Hollow and fenestrated penile prosthesis: a new implant for treatment of impotence.

摘要

Penile implants are used for erectile dysfunction (ED). Their main disadvantage is that the cavernous tissue is destroyed and replaced by fibrous so that implant replacement is difficult and the penis loses its erectile function permanently. This paper describes a novel prosthesis which is hollow and fenestrated to preserve, as much as possible, the cavernous tissue. The fenestrated implant was used in 18 men with ED, while the solid Small-Carrion implants were used in 14 impotent men who matched the 18 men in age and cause of impotence and acted as controls. Routine erectile function tests suggested that the ED was neurogenic. The fenestrated prosthesis was a hollow semisolid silicone rod with multiple openings (2-3 mm in diameter) along its whole length. The mean follow up of the patients was 43 +/- 12 SD months. No complications were encountered. Vaginal penetration was successful in the fenestrated and Small-Carrion implant groups. A total of 14/18 patients of the fenestrated prosthesis group experienced spontaneous erections upon sexual arousal, while none of the Small-Carrion prosthesis group did. During the sexual act the penis became tumescent in the patients of the former group but not in those of the latter. It is suggested that the residual cavernous tissue after insertion of the hollow fenestrated implant regenerates through the fenestrae into the implant lumen. This might explain the spontaneous erections upon sexual arousal and the tumescence during the sexual act, but this hypothesis remains to be proved histologically.