Predictors of Patient Willingness to Consider Surgery Prior to Consultation at Sexual Health Clinic.

OBJECTIVE: To identify factors associated with patient willingness to consider surgical treatment for erectile dysfunction (ED) prior to urologic consultation. METHODS: A prospective database of patients presenting to the sexual health clinic at our institution was created from 2014 to 2018, consisting of previsit patient questionnaires and clinical information. Univariable and multivariable logistic regression analysis was performed to determine factors associated with consideration of surgery and decision to undergo surgery. RESULTS: Of 1359 men presenting to the clinic, 991 men had a chief complaint of ED with 630 (63.6%) considering surgery. On multivariable analysis, factors significantly associated with previsit willingness for surgery included history of diabetes mellitus (P = .0009), increasing symptom bother (P <.0001), and decreasing relationship duration (P = .0005). Approximately 16% (162/991) patients considering surgery prior to consultation ultimately underwent penile implant insertion. Multivariable analysis demonstrated that older age (P = .003), history of diabetes mellitus (P = .03), lower international index of erectile function-EF domain (P = .0009) and history of intracavernosal injection therapy (P <.0001) were significantly associated with proceeding to ED surgery. Initial declaration of willingness to undergo ED surgery led to nearly 8-fold increased odds for surgery (P <.0001). CONCLUSION: Over 60% of patients presenting for ED consultation considered surgical intervention, of whom 25% underwent penile prosthesis. Both patient and relationship factors were predictors of surgical willingness. Previsit surgical willingness was associated with highest odds of eventual decision for surgery, suggesting that knowledge of ED treatment options in the general public may play a role. Our findings highlight opportunities for shared decision-making in a patient-centered model of care.

Analysis of preoperative and postoperative expectations of penile implant candidates. / Evaluación de las expectativas preoperatorias y postoperatorias del candidato a prótesis peneana. Estudios de satisfacción.

Penile prosthesis implantation is a good option for the treatment of refractory erectile dysfunction. However, the patient's expectations, among other factors, condition his satisfaction after surgery. This review article aims to present the scientific evidence available concerning patient satisfaction with penile prosthesis surgery.

Comparison of the patient's satisfaction underwent penile prosthesis; Malleable versus Ambicor: Single center experience.

OBJECTIVE: To compare the surgical results, complications, and satisfaction levels of patients who underwent malleable penile prosthesis implantation (M-PPI) and Ambicor penile prosthesis implantation (A-PPI). MATERIAL AND METHODS: One hundred forty two patients who underwent penile prosthesis implantation [M-PPI (Promedon- Tube®, Cordoba, Argentina): 81, and A-PPI (American Medical Systems, Minnesota, USA): 61] between 2013-2018 were evaluated retrospectively. Patients' age, body mass index, smoking history, etiological factors, modified "Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) Questionnaire" scores, shortening of the penis, and complications were recorded. RESULTS: The patients who performed A-PPI implantation were younger (56.27 ± 10.81 vs. 51.47 ± 11.79, p = 0.009). The EDITS scores of 31(38.2%) patients who underwent M-PPI and 44 (72.4%) patients who underwent A-PPI were available. It was observed that the scores on the following questions were statistical significantly higher in the A-PPI group: "Overall, are you satisfied with your penile prosthesis?, How much of your expectations did penile prosthesis meet?, How often do you use your penile prosthesis?" (p = 0.05, p = 0.048, p = 0.038). No difference was observed between the groups in terms of the scores on the other three questions (p = 0.447, p = 0.326, p = 0.365). A 61.3% of patients in MPPI (19/31) group, and 56.8% of patients in A-PPI (25/44) group stated penile shortening (p = 0.417). Mean shortening was reported as 2.1 ± 0.45 cm, and 2.12 ± 0.52 cm, in M-PPI and A-PPI groups, respectively (p = 0.90). CONCLUSION: It is remarkable that the patients who underwent A-PPI experienced higher satisfaction with their prosthesis. Even though it has not been evidenced in the current literature data, patients who have had either M-PPI or A-PPI should be informed about the risk of penile shortening.

A Thematic Analysis of the Online Discussion Board, FrankTalk, Regarding Penile Implant.

INTRODUCTION: Medical websites and discussion boards are commonly used by patients to obtain information. The online forum FrankTalk.org provides a venue specifically for men to discuss sexual dysfunction and particularly inflatable penile prosthesis (IPP). By querying and better understanding the content of this forum related to implants, we can better understand patient concerns before and after IPP. AIM: The aim of this study is to understand the main topics being discussed about IPPs online and to use these topics to understand patient concerns and patient needs and to improve care. METHODS: Messages posted in a 6-month window from January 2018 to June 2018 under the topic "Implant" were identified on FrankTalk.org. Posts were broken down into preoperative and postoperative and then organized using a 3-stage analysis to determine central themes of each post: open coding, axial coding, and selective coding. MAIN OUTCOME MEASURE: The primary outcome measure is the prevalence of each selective code. RESULTS: Of all 587 posts, 304 were written preoperatively with the most common theme being "Size" (23.0%), followed by "seeking support" (18.4%). 283 posts were considered postoperative, of which the most common theme was "Concern about healing" (22.6 %) which questioned if they needed to see a physician, followed by size concerns (20.1%).When analyzed with the 3-stage coding system, there were a total of 41 axial codes which were organized into 6 selective codes: "Social Support" (27.8% of all posts), "Pre-Operative Worries" (23.58%),"Technical Issues" (11.1%), "Prosthesis Logistics" (14.37%), "Post-Operative Worries" (20.22%), "Forum and Misc" (2.93%) for topics outside the scope of penile prosthesis. CLINICAL IMPLICATIONS: The percentage of men seeking medical opinion is concerning, and providers should consider using resources to better educate patients on normal postoperative findings. Implanters should continue to preoperatively counsel patients on size-related changes with surgery. STRENGTH & LIMITATIONS: Strengths include the use of a common online website for men to discuss IPPs and a systematic coding system. Limitations include the applicability of these results to nonheterosexual men as these are likely oversampled in this population. The inherent bias of those willing to post on an online forum may have influenced results along with no oversight for factual accuracy. CONCLUSION: Patients use online discussion boards like FrankTalk.org for social support, medical advice, and validation of their concerns. Providers should be aware of these online topic focuses to help open a discussion with patients about concerns they may feel are difficult to approach with providers. Lu JY, Miller EJ, Welliver C. A Thematic Analysis of the Online Discussion Board, FrankTalk, Regarding Penile Implant. J Sex Med 2020;17:325-330.

Predictors of Satisfaction in Men After Penile Implant Surgery.

INTRODUCTION: Despite the high satisfaction with penile implant (PI) surgery reported in the literature, a significant proportion of patients remain dissatisfied. AIM: To evaluate satisfaction after PI surgery, using a single question and a scoring system. Furthermore, we attempted to define factors that predicted high patient satisfaction. METHODS: The study population consisted of all patients undergoing PI surgery between 2009 and 2015. Comorbidity, demographic, and implant information were recorded. Complications recorded included: minor (requiring no re-operation) such as penile or scrotal hematoma, superficial wound breakdown; major (requiring hospitalization or re-operation) such as device infection, erosion, and mechanical malfunction. Patient satisfaction was defined using a single question posed to the patient 6 months after surgery using a 5-point Likert scale (5 being the most satisfied). Descriptive statistics were used to define complication rates and multivariable analysis (MVA) was performed to define predictors of high satisfaction (score ≥ 4), including presence and degree of complications, Peyronie's disease (PD), diabetes mellitus (DM), number of vascular comorbidities, body mass index (BMI) > 30, and patient age. MAIN OUTCOME MEASURE: Patients with a major complication, with or without an additional minor complication, had a higher likelihood of being dissatisfied (25%) compared to patients with no complication or only minor complication 1.9% (no complications) and 3.7% (only minor complications), P < .001. RESULTS: 902 patients were analysed. Mean age was 56.6 ± 10.6 years. Mean BMI was 30 ± 5. Comorbidity profile was diabetes 75%, dyslipidaemia 44%, hypertension 33%, cigarette smoking 32%, and PD 34%. 76% had a malleable implant (MPP) and 24% an inflatable implant (IPP). 31% had a minor complication and 9% a major complication. 93% had high satisfaction (score ≥4). Patients with any complication had a reduced rate of high satisfaction (97.5% vs 87.7%; P < .001) and even more pronounced with a major complication (96.7% vs 64.2%; P < .001). On MVA, only the absence of a major complication was a significant predictor of high satisfaction (OR 20, 95% CI 9-50, P < .001). CONCLUSION: A high percentage of men are satisfied after penile implant surgery. Only the presence of a major complication is linked to a lower likelihood of achieving high satisfaction. Habous M, Tal R, Tealab A, et al. Predictors of Satisfaction in Men After Penile Implant Surgery. J Sex Med 2018;15:1180-1186.

Penile Prosthesis Implantation in Patients With Peyronie's Disease: Results of the PROPPER Study Demonstrates a Decrease in Patient-Reported Depression.

BACKGROUND: Although there is a strong correlation between erectile dysfunction and Peyronie's disease (PD), there are limited data on the efficacy and satisfaction of inflatable penile prosthesis (IPP) placement in this population. AIM: To assess the efficacy and overall satisfaction of IPP placement in men with erectile dysfunction and concomitant PD using the Prospective Registry of Outcomes with Penile Prosthesis for Erectile Restoration (PROPPER). METHODS: Data from the PROPPER study were examined to determine patient baseline characteristics and primary and secondary etiologies before IPP treatment and included type and size of implant received, presence of corporal fibrosis, and operative time. Men completed 5 validated questionnaires at baseline and annually out to 5 years. OUTCOMES: IPP placement was performed in 250 patients with PD with comparable surgical times and outcomes as in patients without PD. RESULTS: 1,180 men underwent IPP insertion at 11 sites; of these, 250 (21.2%) were diagnosed with PD. This is an ongoing study; 1- and 2-year data are available for 177 (70.8%) and 130 (52.0%) patients, respectively. Intraoperatively, 51.2% patients with PD had corporal fibrosis, with an average operative time of 52.8 minutes. At baseline, 19.3% of men (36 of 187) with PD reported being depressed, with a decrease to 10.5% (6 of 57; P = .02) and 10.9% (5 of 46; P = .07) at 1- and 2-year follow-ups, respectively. More than 80% of patients with PD were satisfied or very satisfied at 1- and 2-year follow-ups. In addition, more than 88% of patients with PD were using their device at the 1- and 2-year follow-up visits. CLINICAL IMPLICATIONS: Patients with concomitant PD and erectile dysfunction can safely and effectively have an IPP placed with similar outcomes as patients without PD. STRENGTHS AND LIMITATIONS: The 1st limitation was that all participating prosthetic urologists were high-volume implanters and these results might not be representative of those of general urologists. A 2nd limitation was that none of the patients were randomized. A 3rd limitation was that although most study points were mandatory, some of the data collection, including depression data, was optional, with not all sites participating. A 4th limitation was that depression data were self-reported. CONCLUSION: IPP can be inserted in patients with PD with acceptable patient satisfaction and usage and depressive symptoms appear to lessen in patients with PD after IPP placement. Khera M, Bella A, Karpman E, et al. Penile Prosthesis Implantation in Patients With Peyronie's Disease: Results of the PROPPER Study Demonstrates a Decrease in Patient-Reported Depression. J Sex Med 2018;15:786-788.

Quality of Life, Psychological Functioning, and Treatment Satisfaction of Men Who Have Undergone Penile Prosthesis Surgery Following Robot-Assisted Radical Prostatectomy.

BACKGROUND: Penile prosthesis surgery is last-line treatment to regaining erectile function after radical prostatectomy (RP) for localized prostate cancer. AIMS: To assess quality of life, psychological functioning, and treatment satisfaction of men who underwent penile implantation after RP; the psychosocial correlates of treatment satisfaction and sexual function after surgery; and the relation between patients' and partners' ratings of treatment satisfaction. METHODS: 98 consecutive patients who underwent penile implantation after RP from 2010 and 2015 and their partners were invited to complete a series of measures at a single time point. Of these, 71 patients and 43 partners completed measures assessing sexual function, psychological functioning, and treatment satisfaction. Proportions of patients who demonstrated good sexual function and satisfaction with treatment and clinical levels of anxiety and depression were calculated. Hierarchical regression analyses were conducted to determine psychosocial factors associated with patient treatment satisfaction and sexual function and patient-partner differences in treatment satisfaction. OUTCOMES: Patients completed the Expanded Prostate Cancer Index Composite Short Form (EPIC-26), Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), Prostate Cancer-Related Quality of Life Scale, Self-Esteem and Relationship Questionnaire (SEAR), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). Partners completed the GAD-7, PHQ-9, EDITS (partner version), and SEAR. RESULTS: 94% of men reported satisfaction with treatment (EDITS score > 50). 77% of men reported good sexual function (EPIC-26 score > 60). Lower depression scores were associated with higher sexual confidence and sexual intimacy, and these were correlated with better treatment satisfaction and sexual function. Patients experienced higher sexual relationship satisfaction (median score = 90.6) than their partners (median score = 81.2), but there was no difference in treatment satisfaction between groups. Higher patient treatment satisfaction was more likely to be reported for couples whose depression scores were more similar. CLINICAL IMPLICATIONS: It is important to provide preoperative penile implant counseling and encourage patients to seek postoperative counseling if needed. STRENGTHS AND LIMITATIONS: This is one of the first Australian-based studies comprehensively assessing treatment satisfaction and psychosocial health of men after penile prosthesis surgery after RP. This was a retrospective cross-sectional study, so there is a possibility of recall bias, and causal associations could not be determined. CONCLUSION: Men in this Australian series who underwent penile prosthesis surgery after RP generally reported good sexual function and treatment satisfaction. Nevertheless, patient and partner mental health influenced their reported experience of the treatment. Pillay B, Moon D, Love C, et al. Quality of Life, Psychological Functioning, and Treatment Satisfaction of Men Who Have Undergone Penile Prosthesis Surgery Following Robot-Assisted Radical Prostatectomy. J Sex Med 2017;14:1612-1620.

Patient satisfaction and penile morphology changes with postoperative penile rehabilitation 2 years after Coloplast Titan prosthesis.

A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement technique (NLMT) coupled with postoperative IPP rehabilitation of the implant for 1-year helped to improve patient satisfaction and erectile penile measurements. This is a 2 years follow-up of a prospective, three-center, study of 40 patients who underwent Titan prosthesis placement, with new length measurement technique for erectile dysfunction. Patient instructions were to inflate daily for 6 months and then inflate maximally for 1-2 h daily for 6-24 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. Measurement changes were improved at 24 months as compared to immediately postoperative and at 12 months. 67.8% of subjects were satisfied with their length at 2 years, and 77% had perceived penile length that was longer (30.8%) or the same (46.2%) as prior to the surgery. 64.3% and 17.9% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared to prior to penile implant surgery. All but one subject (96.5%) was satisfied with the overall function of his implant. This study suggests using the Coloplast Titan with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol can optimize patient satisfaction and erectile penile measurements at 2 years postimplant.

Why Are Men Satisfied or Dissatisfied with Penile Implants? A Mixed Method Study on Satisfaction with Penile Prosthesis Implantation.

INTRODUCTION: Studies have demonstrated high levels of satisfaction with penile prosthesis implantation (PPI). However, qualitative research exploring the experience of PPI through men's narratives is scarce. AIM: The main goals were to analyze (i) the level of sexual satisfaction (quantitatively), and (ii) the reasons for satisfaction and/or dissatisfaction with PPI (qualitatively). METHOD: Participants were 47 men with erectile dysfunction who underwent surgery between 2003 and 2012, placed by a single surgeon. Structured telephone interviews were carried out. MAIN OUTCOME MEASURES: Satisfaction with PPI was a qualitative and quantitative measure assessed through the following four items: (i) "Would you repeat the PPI surgery?"; (ii) "Would you recommend the PPI surgery?"; (iii) "How satisfied are you with the PP?"; and (iv) "Could you explain the motives of your satisfaction/dissatisfaction?". RESULTS: The majority of men (79%) reported to be satisfied with PPI. Content analysis revealed four main themes for men's satisfaction with the PPI: (i) psychological factors were reported 54 times (n = 54) and included positive emotions, self-esteem, confidence, enhancement of male identity, major live change, and self-image; (ii) improvement of sexual function was reported 54 times (n = 54) and referred to achievement of vaginal penetration, increase of sexual desire, sexual satisfaction, penis size, and improvement of erectile function; (iii) relationship factors were reported 11 times (n = 11) and referred to relationship improvement and the possibility of giving pleasure to the partner; and (iv) improvement in urinary function (n = 3). CONCLUSIONS: The level of satisfaction with the implementation of penile prostheses is very high, therefore constituting a treatment for erectile dysfunction with a positive impact on the experience of men at sexual, psychological and relational level.

The importance of psychosexual counselling in the re-establishment of organic and erotic functions after penile prosthesis implantation.

Although many studies about penile prosthesis implantation (PPI) have been published so far, only a small amount of them take into account patients and partners outcome in terms of satisfaction and erotic function. The aim of this study is to explore the value of psycosexual counselling in and the sexual and erotic function of penile prosthesis recipients. Thirty patients and their partners were randomised into two groups. In arm A (case group) patients and their partners underwent a multistep psychosexual counselling before and after surgery. In arm B (control group) surgery was performed without the specific psychosexual counselling scheme. Specific questionnaires (International Index of Erectile Function (IIEF) and the Sexual Daydreaming Scale (SDS)) were administered before surgery and 12 months afterwards. Twenty-four months postoperatively patients were asked to complete the Global Assessment Questions (GAQ) and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), while their partners were asked to answer to the EDITS partner's section. Between January 2009 and October 2011, we enrolled 30 patients undergoing PPI in our institution (15 in each arm). Twenty-four months postoperative follow-up is available for all of them. No significant differences between the two groups in terms of baseline questionnaires scores were observed. Mean IIEF score was significantly higher in case group (arm A 68.3, arm B 53.4, P-value<0.001). At 12 months after PPI the improvement of erotic function according to SDS was significantly higher in the study group for both patients and their partners. Improvement in satisfaction rates were confirmed at 24 months, with statistically significant scores for EDITS in arm A patients and partners as compared with arm B. PPI with a pre- and postoperative psychosexual counselling scheme resulted in better postoperative sexual activity and erotic function for both patients and partners than PPI alone.

Shortened penis post penile prosthesis implantation treated with subcutaneous soft silicone penile implant: case report.

Penile prosthesis surgery for erectile dysfunction has the highest satisfaction rates among all treatment options but is often associated with subjective and objective loss of penile length and girth following surgery. To present a novel technique using a subcutaneous soft silicone implant for reversal of penile shortening and narrowing after prosthesis surgery, with additional gains in overall penile length and girth. Nine patients were treated with the insertion of a subcutaneous soft silicone penile implant. All patients had previously reported a loss in penile length (0.5-2 cm), and seven of nine patients also reported a loss in penile girth (0.5-2.6 cm) after penile prosthesis surgery. During a follow-up period of 4-24 months, penile length and girth measurements showed a mean increase in length of 2.4 cm (±0.75 cm) and a mean increase in girth of 3.4 cm (±0.94 cm). The additional insertion of a subcutaneous soft silicone implant in patients with decreased penile length and girth after penile prosthesis surgery is an effective treatment option that provides reversal of lost penile length and girth.

Patient expectations prior to coloplast titan penile prosthesis implant predicts postoperative satisfaction.

INTRODUCTION: Managing and understanding expectations of patients prior to inflatable penile prosthesis (IPP) surgery is a critical. Clinicians vary in the way they explain the operation, and patients have varied expectations prior to surgery. AIMS: The goal is to understand the role that preoperative counseling and patients' realistic understanding of IPP surgery play in determining postoperative satisfaction. METHODS: 21 Patients underwent IPP surgery, and received a preoperative expectations survey, then, 4 months later, gave a single score of 1-100 (1 is very dissatisfied, 100 is extremely satisfied). MAIN OUTCOME MEASURES: The results were correlated with an R(2) value and visualized on a scatter plot. This significance is tested using a two-tailed test. RESULTS: Lower preoperative expectations scores correlated almost linearly with higher satisfaction scores after surgery. The R (Pearson) value was -0.489, with an R(2) of 0.239. This was significant using a two-tailed test, with a P value of 0.0245. CONCLUSION: Giving patients an accurate description of the procedure and setting realistic expectations leads to higher postoperative satisfaction.

Patient and partner satisfaction after AMS inflatable penile prosthesis implant.

INTRODUCTION: The implantation of penile prostheses is an effective option for treating erectile dysfunction (ED), and nowadays it is used to treat those cases where pharmacological agents have not provided a useful result. AIMS: The primary aim of the present study was to verify the patient and their partner's satisfaction, in 80 patients who underwent AMS CX 700 prostheses implant in a single center, by the same surgeon, in the period between 2004 and 2008. METHODS: In the period between March 2004 and May 2008, 80 penile prostheses implantations have been performed. Any information regarding patients has been retrospectively collected consulting their case histories stored in our archive. Each patient was followed postoperatively, and surgical complications were recorded. MAIN OUTCOME MEASURE: All the patients entered in this study were contacted by phone by a single operator who asked for their consent to collect information regarding their operation, the use of the prostheses, and the couple satisfaction. Once the consent was obtained, a nine-point questionnaire was administered. RESULTS: Seventy-six patients (97%) affirmed to use penile prostheses frequently. Fifty-four patients (69%) and 70 partners (90%) affirmed that they never had problems with the use of the prosthesis and they considered themselves satisfied. Sixty-two patients (79%) answered that this therapeutic method has led to evident improvements in their sexual life. Sixty-two patients (79%) gave a score equal or major than seven and sixty-four partners (82%) gave a score equal or major than seven. All but two patients (97%) reported they would suggest this treatment to other people. CONCLUSIONS: Penile prosthetic surgery constitutes a valid therapeutic alternative, capable of modifying the prognosis and the course of ED. This consideration is emphasized by the high rate of patients and partner's satisfaction emerged in our series and in literature.

Should being aged over 70 years hinder penile prosthesis implantation?

OBJECTIVE: To assess the satisfaction profiles following penile prosthesis surgery in patients with erectile dysfunction (ED) in their seventh decade of life. PATIENTS AND METHODS: In all, 174 patients received, for the first time, a penile prosthesis between 1990 and 2007 in our department. Among these, 35 patients were aged > or =70 years at prosthesis implantation. Of these, 18 patients were still alive at the time of follow-up. Using a telephone survey, patients were asked to answer the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) as well as the International Index of Erectile Dysfunction (IIEF). Another question in the survey was developed by the authors based on a comprehensive review of the literature, which assessed the usefulness of the device for the patient and the degree of their usage. This was formulated as follows: How many times per 2 weeks do you have a sexual intercourse? RESULTS: In all, 15 of 18 patients were either very or somewhat satisfied (83%). At follow-up 11 out of 15 (73%) patients were using their prosthesis regularly. The mean IIEF and EDITS scores were 21.80 and 75.20, respectively. CONCLUSION: A penile prosthesis remains a highly promising treatment in older patients with a similar satisfaction rate to those published for younger patients. Thus, the motivation of the patient and not the age of the patient should be the main determinant factor in this surgical procedure.

A comparative study on two kinds of surgical procedures of penile corpora cavernosa augmentation.

OBJECTIVE: Penile augmentation surgery is still a controversial issue because of the uncertain indication, the possibility of severe complications and a variety of surgical techniques. The purpose of this study is to provide two surgical procedures of penile corpora cavernosa augmentation and to investigate its effect by implanting autogenous saphenous vein grafts or expanded polytetrafluoroethylene (ePTFE) vessel patches. METHODS: Between January 2001 and December 2005, 20 patients underwent surgeries in which bilateral longitudinal incisions were placed on the tunica albuginea and the penile corpora cavernosa were extended by means of implantation of saphenous grafts or PTFE artificial vessel patches. The patients included in this study presented either with congenital idiopathic micropenis or normal penile length and perimeter (dysmorphophobia). Before the operation, the penile length and perimeter in the flaccid and erectile states were as follows: flaccid length 2.5-7.5 cm and flaccid perimeter 3.0-7.5 cm; erectile length 4.9-10.5 cm and erectile perimeter 4.5-10.0 cm. RESULTS: Immediately after surgery, the penile corpus circumferential measurements (on table), showed remarkable increases which were 1.0-2.3 cm and 1.5-3.0 cm in the flaccid and erectile states, respectively; then, at 12 months to 5 years' follow-up, these girth gains had reduced by 0.5-1 cm in some cases. All cases in the two groups obtained satisfactory surgical results with satisfactory erection and no serious complications, such as infection and fistula. In 20 cases, 17 married cases resumed regular and satisfactory sexual activities 1 month after the operation without any functional limitation. CONCLUSION: The two kinds of surgical procedures for augmenting penile corpora cavernosa were proved to be effective and reliable, with few complications. Both saphenous grafts and ePTFE artificial vessel patches are excellent materials for reconstructing the tunica albuginea. These augmenting phalloplasties can not only be used for patients with micropenis, but also applied to satisfy the cosmetic and functional requests of patients with normal penile length and perimeter. However, the long-term outcomes of these surgical procedures need a further, detailed follow-up study.

Penile enlargement.

PURPOSE OF REVIEW: As male genital corrective surgery is becoming increasingly requested by patients, the need to reach a general consensus on indications and techniques is now imperative. This review of published data provides an overview concerning patient selection modalities, benefits/risks and expected outcomes of surgery. Finally, the article focuses on ethical issues caused by the growing aesthetic nature of this surgery. RECENT FINDINGS: Interest has been sparked by animal studies, the description of innovative techniques for lengthening and girth enhancement techniques, reconstructive phalloplasty and penile implant surgery. Data suggest that better objective surgical outcomes are possible, though in many cases long-term data and patient-rated satisfaction details are lacking. Most importantly, studies show the importance of having a multidisciplinary team in charge of patient selection. SUMMARY: Although more long-term data are required before a general consensus can be reached, recent findings point to the absolute need for a thorough psychological assessment of men requesting penile enhancement surgery. Urologists should work in very close collaboration with psychologists or psychosexologists both during the preoperative phase (to verify eligibility for surgery) and afterwards (to provide counselling).

Preoperative psychosocial evaluation of penile prosthesis candidates.

Penile prosthesis surgery is a recommended treatment option for a subset of patients who present with erectile dysfunction (ED). Although treatment outcome research indicates that patients are generally satisfied with this intervention, it remains an invasive procedure with risk for complications. A review of the literature reveals general agreement for the importance of a thorough preoperative evaluation to determine appropriateness for a penile implant; however, there are no known descriptions of such an evaluation in the literature. This article provides an introduction to the domains that are most relevant to assess in a patient who is considering penile implant surgery: sexual history (including organic and psychogenic causes of ED), success and utilization of other treatment interventions, relationship functioning, and patient expectations for and knowledge of the procedure. The advantages to this approach are presented, particularly in enhancing patient satisfaction with treatment outcomes.

Determinants of patient satisfaction following penile prosthesis surgery.

PURPOSE: Penile prosthetic surgery is associated with satisfaction rates >90% for the general penile implant population. It is suggested that satisfaction rates may be lower in certain populations. This study was undertaken to define potential predictors of satisfaction. METHODS: Patients undergoing penile prosthesis surgery completed the International Index of Erectile Function (IIEF) prior to surgery, and the IIEF and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires at least 6 months postoperatively accompanied by a Global Satisfaction Question (GSQ). RESULTS: A total of 114 patients constituted the study population. Subgroups evaluated included patients with Peyronie's disease (PD), body mass index (BMI) > 30 kg/m2, radical prostatectomy (RP), and patient age > 70 years. The mean patient age and duration of ED were 59 +/- 14 and 3.2 +/- 1.9 years, respectively. All groups demonstrated statistically significant differences between pre- and postoperative scores for the IIEF and EDITS. Patients with PD, a history of RP, and BMI > 30 kg/m2 had significantly lower scores on the GSQ, IIEF satisfaction domain, and EDITS compared with the general implant population. Only PD impacted negatively on the postoperative IIEF erectile function domain score. On the multivariate analysis, factors associated with >or=5-point difference in the IIEF satisfaction domain score compared with the general implant population were PD (RR = 4.2), RP (RR = 2.2), and BMI > 30 (RR = 1.8). CONCLUSIONS: These data suggest that men diagnosed with PD, BMI > 30, or previous RP undergoing penile prosthesis surgery have lower satisfaction rates than the general penile implant population.

Serial assessment of efficacy and satisfaction profiles following penile prosthesis surgery.

PURPOSE: Penile implants are associated with a high level of patient satisfaction. Studies to date have failed to use instruments that accurately record patient satisfaction data. We used 2 validated instruments to assess the chronology of efficacy and satisfaction profiles in men undergoing penile prosthetic surgery. MATERIALS AND METHODS: Men who elected penile implant surgery were administered the International Index of Erectile Function (IIEF) questionnaire preoperatively, and 3, 6 and 12 months postoperatively as well as the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire 3, 6 and 12 months postoperatively. Comparison was done of preoperative and postoperative values for the overall IIEF, IIEF erectile function domain, IIEF satisfaction domain and EDITS. All surgeries were primary and in all patients an inflatable implant device was placed. RESULTS: A total of 96 men with a mean age of 56 years were enrolled in the study. All 12-month scores were statistically significantly higher than baseline scores. The 12-month values were statistically higher than 6-month values for the IIEF satisfaction domain and for EDITS. CONCLUSIONS: This study indicates that implant surgery causes a dramatic improvement in erectile function. It also indicates that satisfaction increases in year 1 after implant surgery with significant improvements in the second half of year 1. Current efforts are aimed at following this cohort of patients in an even more long-term fashion as well as evaluating partner satisfaction profiles. These findings should permit clinicians to provide penile prosthesis candidates with optimistic and realistic expectations for implant device function and postoperative satisfaction.