Herbal Medicine and Supplements

Numerous studies have shown high satisfaction rates with penile prosthesis implantation for both patients and their partners. In a series of 185 patients from a number of institutions, the authors reported a 98% patient and 96% partner satisfaction rate. Lower success rates have been noted in situations where there is an overall loss of penile length. In a multi-institution report from Italy surveying patients with penile implants and Peyronie’s disease, 79% of the patients were satisfied and 75% of the partners reported satisfaction with the result. In another study of 146 recipients of a two-piece penile prosthesis, the authors reported 85% satisfaction among the recipients, and 76% satisfaction among their partners. In some studies, inflatable and other prosthesis had been compared. Beutler et al. found increased satisfaction in men using an inflatable penile prosthesis compared to men receiving a no inflatable penile prosthesis, and, in another study, they showed greater satisfaction among female partners of men using inflatable compared to no inflatable prostheses. As previously noted, satisfaction domain scores for patients with corporal fibrosis and shortened penises undergoing revision prosthesis surgery are reported to be lower than other revision implant groups.

Patient satisfaction is a multifactorial issue and includes the degree of postoperative pain and swelling, postoperative complications, cosmetic outcome, device function, ease of use, and partner acceptance. The rapid development of erections and the consistently excellent rigidity obtained with a prosthesis are two major factors contributing to high levels of satisfaction. The major reason for dissatisfaction with penile prosthesis placement is shorter length of the penile erection. Other explanations for dissatisfaction include not feeling natural by the partner, reduced sensitivity and diminished drive, and the partner not having the same role in creating an erection as she once did. Another common patient complaint is the lack of adequate engorgement of the glans during sexual activity. Typically, the patient reports that the corpora cavernosa provide satisfactory rigidity after activating the implant but notes the glans that remains soft. One recent study reported on the beneficial effect of sildenafil on glans engorgement in patients having undergone penile implant. By using the IIEF, researchers documented that sildenafil caused a statistically significant improvement in implant-assisted intercourse. Similar results were reported in a case report which showed the benefits of administering 500 mg of transurethral alprostadil (MUSE, Vivus Inc, Mountainview, CA) on demand in patients with self-contained inflatable penile prostheses. Viagra best price Australia – www.myviagrainaustralia.com

It is recognized that patients with Peyronie’s disease, radical prostatectomy, or a BMI >30 kg/m2 have a statistically significant reduction in their level of satisfaction compared with the general implant population. It is likely that penile length issues play a large role in the Peyronie’s disease and radical prostatectomy patients in this regard. It has not been clearly delineated why a BMI >30 kg/m2 should be associated with reduced satisfaction, but mechanical issues relating to the prepubic fat pad size have been noted in many of these men.

Summary

Penile prosthesis is a safe and effective therapy for ED of various causes, including ED refractory to first and second-line therapies. Current options for prosthesis include malleable and inflatable, and the inflatable option includes various two-and three-piece models. Preoperative preparation requires meticulous sterilization procedures, including prophylactic antibiotics and chlorhexidine scrub. Implantation can be accomplished either penoscrotally or infrapubically, with the advantages of the penoscrotal approach being avoidance of the dorsal nerves of the penis and ease of pump anchoring. There are a variety of complications that can occur postoperatively cheap priligy Australia, but infection is the most concerning. If infection does occur, the surgeon can elect to remove and replace the prosthesis at a later date or attempt a salvage procedure. Patient and partner satisfaction have been reported to be high in many studies.

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