Using malleable penile implants is an effective way to treat refractory ischemic priapism (RIP), American researchers say. It is also a less expensive approach that requires fewer hospital resources.
RIP is a painful erection that develops when blood cannot leave the penis. Such erections last four hours or longer. They can sometimes be treated with medication or with shunts, which allow drainage. But these treatments are not always effective. Men who have erections for 48 hours or longer are at higher risk for tissue damage and erectile dysfunction.
During a malleable implant procedure, surgeons remove the corpora cavernosa (the spongy tissue that fills with blood during an erection) and replaces them with a flexible rod. The patient can move the penis into an erect position as desired.
For this study, the researchers analyzed data from fourteen men who were treated for RIP at Parkland Memorial Hospital in Dallas, Texas, USA from 2007 to 2013. On average, the men’s RIP erections lasted for 82 hours. Each patient received a malleable penile implant and was discharged within 24 hours of surgery.
Before implantation, the average cost per patient was an estimated US $83,818. This figure, based on standard Medicare reimbursement rates, included the costs of emergency room visits and hospital admission days. It also included shunt, irrigation, and drainage procedures.
In contrast, the cost of the malleable implant procedure was US $3,850 per patient.
According to the researchers, the patients experienced “immediate pain relief” after implantation. Three men had complications: one infection, one urethral erosion, and one impending distal extrusion. In these men, the malleable implants were replaced with inflatable versions. The overall infection rate was 7%.
The study authors explained that the average cost of RIP treatment per admission in the U.S. is US 41,909. With almost 10,000 cases of RIP occurring each year, the annual cost of this condition reaches US $124 million.
“In those with a high risk of erectile dysfunction, acute [malleable penile prosthesis] insertion resulted in relief of pain and discharge within 24 hours – this treatment strategy could thus substantially decrease the resources consumed during a prolonged admission,” they wrote.
However, they noted that implant procedures are complex and that having an experienced surgeon conduct the surgery may reduce the risk of complications and help keep costs down.
Having immediate access to implants is also important, they said.
The study was first published online in December in The Journal of Sexual Medicine.
The Journal of Sexual Medicine
Tausch, Timothy J., MD, et al.
“Malleable Penile Prosthesis Is a Cost-Effective Treatment for Refractory Ischemic Priapism”
(Full-text. First published online: December 23, 2014)
Sexual Medicine Society of North America
“Penile Implants – Erectile Dysfunction”