Penile prosthesis surgery can improve patient and partner satisfaction rates. Studies have found satisfaction rates ranging from 69-97% for patients and 76-96% for partners. Major complications are linked to lower satisfaction, with rates of 1.9% for those with no complications and 25% for those with major complications. Proper patient selection, management of expectations, counseling, and minimizing complications can help improve satisfaction outcomes.

1. Patient & Partner Satisfaction after
Penile Prosthesis Surgery
Dr Tarig Hassan Hag Ali

2. Erectile Dysfunction (ED)
“The consistent
or recurrent inability to
obtain and/or maintain an
erection sufficient for
satisfactory sexual activity”

3. Prevalence of ED Massachusetts Male Aging Study
Men aged 40 to 70 years (N = 1290)
*

4. Treatment options for ED
• Lifestyle Modification.
• Medical Phosphodiesterase Type 5 Inhibitors(PDE5i)
• Vacuum Constriction Device.
• Intraurethral Rx: MUSE.
• Intracavernosal Injection: PG, Trimix
• Penile Prosthesis
• Sex Therapy/Counseling.

5. Indications for Penile Prosthesis
PPs are considered third-line
therapy after inadequate response or
inability or refusal to use PDI, intraurethral
or intracavernosal injections, and vacuum
erection devices.

6. Evolution of the PenileProsthesis
• 1936 – Borgoraz uses rib cartilage as penile implant
• 1952 – Goodwin and Scott use acrylic prosthesis
• 1967 – Pearman describes placement of rod implant
• 1973 – Scott,Tim and Bradley invent inflatable prosthesis
• 1974 – Small&Carrion design silicone penile implant
• 1983 – 3-piece inflatable implant (Mentor)
• 1998 – Viagra (sildenafil) released
• 2001-present –antibiotic coatings,design modifications
materialschanges.
Le and Burnett. Korean J Urol.2015
Martinez, et al. J Sex Med 2015
Penile Prosthesis

7. 2001-2010
• 1,763,260 men diagnosed with ED
• 53,180 implants performed
• about 5,000 per year
Penile Prosthesis
(Lee. J Sex Med. 2015)

8. Complication type
Mechanical failure 5-20%
Infection 1-3%
Erosion 1-11%
Corporal crossover
Corporal perforation
Urethral perforation
Glans bowing
Risks of penile prosthesis

10. Type Advatage Disadvantage
Semirigid rod
(malleable)
• Simplest.Cheapest.
• Has a low chance of
malfunction due to the small
number of parts
• Is easy to use for those
with limited mental or
manual dexterity
• Simplest surgical procedure
• Results in a penis that is
always slightly rigid
• Puts constant pressure
on the inside of the penis,
which can cause injury
• Can be difficult to
conceal under clothing

11. Type of penile
implant
Advatage Disadvantage
Two-piece
inflatable
• Simple to use
• Provides flaccidity
when deflated
• Totally concealed in body
• Is mechanically more
complicated than is a
semirigid implant
• Provides less firm
erections than does a
three-piece implant

12. Type of penile implant Advatage Disadvantage
Three-piece
inflatable
• Creates the most
natural, rigid erection
• Provides flaccidity
when deflated
• Expensive.
• Has more parts that
could malfunction than
does any other implant
• Requires a reservoir
inside the abdomen

13. • Treatment satisfaction was defined
as having satisfactory intercourse
and happiness with the device.
Patient Satisfaction
Treatment satisfaction
Vs
Treatment efficacy

14. Patient Satisfaction
is a patient’s reported outcome that
may give both useful insights into the
patients’ perspective on their current
treatment and differentiation among
alternative treatments.

15. Pts who were more satisfied with their implant had
statistically significant higher partner satisfaction
scores, compared with men reporting dis-satisfaction
with their device.
Pts who were dissatisfied with their implant were
more likely to have partners with low female sexual
functional scores.
Patient & Partner Satisfaction
Gittens and colleagues

16. Patient & Partner Satisfaction
• Improve type of management.
• Choose the most appropriate.

17. Identifying the “difficult patient” .
carrying psychosocial variables that affect
operative success and long term satisfaction.
“CURSED Patient”,
Compulsive, Unrealistic,
Revision, Surgeon Shopping,
Entitled, Denial, Psychiatric.
Dissatisfaction

18. • Regular follow up.
• Direct Interview.
• Doctor administered questionnaires.
• Patient self-administered questionnaires.
• ? Telephone.
• Mailed questionnaires.
Patient & Partner Satisfaction

19. Questionnaire Satisfied
Neither
satisfied nor
dissatisfied
Dissatisfied
Is the device easy to use?
How about the natural feeling of device?
Is the rigidity of device adequate to penetrate?
Do you experience an orgasm?
Do you consider that the device improves your sexual life?
Are you satisfied with the device?
Would you recommend the device to a friend?
Would you undergo the same procedure?

20. Andrianne,

21. 50 patients
AMS 650 and Acu-form penile prostheses
patient and partner questionnaires.
70% of the pts and 57% of the partners were satisfied.
Improved: frequency of intercourse.
sexual desire.
ability to achieve orgasm.
Salama
Satisfaction with malleable prosthesis

22. Non-satisfaction
• Dislike for the device
• Sense of unnaturalness was that for partners.
Emphasized the need for proper preoperative
counseling for both the patient and his partner,
to avoid unrealistic expectations
Satisfaction with malleable prosthesis

23. • 257 men 2yrs
• 118 inflatable penile prosthesis (IPP)
• 139 semirigid penile prosthesis (SPP)
• pre-operative and post-operative (IIEF) questionnaire.
• Postoperative EDITS questionnaire .
• overall major complication rate was higher in IPP
• improved in IIEF scores in both groups.
Halil Bozkurt
Satisfaction with penile prostheses

24. • Comparison of patient satisfaction rates for the
malleable and two piece-inflatable penile
prostheses
• The modified Erectile Dysfunction Inventory of
Treatment Satisfaction (EDITS) questionnaires
• six months after implantation
• 46 patients who underwent
• malleable AMS 600–650 (n=23)
• Ambicore placement IPP (n=23)
Haka n
Satisfaction with penile prostheses

25. Hakan

26. Literature review
• 20 years
• 194 articles >>> only 9 articles
Raymond . Henry
Satisfaction with inflatable prosthesis

27. Satisfaction metrics %
Patient overall satisfaction 69- 97
Sustained satisfaction 86 - 93
Likelihood of continued use 92- 97
Lack of difficulty in use 91
Confidence in having sex 80 - 91
Ability to have intercourse 83 - 87
Same or improved hardness before ED 84 - 100
Device function 84
Considerably met expectations 82 - 91
Would undergo procedure again 98
Would recommend surgery 86 - 98

28. Partner satisfaction
Satisfaction metrics %
Assessment of partner satisfaction 76 - 96
Feels partner wants continued use 93 - 93

29. Satisfaction metrics %
Patient overall satisfaction 69- 97
Sustained satisfaction 86 - 93
Likelihood of continued use 92- 97
Lack of difficulty in use 91
Confidence in having sex 80 - 91
Ability to have intercourse 83 - 87
Same or improved hardness before ED 84 - 100
Device function 84
Considerably met expectations 72 - 91
Would undergo procedure again 98
Would recommend surgery 86 - 98
• Penile size
• Rigidity..Hardness of erection

30. Predictors of Satisfaction in Men After Penile Implant Surgery
Mohamad Habous,
• 902 patients 2009 and 2015
- 76% malleable implant (MPP)
- 24% inflatable implant (IPP)
• Comorbidity, demographic information.
• Complications recorded: minor & major .
• Patient satisfaction.

31. • Patients with a major complication, with or
without an additional minor complication, had
a higher likelihood of being dissatisfied
compared to patients with no complication or
only minor complication
• major complication (25 %)
• no complications (1.9% )
• only minor complications (3.7% ) P < .001
Predictors of Satisfaction in Men After Penile Implant Surgery

32. The presence of a major complication is
linked to a lower likelihood of achieving
high satisfaction.
Predictors of Satisfaction in Men After Penile Implant Surgery
Mohamad Habous, John P. Mulhall, August 2018

33. Take Home Message
• PP has the highest SR among all therapies of ED.
• PP should be offered to patients who failled others.
• IPP has the highest SR among PP.
• Malleable implants: cheap, simple & with good SR.
• Minimizing complications and recognizing difficult
patients (CURSED) is important in improving SR.

34. Preoperative counseling and expectation management
Framework Overview
Patient
selection
Identify concerning patient factors and the “CURSED” patient
Initial evaluation of expectations
Preoperative
optimization
Evaluate for pertinent operative risk factors
Discuss smoking cessation and glucose control
For patients with length concerns, discuss preoperative vacuum
or penile traction therapy
Informed
consent
Formal platform to discuss and counsel patient on operative risk,
infections and device reliability
Device
selection
Discussion of clinical factors that may effect device selection
Highlight appropriate AMS/Coloplast devices
Postoperative
expectations
Candid discussion regarding postoperative changes to penile length
and sensation
Partner
involvement
Encourage partner participation and involvement from the initial visit
Discuss implications of IPP placement on the dynamics of
sexual intercourse
Discuss potential benefits of sex therapy for interested couples

35. Patient & Partner Satisfaction after
Penile Prosthesis