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from Section 26 - Urologic Surgery
Published online by Cambridge University Press: 05 September 2013
In 1998, the introduction of sildenafil allowed erectile dysfunction to gain public recognition and acknowledgment among men. Subsequently, more and more patients have become comfortable in seeking treatment for this condition. Once erectile dysfunction becomes refractory to medical measures, motivated patients may consider undergoing surgical placement of an inflatable penile prosthesis (IPP). Since its introduction in 1973, the IPP has undergone many revisions and improvements. These changes have allowed for easier surgical insertion, decreased complications, and patient and partner satisfaction rates consistently greater than 90%.
The inflatable penile prosthesis typically comes in two forms: two-piece and three-piece. The difference between the two is that the latter contains a fluid reservoir within the pelvis, which is typically placed below the rectus abdominis fascia. A manually operated internal pump allows for the movement of fluid between the reservoir and cylinders to create an erect penile state. The reservoir within the three-piece IPP allows for greater changes in penile size when compared with the two-piece model, which relies on the movement of much smaller amounts of fluid from the base of the cylinders to the distal ends. In both cases, the penile cylinders are placed within the paired corpora cavernosa, and the pump is located within the base of the scrotum. There are two surgical approaches for placing the implant: infrapubic and penoscrotal. It is currently estimated that ~85% of IPPs are placed penoscrotally, with an occasional abdominal counter-incision for placement of the reservoir. The principle of the IPP is that a patient can squeeze the scrotal pump to allow fluid to fill the penile cylinders, creating tumescence for successful coitus. At the conclusion of intercourse, the release mechanism on the pump is pushed and fluid exits the cylinders, allowing for detumescence. While the basic principles of the device are similar, the specific components depend on the manufacturer of the prosthesis.
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