Surgical implant of a penile prosthesis to treat erectile dysfunction or urinary incontinence can be safely performed in neurologically impaired patients, according to a report in The Journal of Urology for March. Of the three prostheses examined in the study, an inflatable 3-piece type carried the lowest complication risk.

The study involved 245 paraplegic or quadriplegic men who received penile prostheses between 1980 and 1996. Other prostheses used besides the inflatable 3-piece type (AMS 700), included semirigid (Jonas) and self-contained inflatable types (Dynaflex).

The average patient age was 40.8 years old. The causes of spinal cord injury were trauma (80 percent), spina bifida (7 percent), tumors (6 percent), central nervous system infections (5 percent) and multiple sclerosis (2 percent).

The majority of patients - 134 - received the prosthesis to control urinary incontinence to improve “urinary drainage when penile retraction has made this difficult,” lead author Dr. Dirk-Henrik Zermann, from Friedrich-Schiller-University Jena in Germany, and colleagues note. Sixty patients received the device for erectile dysfunction and 51 received the implant for both problems.

After an average follow-up period of 7.2 years, urinary incontinence has resolved in 90.3 percent of the patients and erectile dysfunction was successfully treated in 82.6 percent of the patients.

Forty-three revisions, due to technical issues or infections, were performed, the report indicates. The overall infection rate was 5 percent.

The number of perforations associated with the implant varied by the type of device, ranging from none with the inflatable 3-piece device to 18.1 percent for the semi-rigid type.

The results of long-term follow-up indicate that the inflatable 3-piece prosthesis has the lowest risk of complications, the authors conclude. A successful outcome for penile implant surgery requires special preoperative and postoperative care, they add, particularly in men with neurologic impairments.

SOURCE: The Journal of Urology, March 2006.