Penile implants in the era of oral drug treatment for erectile dysfunction

The advent of phosphodiesterase type 5 inhibitors (PDE5-I) has revolutionized the management of patients with erectile dysfunction (ED) of various causes. Currently, all patients with ED should be assessed with a thorough medical and sexual history, physical examination and selected blood tests, including serum glucose, lipid profile, morning total testosterone and prolactin [ 1]. At the end of this initial assessment phase most patients may be counselled on the different treatment options available and oral drug therapy results as most frequently chosen by current patients [ 2]. Patients who do not respond to oral drug therapy and those who cannot use PDE5-I because of specific contraindications may be given the option to be treated with either intracavernosal or intraurethral medical therapy, or with a vacuum device. Penile implants are usually considered as an option for patients who fail to respond to any kind of non-surgical therapy. Although this group of patients is much smaller than the overall population of patients with ED seeking medical advice, it is also becoming evident that with increasing knowledge of the efficacy and safety of oral drug therapy for ED, there has been a progressive increase of the number of office visits for this medical condition, and the final result includes a proportional increase of the number of those not responding to nonsurgical therapies. Thus the number of potential candidates for a penile implant has certainly increased in the recent past, in the experience of most urologists who work in andrology referral centres. This is the main reason why penile prostheses are important in treating ED. In this article we review the critical aspects of patient selection criteria, types of implants available and criteria leading to a specific choice, preoperative management of the patient, surgical technique, postoperative management, long-term results, and the management of complications. We consider that every resident should be knowledgeable on this list of topics. This review was based on a Medline search for a full-length reports in English, published from January 2000 to April 2004. The key words 'penile implants', 'penile prostheses', and 'erectile dysfunction' were used in the search. Updated information on the various types of implants was collected from the websites of the companies manufacturing these prostheses. OI MIRONE, Vincenzo/0000-0002-7639-2560; Gallina, Andrea/0000-0002-4540-9569