnosed with erectile dysfunction opt for penile implantation.<ref>{{cite journal |last1=Lee |first1=Daniel J. |last2=Najari |first2=Bobby B. |last3=Davison |first3=Wesley L. |last4=Al Awamlh |first4=Bashir Al Hussein |last5=Zhao |first5=Fujun |last6=Paduch |first6=Darius A. |last7=Mulhall |first7=John P. |last8=Chughtai |first8=Bilal |last9=Lee |first9=Richard K. |title=Trends in the Utilization of Penile Prostheses in the Treatment of Erectile Dysfunction in the United States |journal=The Journal of Sexual Medicine |date=July 2015 |volume=12 |issue=7 |pages=1638–1645 |doi=10.1111/jsm.12921 |pmid=26096365 }}</ref> Each year nearly 25,000 inflatable penile prostheses are implanted in the USA.<ref>{{cite journal |last1=Darouiche |first1=Rabih O. |last2=Bella |first2=Anthony J. |last3=Boone |first3=Timothy B. |last4=Brock |first4=Gerry |last5=Broderick |first5=Gregory A. |last6=Burnett |first6=Arthur L. |last7=Carrion |first7=Raphael |last8=Carson |first8=Culley |last9=Christine |first9=Brian |last10=Dhabuwala |first10=Chipriya B. |last11=Hakim |first11=Lawrence S. |last12=Henry |first12=Gerard |last13=Jones |first13=LeRoy A. |last14=Khera |first14=Mohit |last15=Montague |first15=Drogo K. |last16=Nehra |first16=Ajay |title=North American Consensus Document on Infection of Penile Prostheses |journal=Urology |date=October 2013 |volume=82 |issue=4 |pages=937–942 |doi=10.1016/j.urology.2013.05.048 |pmid=23958508 }}</ref>


The list shows penile implants available in the market in 2020.
The list shows penile implants available in the market in 2020.
Line 51: Line 54:
| Malleable
| Malleable
| 2004
| 2004
|-
|Shah Indian Malleable
|Dr.Rupin Shah
|[[India]]
| Malleable
| 2008
|-
|-
| ZSI 100, ZSI 100 FtM and ZSI 100 D4
| ZSI 100, ZSI 100 FtM and ZSI 100 D4
Line 89: Line 98:
|-
|-
| Infla10 series (AX, X, NarrowBody)
| Infla10 series (AX, X, NarrowBody)
| [[Rigicon Innovative Urological Solutions]]
| Rigicon Innovative Urological Solutions
| [[United States of America]]
| [[United States of America]]
| Inflatable
| Inflatable
| 2019
| 2019
|-
|-
| Rigi10<ref>https://www.accessdata.fda.gov/cdrh_docs/pdf18/K181673.pdf</ref>
| Rigi10<ref>{{Cite web|url=https://www.accessdata.fda.gov/cdrh_docs/pdf18/K181673.pdf|title=Enforcement Reports|website=www.accessdata.fda.gov}}</ref>
| [[Rigicon Innovative Urological Solutions]]
| Rigicon Innovative Urological Solutions
| [[United States of America]]
| [[United States of America]]
| Malleable
| Malleable
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|-
|-
| Rigi10 Hydrophilic
| Rigi10 Hydrophilic
| [[Rigicon Innovative Urological Solutions]]
| Rigicon Innovative Urological Solutions
| [[United States of America]]
| [[United States of America]]
| Malleable
| Malleable
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==Types==
==Types==
===Malleable penile implant===
===Malleable penile implant===
[[File:Comparison of penile implants.jpg|thumb|350 px|Comparison of penile implants (inflated cylinder diameter and length)]][[File:Penile implant pump design comparison.jpg|350 px|thumb|Penile implant pump design comparison]]
[[File:Comparison of penile implants.jpg|thumb|350 px|Comparison of penile implants (inflated cylinder diameter and length)]] [[File:Penile implant pump design comparison.jpg|350 px|thumb|Penile implant pump design comparison]]
The malleable (also known as non-inflatable or semi-rigid) penile [[prosthesis]] is a set of a pair of rods implanted into the corpora of the penis. The rods are hard, but 'malleable' in the sense that they can be adjusted manually into the erect position.<ref>{{cite web|last1=Perito|first1=Paul|title=Malleable Penile Implant Prosthesis|url=https://peritourology.com/malleable-penile-implant/|website=PeritoUrology.com|publisher=Perito Urology|accessdate=12 November 2019}}</ref> There are two types of malleable implants: one that is made of silicone and does not have a rod inside, also called soft implants, and another with a silver or steel spiral wire core inside coated with silicone. Some of the models have trimmable tails intended for length adjustment.<ref name="Chung" /> Currently, a variety of malleable penile implants are available worldwide.<ref>{{cite journal |last1=Le |first1=Brian |last2=Burnett |first2=Arthur L. |title=Evolution of penile prosthetic devices |journal=Korean Journal of Urology |date=2015 |volume=56 |issue=3 |pages=179–86 |doi=10.4111/kju.2015.56.3.179 |pmid=25763121 |pmc=4355428 |doi-access=free }}</ref>
The malleable (also known as non-inflatable or semi-rigid) penile [[prosthesis]] is a pair of rods implanted into the corpora of the penis. The rods are hard, but 'malleable' in the sense that they can be adjusted manually into the erect position.<ref>{{cite web|last1=Perito|first1=Paul|title=Malleable Penile Implant Prosthesis|url=https://peritourology.com/malleable-penile-implant/|website=PeritoUrology.com|publisher=Perito Urology|access-date=12 November 2019}}{{self-published inline|date=December 2020}}</ref> There are two types of malleable implants: one that is made of silicone and does not have a rod inside, also called soft implants, and another with a silver or steel spiral wire core inside coated with silicone. Some of the models have trimmable tails intended for length adjustment.<ref name="Chung" /> Currently, a variety of malleable penile implants are available worldwide.<ref>{{cite journal |last1=Le |first1=Brian |last2=Burnett |first2=Arthur L. |title=Evolution of penile prosthetic devices |journal=Korean Journal of Urology |date=2015 |volume=56 |issue=3 |pages=179–86 |doi=10.4111/kju.2015.56.3.179 |pmid=25763121 |pmc=4355428 |doi-access=free }}</ref>


===Inflatable penile implant===
===Inflatable penile implant===
The inflatable penile implant (IPP), more recently developed, is a set of inflatable cylinders and a pump system. Based on the differences in structure, there are two types of inflatable penile implants: two-piece and three-piece IPPs. Both types of inflatable devices are filled with sterile [[Saline (medicine)|saline solution]] which is pumped into cylinders when in process. The cylinders are implanted into the [[Corpus cavernosum penis|cavernous body of the penis]]. The pump system is attached to the cylinders and placed in the [[scrotum]].<ref name="Chung" /> Three-piece implants have a separate large reservoir connected to the pump. The reservoir is commonly placed in the [[retropubic space]] (Retzius' space), however other locations have also been described, such as between the [[Transverse abdominal muscle|transverse muscle]] and [[Rectus abdominis muscle|rectus muscle]]. Three-piece implants provide more desirable rigidity and girth of the penis resembling natural erection. Additionally, due to the presence of a large reservoir, three-piece implants provide full flaccidity of the penis when deflated, thus bringing more comfort than two-piece inflatable and malleable implants.<ref name="Rodriguez" />
The inflatable penile implant (IPP), more recently developed, is a set of inflatable cylinders and a pump system. Based on the differences in structure, there are two types of inflatable penile implants: two-piece and three-piece IPPs. Both types of inflatable devices are filled with sterile [[Saline (medicine)|saline solution]] which is pumped into cylinders when in process. The cylinders are implanted into the [[Corpus cavernosum penis|cavernous body of the penis]]. The pump system is attached to the cylinders and placed in the [[scrotum]].<ref name="Chung" /> Three-piece implants have a separate large reservoir connected to the pump. The reservoir is commonly placed in the [[retropubic space]] (Retzius' space), however other locations have also been described, such as between the [[Transverse abdominal muscle|transverse muscle]] and [[Rectus abdominis muscle|rectus muscle]]. Three-piece implants provide more desirable rigidity and girth of the penis resembling natural erection. Additionally, due to the presence of a large reservoir, three-piece implants provide full flaccidity of the penis when deflated, thus bringing more comfort than two-piece inflatable and malleable implants.<ref name="Rodriguez" />


The saline solution is pumped manually from the reservoir into bilateral chambers of cylinders implanted in the shaft of the penis, which replaces the non- or minimally-functioning erectile tissue. This produces an erection. The [[glans penis|glans of the penis]], however, remains unaffected. Ninety to ninety-five percent of inflatable prostheses produce erections suitable for [[sexual intercourse]]. In the United States, the inflatable prosthesis has largely replaced the malleable one, due to its lower rate of infections, high device survival rate and 80-90% satisfaction rate.<ref>{{cite web|last1=Perito|first1=Paul|title=Penile Implants|url=https://peritourology.com/penile-implants/|website=PeritoUrology.com|publisher=Perito Urology|accessdate=12 November 2019}}</ref>
The saline solution is pumped manually from the reservoir into bilateral chambers of cylinders implanted in the shaft of the penis, which replaces the non- or minimally-functioning erectile tissue. This produces an erection. The [[glans penis|glans of the penis]], however, remains unaffected. Ninety to ninety-five percent of inflatable prostheses produce erections suitable for [[sexual intercourse]]. In the United States, the inflatable prosthesis has largely replaced the malleable one, due to its lower rate of infections, high device survival rate and 80–90% satisfaction rate.<ref name="peritourology.com penile-implants"/>


The first IPP prototype presented in 1975 by Scott and colleagues was a three-piece prosthesis (two cylinders, two pumps and a fluid reservoir). Since then, the IPP has undergone multiple modifications and improvements for device reliability and durability, including change in the chemical material used in implant manufacturing, using hydrophilic and antibiotic eluting coatings to reduce the rates of infections, introducing one-touch release etc.<ref name="Chung" /> Surgical techniques used for the implantation of penile prostheses have also improved along with evolution of the device. Inflatable penile implants were one of the first interventions in urology where the "no-touch" surgical technique was introduced. This has significantly reduced the rates of post-operative infections.<ref>{{cite journal |last1=Eid |first1=J. Francois |title=Penile Implant: Review of a "No-Touch" Technique |journal=Sexual Medicine Reviews |date=July 2016 |volume=4 |issue=3 |pages=294–300 |doi=10.1016/j.sxmr.2016.01.002 |pmid=27871962 }}</ref>
The first IPP prototype presented in 1975 by Scott and colleagues was a three-piece prosthesis (two cylinders, two pumps and a fluid reservoir). Since then, the IPP has undergone multiple modifications and improvements for device reliability and durability, including change in the chemical material used in implant manufacturing, using hydrophilic and antibiotic eluting coatings to reduce the rates of infections, introducing one-touch release etc.<ref name="Chung" /> Surgical techniques used for the implantation of penile prostheses have also improved along with evolution of the device. Inflatable penile implants were one of the first interventions in urology where the "no-touch" surgical technique was introduced. This has significantly reduced the rates of post-operative infections.<ref>{{cite journal |last1=Eid |first1=J. Francois |title=Penile Implant: Review of a "No-Touch" Technique |journal=Sexual Medicine Reviews |date=July 2016 |volume=4 |issue=3 |pages=294–300 |doi=10.1016/j.sxmr.2016.01.002 |pmid=27871962 }}</ref>
Line 123: Line 132:
[[File:Inflatable penile implant.jpg|thumb|350 px|A diagram of an inflatable penile implant inserted into corpus cavernosum of the penis]]
[[File:Inflatable penile implant.jpg|thumb|350 px|A diagram of an inflatable penile implant inserted into corpus cavernosum of the penis]]
[[File:Penile implant in action.gif|thumb|250 px|Evoking an erection with an implanted penile implant]]
[[File:Penile implant in action.gif|thumb|250 px|Evoking an erection with an implanted penile implant]]

===Erectile dysfunction===
===Erectile dysfunction===
In spite of recent rapid and extensive development of non-surgical management options for [[erectile dysfunction]], especially novel targeted medications and [[gene therapy]], the penile implants remain the mainstay and the gold standard choice for the treatment of erectile dysfunction refractory to oral medications and injectable therapy.<ref name="F1000">{{cite journal |last1=Fakhoury |first1=Mathew Q |last2=Halpern |first2=Joshua |last3=Bennett |first3=Nelson |title=Recent advancements in penile prosthetics |journal=F1000Research |date=18 February 2019 |volume=8 |pages=193 |doi=10.12688/f1000research.17407.1 |pmid=30828431 |pmc=6381800 |doi-access=free }}</ref><ref name="Rodriguez" /> Additionally, penile implants can be a relevant option for those with erectile dysfunction who wants to proceed with a permanent solution without medical therapy. Penile implants have been used for the treatment of erectile dysfunction with various etiologies, including vascular, [[Corpus cavernosum penis|cavernosal]], neurogenic, psychological and post-surgical (e.g. [[prostatectomy]]). The [[American Urological Association]] recommends informing all men with erectile dysfunction about penile implants as a choice of treatment and discussing the potential outcomes with them.<ref>{{cite journal |last1=Burnett |first1=Arthur L. |last2=Nehra |first2=Ajay |last3=Breau |first3=Rodney H. |last4=Culkin |first4=Daniel J. |last5=Faraday |first5=Martha M. |last6=Hakim |first6=Lawrence S. |last7=Heidelbaugh |first7=Joel |last8=Khera |first8=Mohit |last9=McVary |first9=Kevin T. |last10=Miner |first10=Martin M. |last11=Nelson |first11=Christian J. |last12=Sadeghi-Nejad |first12=Hossein |last13=Seftel |first13=Allen D. |last14=Shindel |first14=Alan W. |title=Erectile Dysfunction: AUA Guideline |journal=Journal of Urology |date=September 2018 |volume=200 |issue=3 |pages=633–641 |doi=10.1016/j.juro.2018.05.004 |pmid=29746858 |url=https://www.auanet.org/guidelines/erectile-dysfunction-(ed)-guideline |accessdate=5 February 2020|doi-access=free }}</ref>
In spite of recent rapid and extensive development of non-surgical management options for [[erectile dysfunction]], especially novel targeted medications and [[gene therapy]], the penile implants remain the mainstay and the gold standard choice for the treatment of erectile dysfunction refractory to oral medications and injectable therapy.<ref name="F1000">{{cite journal |last1=Fakhoury |first1=Mathew Q |last2=Halpern |first2=Joshua |last3=Bennett |first3=Nelson |title=Recent advancements in penile prosthetics |journal=F1000Research |date=18 February 2019 |volume=8 |pages=193 |doi=10.12688/f1000research.17407.1 |pmid=30828431 |pmc=6381800 |doi-access=free }}</ref><ref name="Rodriguez" /> Additionally, penile implants can be a relevant option for those with erectile dysfunction who want to proceed with a permanent solution without medical therapy. Penile implants have been used for the treatment of erectile dysfunction with various etiologies, including vascular, [[Corpus cavernosum penis|cavernosal]], neurogenic, psychological and post-surgical (e.g. [[prostatectomy]]). The [[American Urological Association]] recommends informing all men with erectile dysfunction about penile implants as a choice of treatment and discussing the potential outcomes with them.<ref>{{cite journal |last1=Burnett |first1=Arthur L. |last2=Nehra |first2=Ajay |last3=Breau |first3=Rodney H. |last4=Culkin |first4=Daniel J. |last5=Faraday |first5=Martha M. |last6=Hakim |first6=Lawrence S. |last7=Heidelbaugh |first7=Joel |last8=Khera |first8=Mohit |last9=McVary |first9=Kevin T. |last10=Miner |first10=Martin M. |last11=Nelson |first11=Christian J. |last12=Sadeghi-Nejad |first12=Hossein |last13=Seftel |first13=Allen D. |last14=Shindel |first14=Alan W. |title=Erectile Dysfunction: AUA Guideline |journal=Journal of Urology |date=September 2018 |volume=200 |issue=3 |pages=633–641 |doi=10.1016/j.juro.2018.05.004 |pmid=29746858 |doi-access=free }}</ref>


===Penile deformity===
===Penile deformity===
Penile implants can help recover the natural shape of the penis in various conditions that have led to penile deformity. These can be traumatic injuries, penile surgeries, disfiguring and [[Fibrosis|fibrosing]] diseases of the penis, such as [[Peyronie's disease]].<ref name="Rodriguez" /> In Peyronie's disease, the change in penile curvature affects normal sexual intercourse as well as causing [[erectile dysfunction]] due to disruption of blood flow in the [[Corpus cavernosum penis|cavernous bodies]] of the penis.<ref name="Anaissie">{{cite journal |last1=Anaissie |first1=James |last2=Yafi |first2=Faysal A. |title=A review of surgical strategies for penile prosthesis implantation in patients with Peyronie's disease |journal=Translational Andrology and Urology |date=June 2016 |volume=5 |issue=3 |pages=342–350 |doi=10.21037/tau.2016.04.04 |pmid=27298781 |pmc=4893506 }}</ref> Therefore, implantation of penile prosthesis in Peyronie's disease addresses several mechanisms involved in the pathophysiology of the disease.
Penile implants can help recover the natural shape of the penis in various conditions that have led to penile deformity. These can be traumatic injuries, penile surgeries, disfiguring and [[Fibrosis|fibrosing]] diseases of the penis, such as [[Peyronie's disease]].<ref name="Rodriguez" /> In Peyronie's disease, the change in penile curvature affects normal sexual intercourse as well as causing [[erectile dysfunction]] due to disruption of blood flow in the [[Corpus cavernosum penis|cavernous bodies]] of the penis.<ref name="Anaissie">{{cite journal |last1=Anaissie |first1=James |last2=Yafi |first2=Faysal A. |title=A review of surgical strategies for penile prosthesis implantation in patients with Peyronie's disease |journal=Translational Andrology and Urology |date=June 2016 |volume=5 |issue=3 |pages=342–350 |doi=10.21037/tau.2016.04.04 |pmid=27298781 |pmc=4893506 |doi-access=free }}</ref> Therefore, implantation of penile prosthesis in Peyronie's disease addresses several mechanisms involved in the pathophysiology of the disease.


===Female-to-male sex reassignment===
===Female-to-male sex reassignment===
Although different models of penile prostheses have been reported to be implanted after [[phalloplasty]] procedures,<ref>{{cite journal |last1=Falcone |first1=Marco |last2=Garaffa |first2=Giulio |last3=Gillo |first3=Arianna |last4=Dente |first4=Dino |last5=Christopher |first5=Andrew N. |last6=Ralph |first6=David J. |title=Outcomes of inflatable penile prosthesis insertion in 247 patients completing female to male gender reassignment surgery |journal=BJU International |date=January 2018 |volume=121 |issue=1 |pages=139–144 |doi=10.1111/bju.14027 |pmid=28940910 |doi-access=free }}</ref> with the first case described in 1978 by Pucket and Montie,<ref>{{cite journal |last1=PUCKETT |first1=CHARLES L. |last2=MONTIE |first2=JOSEPH E. |title=Construction of Male Genitalia in the Transsexual, Using a Tubed Groin Flap for the Penis and a Hydraulic Inflation Device |journal=Plastic and Reconstructive Surgery |date=April 1978 |volume=61 |issue=4 |pages=523–530 |doi=10.1097/00006534-197804000-00005 |pmid=345304 |s2cid=42344243 |url=https://insights.ovid.com/crossref?an=00006534-197804000-00005 |accessdate=16 February 2020}}</ref> the first penile implants designed and produced specifically for [[Sex reassignment surgery (female-to-male)|female-to-male gender reassignment surgery]] for [[Trans man|trans men]] were introduced in 2015 by [[Zephyr Surgical Implants]].<ref>{{cite journal |last1=Neuville |first1=Paul |last2=Morel-Journel |first2=Nicolas |last3=Cabelguenne |first3=Delphine |last4=Ruffion |first4=Alain |last5=Paparel |first5=Philippe |last6=Terrier |first6=Jean-Etienne |title=First Outcomes of the ZSI 475 FtM, a Specific Prosthesis Designed for Phalloplasty |journal=The Journal of Sexual Medicine |date=February 2019 |volume=16 |issue=2 |pages=316–322 |doi=10.1016/j.jsxm.2018.11.013 |pmid=30638882 |url=https://www.jsm.jsexmed.org/article/S1743-6095(18)31332-8/fulltext |accessdate=16 February 2020}}</ref> Both malleable and inflatable models are available. These implants have more realistic shape with an ergonomic glans at the tip of the prosthesis. The inflatable model has an attached pump resembling a testicle. The prosthesis is implanted with a sturdy fixation on [[Pubis (bone)|pubic bone]]. Another, thinner malleable implant is intended for [[metoidioplasty]].
Although different models of penile prostheses have been reported to be implanted after [[phalloplasty]] procedures,<ref>{{cite journal |last1=Falcone |first1=Marco |last2=Garaffa |first2=Giulio |last3=Gillo |first3=Arianna |last4=Dente |first4=Dino |last5=Christopher |first5=Andrew N. |last6=Ralph |first6=David J. |title=Outcomes of inflatable penile prosthesis insertion in 247 patients completing female to male gender reassignment surgery |journal=BJU International |date=January 2018 |volume=121 |issue=1 |pages=139–144 |doi=10.1111/bju.14027 |pmid=28940910 |doi-access=free }}</ref> with the first case described in 1978 by Pucket and Montie,<ref>{{cite journal |last1=Puckett |first1=Charles L. |last2=Montie |first2=Joseph E. |title=Construction of Male Genitalia in the Transsexual, Using a Tubed Groin Flap for the Penis and a Hydraulic Inflation Device |journal=Plastic and Reconstructive Surgery |date=April 1978 |volume=61 |issue=4 |pages=523–530 |doi=10.1097/00006534-197804000-00005 |pmid=345304 |s2cid=42344243 }}</ref> the first penile implants designed and produced specifically for [[Sex reassignment surgery (female-to-male)|female-to-male gender reassignment surgery]] for [[Trans man|trans men]] were introduced in 2015 by [[Zephyr Surgical Implants]].<ref>{{cite journal |last1=Neuville |first1=Paul |last2=Morel-Journel |first2=Nicolas |last3=Cabelguenne |first3=Delphine |last4=Ruffion |first4=Alain |last5=Paparel |first5=Philippe |last6=Terrier |first6=Jean-Etienne |title=First Outcomes of the ZSI 475 FtM, a Specific Prosthesis Designed for Phalloplasty |journal=The Journal of Sexual Medicine |date=February 2019 |volume=16 |issue=2 |pages=316–322 |doi=10.1016/j.jsxm.2018.11.013 |pmid=30638882 |doi-access=free }}</ref> Both malleable and inflatable models are available. These implants have more realistic shape with an ergonomic glans at the tip of the prosthesis. The inflatable model has an attached pump resembling a testicle. The prosthesis is implanted with a sturdy fixation on [[Pubis (bone)|pubic bone]]. Another, thinner malleable implant is intended for [[metoidioplasty]].


==Outcomes==
==Outcomes==
===Satisfaction===
===Satisfaction===
The overall satisfaction rate with penile implants reaches over 90%.<ref name="Rodriguez" /> Both self and partner-reported satisfaction rates are evaluated to assess the outcomes. It has been shown that implantation of inflatable penile prosthesis brings more patient and partner satisfaction than medication therapy with [[PDE5 inhibitor|PDE5 inhibitors]] or [[Intracavernous injection|intracavernosal injections]].<ref name ="F1000" /> Satisfaction rates are reported to be higher with inflatable rather than malleable implants, but there are no difference between 2-piece and 3-piece devices.<ref name="Sarah">{{cite journal |last1=Krzastek |first1=Sarah C. |last2=Smith |first2=Ryan |title=An update on the best approaches to prevent complications in penile prosthesis recipients |journal=Therapeutic Advances in Urology |date=8 January 2019 |volume=11 |pages=175628721881807 |doi=10.1177/1756287218818076 |pmid=30671142 |pmc=6329024 |doi-access=free }}</ref><ref>{{cite journal |last1=Çayan |first1=Selahittin |last2=Aşcı |first2=Ramazan |last3=Efesoy |first3=Ozan |last4=Bolat |first4=Mustafa Suat |last5=Akbay |first5=Erdem |last6=Yaman |first6=Önder |title=Comparison of Long-Term Results and Couples' Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation |journal=The Journal of Sexual Medicine |date=July 2019 |volume=16 |issue=7 |pages=1092–1099 |doi=10.1016/j.jsxm.2019.04.013 |pmid=31155387 |url=https://www.jsm.jsexmed.org/article/S1743-6095(19)31140-3/fulltext |accessdate=12 February 2020}}</ref> The most frequent reasons for dissatisfaction are reduced penis length and girth, failed expectations and difficulties with device use.<ref name="F1000" /><ref name="Sarah" /> Thus, it is vital to provide patients and their partners with detailed preoperative counselling and instructions.
The overall satisfaction rate with penile implants reaches over 90%.<ref name="Rodriguez" /> Both self- and partner-reported satisfaction rates are evaluated to assess the outcomes. It has been shown that implantation of inflatable penile prosthesis brings more patient and partner satisfaction than medication therapy with [[PDE5 inhibitor]]s or [[Intracavernous injection|intracavernosal injections]].<ref name ="F1000" /> Satisfaction rates are reported to be higher with inflatable rather than malleable implants, but there are no differences between two-piece and three-piece devices.<ref name="Sarah">{{cite journal |last1=Krzastek |first1=Sarah C. |last2=Smith |first2=Ryan |title=An update on the best approaches to prevent complications in penile prosthesis recipients |journal=Therapeutic Advances in Urology |date=8 January 2019 |volume=11 |pages=175628721881807 |doi=10.1177/1756287218818076 |pmid=30671142 |pmc=6329024 |doi-access=free }}</ref><ref>{{cite journal |last1=Çayan |first1=Selahittin |last2=Aşcı |first2=Ramazan |last3=Efesoy |first3=Ozan |last4=Bolat |first4=Mustafa Suat |last5=Akbay |first5=Erdem |last6=Yaman |first6=Önder |title=Comparison of Long-Term Results and Couples' Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation |journal=The Journal of Sexual Medicine |date=July 2019 |volume=16 |issue=7 |pages=1092–1099 |doi=10.1016/j.jsxm.2019.04.013 |pmid=31155387 |s2cid=173992578 }}</ref> The most frequent reasons for dissatisfaction are reduced penis length and girth, failed expectations and difficulties with device use.<ref name="F1000" /><ref name="Sarah" /> Thus, it is vital to provide patients and their partners with detailed preoperative counselling and instructions.{{cn|date=February 2022}}


===Curvature correction===
===Curvature correction===
33% to 90% of cases of patients with Peyronie's disease that have had an inflatable PI procedure have successfully corrected their penile deformity.<ref name="Anaissie" /> The residual curvature after penile implant placement usually requires intraoperative surgical intervention.
33% to 90% of cases of patients with Peyronie's disease that have had an inflatable PI procedure have successfully corrected their penile deformity.<ref name="Anaissie" /> The residual curvature after penile implant placement usually requires intraoperative surgical intervention.

===Progress in procedure===
Dilation of the corpora cavernosa, typically with Hegar sounds, before inserting the device has been a common part of implantation procedures. This dilation destroys erectile tissue. It has been shown that a tissue-sparing technique, i.e. ''without'' dilation, correlates with superior outcomes{{dash}}some remaining natural erectile response can be preserved, and post-operative pain is reduced as well.<ref name=sparingTumescence> {{cite journal
| last1 = Zaazaa
| first1 = Adham
| last2 = Mostafa
| first2 = Taylor
| date = 14 February 2019
| title = Spontaneous Penile Tumescence by Sparing Cavernous Tissue in the Course of Malleable Penile Prosthesis Implantation
| url = https://academic.oup.com/jsm/article-abstract/16/3/474/6980700
| journal = The Journal of Sexual Medicine
| volume = 16
| issue = 3
| pages = 474–478
| doi = 10.1016/j.jsxm.2019.01.012
| pmid = 30773500
| access-date = 14 January 2024
}}
</ref><ref name=tissueSparingTechnique> {{cite journal
| last1 = Moncada
| first1 = Ignacio
| last2 = Juan Ignacio
| first2 = Martínez-Salamanca
| last3 = José
| first3 = Jara
| last4 = Ramiro
| first4 = Cabello
| last5 = Mercedes
| first5 = Moralejo
| last6 = Carlos
| first6 = Hernández
| date = 1 Mar 2010
| title = Inflatable Penile Prosthesis Implantation Without Corporeal Dilation: A Cavernous Tissue Sparing Technique
| url = https://www.auajournals.org/doi/10.1016/j.juro.2009.11.048
| journal = Journal of Urology
| volume = 183
| issue = 3
| pages = 1123–1126
| doi = 10.1016/j.juro.2009.11.048
| pmid = 20092840
| access-date = 14 January 2024
}}
</ref>


==Complications==
==Complications==
The most common complication associated with penile implant placement appears to be infections with reported rates of 1-3%.<ref name="Sarah" /> Both surgical site and device infections are reported. When the infection involves the penile implant itself, implant removal is required and irrigation of the cavities with [[antiseptic]] solutions. In this scenario, placement of a new implant is needed to avoid further tissue fibrosis and shortening of the penis. The rate of repeat surgeries or device replacements ranges from 6% to 13%.<ref name="Anaissie" /> Other reported complications include perforation of the [[Corpus cavernosum penis|corpus cavernosum]] and [[urethra]] (0.1-3%), commonly occurring in patients with previous [[fibrosis]], prosthesis erosion or extrusion, change in [[Glans penis|glans]] shape, [[hematoma]], shortening of penis length, and device malfunction. Due to continuous improvement of surgical techniques and modifications of implants, complication rates have dramatically decreased over time.
The most common complication associated with penile implant placement appears to be infections with reported rates of 1–3%.<ref name="Sarah" /> Both surgical site and device infections are reported. When the infection involves the penile implant itself, implant removal is required and irrigation of the cavities with [[antiseptic]] solutions. In this scenario, placement of a new implant is needed to avoid further tissue fibrosis and shortening of the penis. The rate of repeat surgeries or device replacements ranges from 6% to 13%.<ref name="Anaissie" /> Other reported complications include perforation of the [[Corpus cavernosum penis|corpus cavernosum]] and [[urethra]] (0.1–3%), commonly occurring in patients with previous [[fibrosis]], prosthesis erosion or extrusion, change in [[Glans penis|glans]] shape, [[hematoma]], shortening of penis length, and device malfunction. Due to continuous improvement of surgical techniques and modifications of implants, complication rates have dramatically decreased over time.{{cn|date=February 2022}}

⚫
To overcome post-operative penile shortening and to increase the perceived length of the penis and patient satisfaction, ventral and dorsal [[phalloplasty]] procedures in combination with penile implants have been described.<ref name ="F1000" /> Modified glanulopexy has been proposed to prevent supersonic transporter deformity and glandular hypermobility which are possible complications of penile implants.<ref>{{cite journal |last1=Ziegelmann |first1=Matthew J. |last2=Alom |first2=Manaf |last3=Bole |first3=Raevti |last4=Kohler |first4=Tobias |last5=Trost |first5=Landon |title=Modified Glanulopexy Technique for Supersonic Transporter Deformity and Glanular Hypermobility in Men With Penile Prostheses |journal=The Journal of Sexual Medicine |date=June 2018 |volume=15 |issue=6 |pages=914–919 |doi=10.1016/j.jsxm.2018.04.633 |pmid=29731427 |s2cid=24785737 }}</ref>


Sliding techniques in which the penis is cut and elongated with penile implants have been performed in cases of severe penile shortening. However, these techniques had higher rates of complications and are currently avoided.{{cn|date=February 2022}}
⚫
To overcome post-operative penile shortening and to increase the perceived length of the penis and patient satisfaction, ventral and dorsal [[phalloplasty]] procedures in combination with penile implants have been described.<ref name ="F1000" /> Modified glanulopexy has been proposed to prevent supersonic transporter deformity and glandular hypermobility which are possible complications of penile implants.<ref>{{cite journal |last1=Ziegelmann |first1=Matthew J. |last2=Alom |first2=Manaf |last3=Bole |first3=Raevti |last4=Kohler |first4=Tobias |last5=Trost |first5=Landon |title=Modified Glanulopexy Technique for Supersonic Transporter Deformity and Glanular Hypermobility in Men With Penile Prostheses |journal=The Journal of Sexual Medicine |date=June 2018 |volume=15 |issue=6 |pages=914–919 |doi=10.1016/j.jsxm.2018.04.633 |pmid=29731427 |url=https://www.jsm.jsexmed.org/article/S1743-6095(18)30936-6/fulltext |accessdate=14 February 2020}}</ref> Sliding techniques in which the penis is cut and elongated with penile implants have been performed in cases of severe penile shortening. However, these techniques had higher rates of complications and are currently avoided.


==References==
==References==
Line 148: Line 203:


==External links==
==External links==
* [https://emedicine.medscape.com/article/446761-overview#showall Medscape: Penile Prosthesis Implantation]
* {{EMedicine|article|446761|Penile Prosthesis Implantation}}


{{Male genital procedures}}
{{Male genital procedures}}
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[[Category:Human penis]]
[[Category:Human penis]]
[[Category:Penile erection]]
[[Category:Penile erection]]
[[Category:Sex reassignment surgery (female-to-male)]]
[[Category:Masculinizing surgery]]
[[Category:Medical devices]]
[[Category:Medical devices]]
[[Category:Medical equipment]]
[[Category:Medical equipment]]

Latest revision as of 09:55, 26 December 2024

Penile implant
Penile implant
Other namesPenile prosthesis
SpecialtyUrology
ICD-10-PCS0VUS0JZ
CPT54400, 54405

A penile implant is an implanted device intended for the treatment of erectile dysfunction, Peyronie's disease, ischemic priapism, deformity and any traumatic injury of the penis, and for phalloplasty or metoidioplasty, including in gender-affirming surgery. Men also opt for penile implants for aesthetic purposes. Men's satisfaction and sexual function is influenced by discomfort over genital size, which leads some to seek surgical and non-surgical solutions for penis alteration.[1] Although there are many distinct types of implants, most fall into one of two categories: malleable and inflatable transplants.[2]

History

[edit]

The first modern prosthetic reconstruction of a penis is attributed to NA Borgus, a German physician who performed the first surgical attempts in 1936 on soldiers with traumatic amputations of the penis. He used rib cartilages as prosthetic material and reconstructed the genitals for both micturition and intercourse purposes.[3] Willard E. Goodwin and William Wallace Scott were the first to describe the placement of synthetic penile implants using acrylic prosthesis in 1952.[4] Silicone-based penile implants were developed by Harvey Lash and the first case series were published in 1964.[5] The development of a high-grade silicone that is currently used in penile implants is credited to NASA.[6] The prototypes of the contemporary inflatable and malleable penile implants were presented in 1973 during the annual meeting of the American Urological Association by two groups of physicians from Baylor University (Gerald Timm, William E. Bradley and F. Brantley Scott) and University of Miami (Michael P. Small and Hernan M. Carrion).[3][7][8] Small and Carrion pioneered the popularization of semi-rigid penile implants with the introduction of Small-Carrion prosthesis (Mentor, USA) in 1975. Brantley Scott described the initial device as composed of two inflatable cylindrical bodies made up of silicone, a reservoir containing radiopaque fluid and two pumping units.[7] The first generation products were marketed through American Medical Systems (AMS; currently Boston Scientific), with which Brantley Scott was associated.[6][9] Many device updates have been released by AMS since the first generation implants. In 1983, Mentor (currently Coloplast) joined the market.[6] In 2017, there were more than ten manufacturers of penile implants in the world, however only a few now remain in the market.[10] The latest additions to the market are Zephyr Surgical Implants and Rigicon Innovative Urological Solutions.[11][12] Zephyr Surgical Implants, along with penile implants for biological men, introduced the first line of inflatable and malleable penile implants designed for sex reassignment for trans men. In recent years, Rigicon Innovative Urological Solutions, a US-based company, has made significant advancements in the field of penile implants. In 2017, they released the 'Rigi10,' a malleable implant that expanded the market's options. Following this, in 2019, they introduced both the 'Infla10' series, which includes the Infla10 AX, Infla10 X, and Infla10 models, and the 'Rigi10 Hydrophilic.' These inflatable and hydrophilic-coated malleable models respectively were important additions to the range of penile implant technologies available. These advancements have contributed to the diversity and progress in the development of penile implants, offering patients more varied and tailored treatment solutions.[13] [14]

According to analysis of the 5% Medicare Public Use Files from 2001 to 2010 approximately 3% of patients diagnosed with erectile dysfunction opt for penile implantation.[15] Each year nearly 25,000 inflatable penile prostheses are implanted in the USA.[16]

The list shows penile implants available in the market in 2020.

Product Company Country of origin Type of the implant Introduced in
AMS Spectra Boston Scientific (formerly American Medical Systems) United States of America Malleable 2009
Tactra Boston Scientific (formerly American Medical Systems) United States of America Malleable 2019
Genesis Coloplast United States of America Malleable 2004
Shah Indian Malleable Dr.Rupin Shah India Malleable 2008
ZSI 100, ZSI 100 FtM and ZSI 100 D4 Zephyr Surgical Implants Switzerland Malleable 2012
Tube Promedon Argentina Malleable 2007
AMS Ambicor Boston Scientific (formerly American Medical Systems) United States of America Inflatable 1994
AMS 700 series (LGX, CX, CXR) Boston Scientific (formerly American Medical Systems) United States of America Inflatable 1983
Titan Coloplast United States of America Inflatable 2002
ZSI 475 and ZSI 475 FtM Zephyr Surgical Implants Switzerland Inflatable 2012
Infla10 series (AX, X, NarrowBody) Rigicon Innovative Urological Solutions United States of America Inflatable 2019
Rigi10[17] Rigicon Innovative Urological Solutions United States of America Malleable 2017
Rigi10 Hydrophilic Rigicon Innovative Urological Solutions United States of America Malleable 2019

Types

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Malleable penile implant

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Comparison of penile implants (inflated cylinder diameter and length)
Penile implant pump design comparison

The malleable (also known as non-inflatable or semi-rigid) penile prosthesis is a pair of rods implanted into the corpora of the penis. The rods are hard, but 'malleable' in the sense that they can be adjusted manually into the erect position.[18] There are two types of malleable implants: one that is made of silicone and does not have a rod inside, also called soft implants, and another with a silver or steel spiral wire core inside coated with silicone. Some of the models have trimmable tails intended for length adjustment.[10] Currently, a variety of malleable penile implants are available worldwide.[19]

Inflatable penile implant

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The inflatable penile implant (IPP), more recently developed, is a set of inflatable cylinders and a pump system. Based on the differences in structure, there are two types of inflatable penile implants: two-piece and three-piece IPPs. Both types of inflatable devices are filled with sterile saline solution which is pumped into cylinders when in process. The cylinders are implanted into the cavernous body of the penis. The pump system is attached to the cylinders and placed in the scrotum.[10] Three-piece implants have a separate large reservoir connected to the pump. The reservoir is commonly placed in the retropubic space (Retzius' space), however other locations have also been described, such as between the transverse muscle and rectus muscle. Three-piece implants provide more desirable rigidity and girth of the penis resembling natural erection. Additionally, due to the presence of a large reservoir, three-piece implants provide full flaccidity of the penis when deflated, thus bringing more comfort than two-piece inflatable and malleable implants.[6]

The saline solution is pumped manually from the reservoir into bilateral chambers of cylinders implanted in the shaft of the penis, which replaces the non- or minimally-functioning erectile tissue. This produces an erection. The glans of the penis, however, remains unaffected. Ninety to ninety-five percent of inflatable prostheses produce erections suitable for sexual intercourse. In the United States, the inflatable prosthesis has largely replaced the malleable one, due to its lower rate of infections, high device survival rate and 80–90% satisfaction rate.[2]

The first IPP prototype presented in 1975 by Scott and colleagues was a three-piece prosthesis (two cylinders, two pumps and a fluid reservoir). Since then, the IPP has undergone multiple modifications and improvements for device reliability and durability, including change in the chemical material used in implant manufacturing, using hydrophilic and antibiotic eluting coatings to reduce the rates of infections, introducing one-touch release etc.[10] Surgical techniques used for the implantation of penile prostheses have also improved along with evolution of the device. Inflatable penile implants were one of the first interventions in urology where the "no-touch" surgical technique was introduced. This has significantly reduced the rates of post-operative infections.[20]

Medical use

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A diagram of an inflatable penile implant inserted into corpus cavernosum of the penis
Evoking an erection with an implanted penile implant

Erectile dysfunction

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In spite of recent rapid and extensive development of non-surgical management options for erectile dysfunction, especially novel targeted medications and gene therapy, the penile implants remain the mainstay and the gold standard choice for the treatment of erectile dysfunction refractory to oral medications and injectable therapy.[21][6] Additionally, penile implants can be a relevant option for those with erectile dysfunction who want to proceed with a permanent solution without medical therapy. Penile implants have been used for the treatment of erectile dysfunction with various etiologies, including vascular, cavernosal, neurogenic, psychological and post-surgical (e.g. prostatectomy). The American Urological Association recommends informing all men with erectile dysfunction about penile implants as a choice of treatment and discussing the potential outcomes with them.[22]

Penile deformity

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Penile implants can help recover the natural shape of the penis in various conditions that have led to penile deformity. These can be traumatic injuries, penile surgeries, disfiguring and fibrosing diseases of the penis, such as Peyronie's disease.[6] In Peyronie's disease, the change in penile curvature affects normal sexual intercourse as well as causing erectile dysfunction due to disruption of blood flow in the cavernous bodies of the penis.[23] Therefore, implantation of penile prosthesis in Peyronie's disease addresses several mechanisms involved in the pathophysiology of the disease.

Female-to-male sex reassignment

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Although different models of penile prostheses have been reported to be implanted after phalloplasty procedures,[24] with the first case described in 1978 by Pucket and Montie,[25] the first penile implants designed and produced specifically for female-to-male gender reassignment surgery for trans men were introduced in 2015 by Zephyr Surgical Implants.[26] Both malleable and inflatable models are available. These implants have more realistic shape with an ergonomic glans at the tip of the prosthesis. The inflatable model has an attached pump resembling a testicle. The prosthesis is implanted with a sturdy fixation on pubic bone. Another, thinner malleable implant is intended for metoidioplasty.

Outcomes

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Satisfaction

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The overall satisfaction rate with penile implants reaches over 90%.[6] Both self- and partner-reported satisfaction rates are evaluated to assess the outcomes. It has been shown that implantation of inflatable penile prosthesis brings more patient and partner satisfaction than medication therapy with PDE5 inhibitors or intracavernosal injections.[21] Satisfaction rates are reported to be higher with inflatable rather than malleable implants, but there are no differences between two-piece and three-piece devices.[27][28] The most frequent reasons for dissatisfaction are reduced penis length and girth, failed expectations and difficulties with device use.[21][27] Thus, it is vital to provide patients and their partners with detailed preoperative counselling and instructions.[citation needed]

Curvature correction

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33% to 90% of cases of patients with Peyronie's disease that have had an inflatable PI procedure have successfully corrected their penile deformity.[23] The residual curvature after penile implant placement usually requires intraoperative surgical intervention.

Progress in procedure

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Dilation of the corpora cavernosa, typically with Hegar sounds, before inserting the device has been a common part of implantation procedures. This dilation destroys erectile tissue. It has been shown that a tissue-sparing technique, i.e. without dilation, correlates with superior outcomes – some remaining natural erectile response can be preserved, and post-operative pain is reduced as well.[29][30]

Complications

[edit]

The most common complication associated with penile implant placement appears to be infections with reported rates of 1–3%.[27] Both surgical site and device infections are reported. When the infection involves the penile implant itself, implant removal is required and irrigation of the cavities with antiseptic solutions. In this scenario, placement of a new implant is needed to avoid further tissue fibrosis and shortening of the penis. The rate of repeat surgeries or device replacements ranges from 6% to 13%.[23] Other reported complications include perforation of the corpus cavernosum and urethra (0.1–3%), commonly occurring in patients with previous fibrosis, prosthesis erosion or extrusion, change in glans shape, hematoma, shortening of penis length, and device malfunction. Due to continuous improvement of surgical techniques and modifications of implants, complication rates have dramatically decreased over time.[citation needed]

To overcome post-operative penile shortening and to increase the perceived length of the penis and patient satisfaction, ventral and dorsal phalloplasty procedures in combination with penile implants have been described.[21] Modified glanulopexy has been proposed to prevent supersonic transporter deformity and glandular hypermobility which are possible complications of penile implants.[31]

Sliding techniques in which the penis is cut and elongated with penile implants have been performed in cases of severe penile shortening. However, these techniques had higher rates of complications and are currently avoided.[citation needed]

References

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  1. ^ Littara, Alessandro; Melone, Roberto; Morales-Medina, Julio Cesar; Iannitti, Tommaso; Palmieri, Beniamino (2019-04-19). "Cosmetic penile enhancement surgery: a 3-year single-centre retrospective clinical evaluation of 355 cases". Scientific Reports. 9 (1): 6323. Bibcode:2019NatSR...9.6323L. doi:10.1038/s41598-019-41652-w. ISSN 2045-2322. PMC 6474863. PMID 31004096.
  2. ^ a b Perito, Paul. "Penile Implants". PeritoUrology.com. Perito Urology. Retrieved 12 November 2019.[self-published source?]
  3. ^ a b Carrion, Hernan; Martinez, Daniel; Parker, Justin; Hakky, Tariq; Bickell, Michael; Boyle, Alexander; Weigand, Luke; Carrion, Rafael (July 2016). "A History of the Penile Implant to 1974". Sexual Medicine Reviews. 4 (3): 285–293. doi:10.1016/j.sxmr.2016.05.003. PMID 27871961.
  4. ^ Goodwin, Willard E.; Scott, William Wallace (December 1952). "Phalloplasty". Journal of Urology. 68 (6): 903–908. doi:10.1016/S0022-5347(17)68301-0. PMID 13000938.
  5. ^ Lash, Harvey; Zimmerman, Donald C.; Loeffler, Robert A. (July 1964). "Silicone Implantation". Plastic and Reconstructive Surgery. 34 (1): 75–80. doi:10.1097/00006534-196407000-00011. PMID 14200523. S2CID 43779571.
  6. ^ a b c d e f g Rodriguez, Katherine M.; Pastuszak, Alexander W. (November 2017). "A history of penile implants". Translational Andrology and Urology. 6 (S5): S851 – S857. doi:10.21037/tau.2017.04.02. PMC 5715175. PMID 29238664.
  7. ^ a b Brantley Scott, F.; Bradley, William E.; Timm, Gerald W. (July 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.
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  15. ^ Lee, Daniel J.; Najari, Bobby B.; Davison, Wesley L.; Al Awamlh, Bashir Al Hussein; Zhao, Fujun; Paduch, Darius A.; Mulhall, John P.; Chughtai, Bilal; Lee, Richard K. (July 2015). "Trends in the Utilization of Penile Prostheses in the Treatment of Erectile Dysfunction in the United States". The Journal of Sexual Medicine. 12 (7): 1638–1645. doi:10.1111/jsm.12921. PMID 26096365.
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  19. ^ Le, Brian; Burnett, Arthur L. (2015). "Evolution of penile prosthetic devices". Korean Journal of Urology. 56 (3): 179–86. doi:10.4111/kju.2015.56.3.179. PMC 4355428. PMID 25763121.
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  22. ^ Burnett, Arthur L.; Nehra, Ajay; Breau, Rodney H.; Culkin, Daniel J.; Faraday, Martha M.; Hakim, Lawrence S.; Heidelbaugh, Joel; Khera, Mohit; McVary, Kevin T.; Miner, Martin M.; Nelson, Christian J.; Sadeghi-Nejad, Hossein; Seftel, Allen D.; Shindel, Alan W. (September 2018). "Erectile Dysfunction: AUA Guideline". Journal of Urology. 200 (3): 633–641. doi:10.1016/j.juro.2018.05.004. PMID 29746858.
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  24. ^ Falcone, Marco; Garaffa, Giulio; Gillo, Arianna; Dente, Dino; Christopher, Andrew N.; Ralph, David J. (January 2018). "Outcomes of inflatable penile prosthesis insertion in 247 patients completing female to male gender reassignment surgery". BJU International. 121 (1): 139–144. doi:10.1111/bju.14027. PMID 28940910.
  25. ^ Puckett, Charles L.; Montie, Joseph E. (April 1978). "Construction of Male Genitalia in the Transsexual, Using a Tubed Groin Flap for the Penis and a Hydraulic Inflation Device". Plastic and Reconstructive Surgery. 61 (4): 523–530. doi:10.1097/00006534-197804000-00005. PMID 345304. S2CID 42344243.
  26. ^ Neuville, Paul; Morel-Journel, Nicolas; Cabelguenne, Delphine; Ruffion, Alain; Paparel, Philippe; Terrier, Jean-Etienne (February 2019). "First Outcomes of the ZSI 475 FtM, a Specific Prosthesis Designed for Phalloplasty". The Journal of Sexual Medicine. 16 (2): 316–322. doi:10.1016/j.jsxm.2018.11.013. PMID 30638882.
  27. ^ a b c Krzastek, Sarah C.; Smith, Ryan (8 January 2019). "An update on the best approaches to prevent complications in penile prosthesis recipients". Therapeutic Advances in Urology. 11: 175628721881807. doi:10.1177/1756287218818076. PMC 6329024. PMID 30671142.
  28. ^ Çayan, Selahittin; Aşcı, Ramazan; Efesoy, Ozan; Bolat, Mustafa Suat; Akbay, Erdem; Yaman, Önder (July 2019). "Comparison of Long-Term Results and Couples' Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation". The Journal of Sexual Medicine. 16 (7): 1092–1099. doi:10.1016/j.jsxm.2019.04.013. PMID 31155387. S2CID 173992578.
  29. ^ Zaazaa, Adham; Mostafa, Taylor (14 February 2019). "Spontaneous Penile Tumescence by Sparing Cavernous Tissue in the Course of Malleable Penile Prosthesis Implantation". The Journal of Sexual Medicine. 16 (3): 474–478. doi:10.1016/j.jsxm.2019.01.012. PMID 30773500. Retrieved 14 January 2024.
  30. ^ Moncada, Ignacio; Juan Ignacio, Martínez-Salamanca; José, Jara; Ramiro, Cabello; Mercedes, Moralejo; Carlos, Hernández (1 Mar 2010). "Inflatable Penile Prosthesis Implantation Without Corporeal Dilation: A Cavernous Tissue Sparing Technique". Journal of Urology. 183 (3): 1123–1126. doi:10.1016/j.juro.2009.11.048. PMID 20092840. Retrieved 14 January 2024.
  31. ^ Ziegelmann, Matthew J.; Alom, Manaf; Bole, Raevti; Kohler, Tobias; Trost, Landon (June 2018). "Modified Glanulopexy Technique for Supersonic Transporter Deformity and Glanular Hypermobility in Men With Penile Prostheses". The Journal of Sexual Medicine. 15 (6): 914–919. doi:10.1016/j.jsxm.2018.04.633. PMID 29731427. S2CID 24785737.
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