Outcome of penile prosthesis implantation for treating erectile dysfunction: our experience with 12 penile implants in a hospital in Kumasi, Ghana
Year: 2025
Type: article
Study design: Observational Study
Abstract: Erectile dysfunction (ED) is a chronic condition that is associated with several co-morbidities, commonly diabetes, hypertension, obesity, prostate hypertrophy, priapism, and prostate cancer treatment among others [ 11 ]. Medical treatment is the main option for many patients suffering from ED [ 4 ]. However, for some patients for whom medical treatment fails, surgical treatment in the form of a penile implant (PI) is considered the final treatment for such severe forms of ED [ 10 ]. The penile implant has been the final option for men with erectile dysfunction since its introduction in 1973. The study evaluates the outcome of penile prosthesis surgery of 12 patients carried out at the Peace and Love Hospital in Kumasi, Ghana. All the patients in our study were implanted with the malleable prosthesis (Coloplast Genesis), mainly due to the high cost of the inflatable device which globally is the preferred option for many patients [ 2 ]. The malleable penile implant was the option chosen for our patients due to the low revision rate. Our study looks at patients who were selected for the surgical implants, the complications which were associated with the implantation procedure and the measures which were taken to improve patient satisfaction. The suitability of candidates for penile prosthesis implantation was based on a thorough review of the patient's medical history, previous erectile dysfunction treatment, and preferences. It also sought to use suitable surgical techniques for penile prosthesis implantation, including accurate sizing, placement, and use of evidence-based peri-operative protocols to improve patient outcomes. Twelve patients had undergone penile implantation surgery with malleable prosthesis (Coloplast Genesis). All the patients had tried first-line medical treatment with Phosphodiesterase-5 inhibitors (PDE-5) without success. Prostaglandin-based injections as a second line treatment were also offered as an option to the patients, which either failed or was declined by the patient before being considered for the penile implantation. Adequate counselling was provided to each patient before surgery. The malleable implant was chosen over the inflatable implant mainly because of its affordability and low revision rates. Consent was obtained from each patient after a comprehensive discussion about the surgical procedure. Each patient had a routine urine examination with culture and sensitivity to ensure urine sterility prior to the surgery. In case a patient had signs of urinary tract obstruction or any condition which could serve as a source of infection, the patient was treated before penile implant was considered. A prophylactic antibiotic was given 2 h prior to the surgery. Surgery was typically done under spinal anesthesia in an aseptic environment, with the patient in a supine position. Intra-operatively, the surgical site was scrubbed with antiseptic soap and water for fifteen minutes after which a urethral catheter was passed. The normal surgical site scrubbing was carried out with chlorhexidine and surgical spirit. Strict aseptic conditions were observed throughout the whole procedure. A penoscrotal incision of about 4 cm was made on the raphe mainly due to the surgeon’s preference. The cavernosum was identified, and stay sutures were secured on the cavernosum after which a cavernostomy was done. Dilatation of the cavernosum using Hegar dilators was done to the size of the implant to be inserted. The same was done on the contra-lateral side of the cavernosum. Intermittently, antibiotic solution for irrigation was applied repeatedly during the whole procedure and signs of possible urethral perforation were also checked. The appearance of irrigation fluid in the penile meatus was a sure sign of urethral perforation. The length of the cavernosum was measured and the corresponding length of the implant was inserted. Checks were done to make sure there was no under-sizing or over-sizing of the inserted implant. When everything was considered to have been done satisfactorily, the cavernosa was closed with 2/0 Vicryl in a continuous airtight manner. The other layers were closed in an interrupted manner. The incisional site was covered with gauze and bandaged to avoid hematoma formation and the urethral catheter was removed the next day. For patients with normal cavernosa, one surgeon can perform the surgery alone but for a highly fibrotic cavernosa in cases such as post priapism and in previous infected penile implant patients, two surgeons may be required for the procedure. The average surgical time is one and a half hours, but for severely fibrotic cavernosa, the operation can take up to 4 h without the guarantee of dilating both cavernosa. Some patients have had only one penile prosthesis implanted due to severe fibrosis of the cavernosa and this did not affect the normal function of the implant. All patients could engage in sexual intercourse, 6 weeks after surgery. Our patients were between 27 and 65 years of age; mean age, 52 years. Five (41.7%) of them were diabetics, two (16.7%) had priapism, and two (16.7%) were hypertensive. One (8.3%) patient was a case of post-radical prostatectomy, one had pelvic trauma and the last had no identifiable pathology (Fig. 1 ). The youngest of our patients, a known sickle-cell (SS), was a previous case of priapism. Ten patients had primary implants, and one patient had revision twice due to infection, and later erosion as a result of an oversized implant with a weak cavernosum from the previous infection. After the first six cases, two of our patients developed infection but following an overhaul of infection prevention procedures alongside administration of potent antibiotics, there were no further cases of infection for the next 6 cases out of the 12 we carried out. Post-operatively, patients were followed up for 50 days. Out of the 12 patients implanted with the penile prosthesis, 11 (92%) reported being satisfied with the outcome of the surgery.
Source: African Journal of Urology
Institution: Kwame Nkrumah University of Science and Technology
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4410718814