Successful Placement of Penile Prostheses in Men With Severe Corporal Fibrosis Following Vacuum Therapy Protocol
Peter N. Tsambarlis, MD; Fahad Chaus, MD; Laurence A. Levine, MD
ONLINE: December 2016 – The Journal of Sexual Medicine
Introduction and Goal
Corporal fibrosis sometimes occurs after explantation of an infected penile prosthesis or after an episode of ischemic priapism. The condition can make subsequent prosthesis implantation difficult.
Some surgeons use narrow cylinders in these cases. However, this approach requires more extensive surgical procedures and can result in complications like perforations, infections, and permanent loss of penile length.
This study evaluates an alternative approach, which involves the preoperative use of daily vacuum therapy (VT).
The researchers retrospectively reviewed all patients who had undergone implantation of 3-piece penile prostheses (using standard-size cylinders) at one institution between 2008 and 2015. Thirteen of those patients had developed corporal fibrosis – 11 from prosthesis infections and 2 from ischemic priapism.
The men were advised to use VT for 10 to 15 minutes at least twice a day for a minimum of 3 months before their next implant surgery.
The researchers compared the men’s baseline stretched flaccid penile length (SFPL) with their post-surgical SFPL measurement.
The men used VT for an average of 32.5 minutes daily for an average of 3.5 months. VT started 3 to 21 months after corporal fibrosis became evident.
All of the men maintained or increased their pre-surgical SFPL, with an average increase of 0.92 cm. This result trended toward statistical significance.
Two morbidities were reported. One patient had his prosthesis removed after developing an infection 26 months after implantation. After recovery from explantation, he again used VT before reimplantation 7 months later.
The other patient experienced erosion of the tubing in his scrotum 2 months following surgery.
All patients, except for the one with erosion, reported satisfaction and were able to engage in penetrative sexual activity.
The authors explained two possible ways that VT can benefit men with corporal fibrosis before penile prosthesis implantation. If used routinely, VT can soften fibrotic tissue because it pulls blood into the penis, causing tumescence. VT also places the fibrosed tissue on tension.
They added that none of the participants required additional surgical maneuvers during implantation surgery. None experienced penile shortening.
Patient satisfaction with the procedure was high. “Each of these men had a frustrating and emotionally taxing setback to his sexual health, with many experiencing multiple insults including surgeries, prosthesis infections, and priapism,” they wrote. “Nevertheless, we were able to achieve a high satisfaction rate using our standardized regimen.”
The authors recommended that VT be started as soon as possible in men at risk for corporal fibrosis after penile prosthesis explantation or refractory priapism.
Small study size was acknowledged as a limitation. However, the authors explained that extensive corporal fibrosis is uncommon.
“Further studies with prospective, multicenter trials will be necessary to confirm this approach,” they wrote.