Malleable Penile Implant Is an Effective Therapeutic Option in Men With Peyronie’s Disease and Erectile Dysfunction
Mohamad Habous, MD, FEBU, FECSM; Alaa Tealab, MD, FECSM; Mohammed Farag, MD, FECSM; Tarek Soliman, MD; Ben Williamson, MBBS; Saad Mahmoud, MD; Amin Elserafy, MD, FECSM; Zenhom Mekawi, FECSM; Abdallah Remeah, FECSM; Mohammed Nassar, MSc, FECSM; Osama Laban, FEBU, FECSM; Osama Abdelwahab, MD; Saleh Binsaleh, MD; Simone Giona, MSc; David Ralph, MD, FRCS; John Mulhall, MD, MSc, FECSM, FACS
FIRST PUBLISHED: January 11, 2018 – Sexual Medicine
An estimated 20% to 30% of men with Peyronie’s disease (PD) also have erectile dysfunction (ED) that does not respond to medical therapy. Some of these men opt for penile prosthesis implantation. With one procedure, surgeons can often correct both the curvature and deformity from PD as well as address the erectile dysfunction.
Research suggests that inflatable penile prostheses (IPPs) are considered more effective than malleable penile prostheses (MPPs) and, as such, are the preferred choice, especially for patients with PD.
However, IPPs and their implantation procedures are more expensive than MPPs. In some areas where penile implants are not covered by health insurance, MPPs may be the only affordable option patients have.
This study compared the outcomes and satisfaction rates for each type of implant in patients with PD and ED.
One hundred sixty-six men with PD, who didn’t respond to medical therapy for ED, participated in the study. Their mean age was 59 years, and they were counseled about their implant options from July 2011 to June 2014.
For this study, men who responded to intra-cavernosal injections (ICIs) for ED, but did not want to pursue that treatment option, could be included in the study.
Criteria for implant surgery were the following:
- Stable relationship
- Penile curvature of at least 30 degrees
- ED refractory to medical therapy
- Stable penile curvature for at least 9 months
Curvature was measured with a goniometer with the penis at maximum rigidity after ICI.
Patients were counseled before surgery and told that a residual curvature of no more than 20 degrees was the treatment goal. Curvatures of 20 degrees or less would not be subject to further maneuvers.
The advantages and disadvantages of MPPs and IPPs were explained. Each patient chose his implant type as his own decision. Men who opted for MPPs did so because of the less expensive cost, fear of IPP mechanical failure, or ease of use. Men who chose IPPs did so mainly for the potential of increased penile girth.
Surgeries were conducted at a single center by 4 high-volume surgeons. A ventral penile approach was used for all men receiving MPPs. Implantations of IPPs were conducted with either a scrotal or penoscrotal approach.
Eighty-two percent of the men received an MPP; the remaining 18% received an IPP.
The men completed the Sexual Health Inventory for Men (SHIM) before surgery and again at 3-, 6-, 12-, and 24-month follow-up points.
Results and Discussion
Ninety-two percent of the combined group had total resolution of curvature. Eight percent had residual curvature ranging from 25 to 40 degrees (mean: 32 degrees) and required adjuvant maneuvers (plaque incision and/or excision).
These findings were also noted:
- Curvature was “completely fixed” for 94% of the MPP group and 83% of the IPP group.
- Postoperative satisfaction scores and SHIM scores were similar for both groups.
- The SHIM satisfaction rate was maintained in both groups for a mean follow-up of 23.4 months.
Advantages of MPPs include the lower cost and simplicity for both surgeon and patient.
Limitations of the study included the following:
- This was not a randomized controlled study.
- Postoperative penile length and long-term residual deformity were not assessed.
- The follow-up was not long term.
- The number of patients receiving IPPs was small.
- There was no validated instrument used to assess satisfaction after surgery.
The ability of the MPP to restore functional erections can be “excellent.” Also, there was no difference in satisfaction between the two groups.