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ORIGINAL ARTICLE
Year : 2018  |  Volume : 45  |  Issue : 1  |  Page : 26-29

Satisfaction with the semirigid penile prosthesis among couples from a Semiurban Indian population


1 Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belagavi, Karnataka, India
2 Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University); Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and MRC, Belagavi, Karnataka, India
3 Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and MRC, Belagavi, Karnataka, India, , Karnataka,
4 Department of Biotechnology and Microbiology, Karnatak University, Dharwad, Karnataka, India

Date of Web Publication27-Jul-2018

Correspondence Address:
R B Nerli
Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and MRC, Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.JSS_29_18

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  Abstract 


Introduction: Insertion of penile prosthesis for treatment of irreversible erectile dysfunction (ED) is a common and well-established treatment in the western countries. Even in the times of the newly available oral medications, penile prostheses continue to have such a nonoptional place in the management of severe ED. In this study, we have assessed the satisfaction among semiurban Indian couples following insertion of the semirigid penile prosthesis. Materials and Methods: Between January 2000 and December 2015, 78 men with ED underwent semirigid penile prosthesis implantation (PPI) at our hospital. The satisfaction of patients and partners was evaluated using the ED Inventory of Treatment Satisfaction (EDITS) questionnaire and EDITS partner survey. Results: The mean age of the patients was 44.84 ± 7.30 years. The mean duration of time with ED in the preimplantation period was 38.69 ± 12.44 months. The satisfaction of patients and partners as assessed by EDITS questionnaire and EDITS partner survey was 80.66 ± 4.49 and 75.66 ± 6.57, respectively, at 12 months after surgery and 71.73 ± 8.10 and 65.6 ± 6.49, respectively, at 24 months after surgery. Conclusions: This study showed a high degree of satisfaction among patients as well as their partners with semirigid PPI. More than 80% of the men reported being very satisfied with their penile implantation surgery.

Keywords: Erectile dysfunction, partner, patient, prosthesis, satisfaction


How to cite this article:
Patil AY, Nerli R B, Dixit NS, Hiremath MB. Satisfaction with the semirigid penile prosthesis among couples from a Semiurban Indian population. J Sci Soc 2018;45:26-9

How to cite this URL:
Patil AY, Nerli R B, Dixit NS, Hiremath MB. Satisfaction with the semirigid penile prosthesis among couples from a Semiurban Indian population. J Sci Soc [serial online] 2018 [cited 2018 Nov 17];45:26-9. Available from: http://www.jscisociety.com/text.asp?2018/45/1/26/237758




  Introduction Top


Erectile dysfunction (ED) is defined as a consistent inability to obtain or maintain a penile erection sufficient for satisfactory sexual relations.[1] It is difficult to assess how common the problem is as many sufferers do not seek help, especially in Indian society, either due to shyness or fear of being branded impotent. It is estimated that only 2.6%–5.2% of patients with ED seek treatment annually.[2] Although ED is a benign disorder, it affects both physical and psychosocial health of sufferers and their partners and has a significant impact on the quality of life (QoL).[3] The prevalence of ED is increasing as the life expectancy of men continues to increase.

There are a wide range of treatment modalities for ED. Currently, most men with organic impotence are treated with a phosphodiesterase type 5 (PDE5) inhibitor. The introduction of sildenafil (Viagra) has revolutionized the treatment of ED. This is an orally active agent with 85% initial success rate, is well tolerated, and is associated with minimal dropout rate.[4],[5] The choices for second-line treatment include vacuum erection devices, intracavernosal vasoactive injections, or transurethral prostaglandin E1, which are all associated with significant discontinuation rates. When all these therapies fail or when the patient refuses conservative treatment, penile prosthesis implantation (PPI) remains the only option.

Insertion of penile prosthesis for treatment of irreversible ED is a common and well-established treatment.[6] Penile prostheses are either semirigid or hydraulic in nature. Implantation of the semirigid prostheses, whether malleable or mechanical, is technically uncomplicated, and due to their simple construction and use, mechanical problems associated with them are rare. They are also reliable and inexpensive.[7] The psychological and interpersonal impacts of these implants remain largely limited, despite the widespread use of penile prosthesis, and more so in Indian community. We report our experience with semirigid penile prosthesis (SPP) in the semiurban Indian population and the satisfaction of the patients and their partners following the surgery.


  Materials and Methods Top


Between January 2000 and December 2015, 78 men with ED underwent PPI at our medical center. Institutional Review Board approval was obtained from the University/Hospital Ethics Committee. The exclusion criteria were known neurological disorder, Peyronie's disease, and moderate-to-severe urinary incontinence, those without a regular partner, and patients who had undergone secondary implant surgery. All patients had completed a minimum of 1-year follow-up period after PPI. The most common type of penile prosthesis implanted was Shah malleable prosthesis followed by AMS 650.

All operations were performed by one surgeon in a single center under intravenous antibiotic prophylaxis and spinal/epidural anesthesia. The skin of the surgical field was scrubbed with povidone–iodine solution for 10 min. In most of the cases, either a circumcoronal or a single penoscrotal incision was used. Data about preoperative assessment and complications were obtained retrospectively from the patients’ records. The preoperative erectile status was evaluated with the international index of erectile function (IIEF). Intraoperative complications were noted and summarized [Table 1]. The satisfaction of patients and partners was evaluated using the ED Inventory of Treatment Satisfaction (EDITS) questionnaire and EDITS partner survey.[8] The patients were also asked if they would undergo the same operation again. All statistical analyses were performed using SPSS software version 20.0 (SPSS Inc., Chicago, IL, USA).
Table 1: Patient characteristics

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  Results Top


During the study period, 78 patients with a mean age of 44.84 ± 7.30 years underwent semirigid PPI. The decision to use the semirigid prosthesis was made by the patient himself based on his social/financial status. The mean duration of time with ED in the preimplantation period was 38.69 ± 12.44 months. All patients had been administered PDE5 inhibitors before surgery and 17.94% (14) were administered intracavernosal injections and 8.97% (7) had used a combination of oral treatment with intracavernosal injections before PPI. None of the patients had tried vacuum erection device previously [Table 1].

The body mass index was normal in 35.89% (28) patients, overweight in 43.58% (34) patients, and Class 1 obesity in 20.51% (16) patients. Fourteen (17.94%) patients were diabetic, 37(47.43%) were hypertensive and 3 (3.84%) had hypercholesterolemia. The mean operating time was 45.84 ± 2.71 min. No major intraoperative complications were noted except excessive cavernosal bleeding in two patients [Figure 1]. The majority of postoperative complications were minored in nature and included superficial wound infection, subcutaneous hematoma, urinary retention, and pain.
Figure 1: (a) Preoperative preparation. (b) Circumcoronal incision is made, and penis degloved. (c) Incision made in the corpora and corpora dilated. (d) Insertion of semirigid prosthesis within the corpora

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During the follow-up period, two (2.56%) patients had extrusion of the prosthesis, and both were counseled for a repeat PPI. The satisfaction of patients and partners as assessed by EDITS questionnaire and EDITS partner survey was 80.66 ± 4.49 and 75.66 ± 6.57, respectively, at 12 months after surgery and 71.73 ± 8.10 and 65.6 ± 6.49, respectively, at 24 months after surgery. When questioned, all patients agreed that they would recommend this form of treatment to their friends and would also undergo the same procedure again.


  Discussion Top


Penile implants have played a definite role in the management of ED since their introduction in the urological armamentarium over 40 years ago.[9] The role of penile implants has changed and evolved since the launch of PDE5 inhibitors. Currently, this procedure of insertion of penile implants is considered the last but a very efficacious option. A substantial percentage of patients with ED will not respond to a conservative pharmacological treatment and will need a penile prosthesis.

Penile prosthesis is subject to a continuous development, and today, they have gained better mechanical reliability and safety,[10] but device-related complications can still occur, more so in inflatable prosthesis.[11],[12] Achieving the highest patient and partner satisfaction with the lowest complication rates remains the most important end point of PPI surgery. Inflatable penile prosthesis has the advantages of penile flaccidity when deactivated, ease of concealment, and low risk of chronic pain.[13] However, they are expensive and have increased risk of mechanical failure, and the implantation process is more sophisticated. The SPP has the advantages of easy implantation, low cost, less mechanical failure, and ease of use. The main disadvantage is the permanent rigidity that results in difficulty in concealment and chronic pain.[13] Cost of the penile implant remains one of the most important factors in all the developing countries.

The ability to generate a mechanically adequate erection is not the sole determinant of seeking or continuing treatment in ED. Satisfaction following treatment is the only way to assess the success and predict further continuation of treatment. Satisfaction measures are intentionally subjective, so as to capture an individual's personal evaluation of the treatment received.[14],[15] This evaluation should include feelings about the effectiveness of treatment, side effects, ease of use, naturalness, and impact on significant others. It is possible that in spite of producing an excellent erection, the patient may rate the treatment as unsatisfactory because the erection was artificially induced, painful to create, failed to enhance the patient's sense of sexual confidence or masculinity, or not acceptable to the partner. Althof et al.[8] constructed two versions of a psychometrically sound measure of satisfaction with treatments for ED – the EDITS. One version intended to assess patients’ treatment satisfaction (patient EDITS) and the other partners’ treatment satisfaction (partner EDITS). Partner satisfaction is very much relevant to understanding treatment continuation for sexual dysfunction, given the dyadic nature of the dysfunction.[16]

Minervini et al.[17] evaluated the outcome of penile prosthesis surgery in 447 men who had undergone 504 PPI. Of the prostheses inserted, 393 were malleable, 81 were three-piece inflatable, and 30 were self-contained hydraulic prosthesis. The mean (range) age of the men was 52 (21–78) years; 404 men had primary implants and 43 had revision surgery after operations at other institutions. The mean follow-up was 50 (1–297) months. The most serious postoperative complications were infection (8%) and erosion (5%), which were more common in diabetic patients (10%) and after pelvic trauma with a urethral injury (21%). Of 482 prosthesis, 21 failed mechanically (4%) and revision surgery was needed for 5% of the prostheses inserted (24/482). Overall, 89% (377/425) of men could have sexual intercourse and 344 (81%) were satisfied with the results.

Bozkurt et al.[13] reported the outcomes and satisfaction rates of inflatable penile prosthesis (IPP) and SPP implantation in a cohort of 257 (118 underwent implantation of IPP and 139 underwent SPP implantation) men with ED. The overall major complication rate was higher in IPP group. PPI led to a significant improvement in IIEF scores in both groups. For IPP and SPP groups, the average EDITS scores were 78 ± 11 and 57 ± 8, respectively, and that for the partners were 72 ± 10 and 49 ± 7, respectively (P < 0.05). It is well known that men report a high degree of satisfaction with PPI, including qualitative effects on their sexual, psychological, and relational well-being.

Despite the widespread use of penile prosthesis, the long-term results have been reported mainly from the western countries. Song et al.[18] retrospectively evaluated the clinical outcome of PPI in 224 Chinese patients with severe ED. A malleable prosthesis (AMS 650) was implanted in 45 cases (20.1%), and a three-piece inflatable prosthesis (AMS 700 CXM or AMS 700 CXR) was implanted in 179 cases (79.9%). Only 201 patients (89.7%) completed the follow-up. All of the patients could perform sexual intercourse post-PPI with the mean postoperative IIEF-5 and QoL scores of 20.02 ± 2.32 and 5.28 ± 0.76, respectively. Three patients needed re-implantation of a new device, and two patients developed a mild curvature of the penis. Satisfactory sexual intercourse at least two times every month was reported by 178 men (88.6%), and overall satisfaction with the PPI surgery was reported by 89.0% of men and 82.5% of partners. Patient satisfaction in the three-piece inflatable prosthesis group was higher than in the malleable prosthesis group (P < 0.05).

Similarly, Salama[19] thought that it would be of interest to investigate satisfaction rates with malleable penile prostheses among couples from the Middle East. A total of 50 patients who underwent the insertion of AMS 650 and Acu-Form penile prostheses and their partners were evaluated. In all, 70% of the patients and 57% of the partners were satisfied with the prosthesis. There was an increase in frequency of intercourse, sexual desire, and ability to achieve orgasm. Dislike for the device was the most common cause for nonsatisfaction of patients with the device. Results from this evaluation highlighted the obvious need for proper preoperative counseling for both the patient and his partner to minimize unrealistic expectations. The author also emphasized the importance of careful screening of both psychosocial and psychosexual aspects of the couple based on cultural ethnic background since these were important predictors of the therapeutic outcome of prosthesis insertion.


  Conclusion Top


This study too showed a high degree of satisfaction among patients as well as their partners with semirigid PPI. More than 80% of the men reported being very satisfied with their penile implantation surgery. For all the patients, it was their first implant. They would also recommend implantation to someone else as well as undergo the same procedure again. The major reasons for satisfaction among the patients were the improvement in sexual function and psychological well-being. The surgery improved their self-esteem and enhanced their sense of male identity many more times. Improvement in sexual function also led to improvement in sexual desire, erectile function, and intercourse. We feel that overall, “the level of satisfaction with the implementation of penile prostheses was very high in the patients undergoing PPI as well as their partners, therefore constituting a treatment for ED with a positive impact on them at sexual, psychological, and relational level.”

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Althof SE, Corty EW, Levine SB, Levine F, Burnett AL, McVary K, et al. EDITS: Development of questionnaires for evaluating satisfaction with treatments for erectile dysfunction. Urology 1999;53:793-9.  Back to cited text no. 8
    
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Chung E, Van CT, Wilson I, Cartmill RA. Penile prosthesis implantation for the treatment for male erectile dysfunction: Clinical outcomes and lessons learnt after 955 procedures. World J Urol 2013;31:591-5.  Back to cited text no. 12
    
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Bozkurt IH, Arslan B, Yonguc T, Kozacıoglu Z, Degirmenci T, Gunlusoy B, et al. Patient and partner outcome of inflatable and semi-rigid penile prosthesis in a single institution. Int Braz J Urol 2015;41:535-41.  Back to cited text no. 13
    
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Ware JE Jr., Snyder MK, Wright WR, Davies AR. Defining and measuring patient satisfaction with medical care. Eval Program Plann 1983;6:247-63.  Back to cited text no. 14
    
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Levine S. Sexual Life: A Clinician's Guide. New York: Plenum Press; 1992.  Back to cited text no. 16
    
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Minervini A, Ralph DJ, Pryor JP. Outcome of penile prosthesis implantation for treating erectile dysfunction: Experience with 504 procedures. BJU Int 2006;97:129-33.  Back to cited text no. 17
    
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Song WD, Yuan YM, Cui WS, Wu AK, Zhu YC, Liu J, et al. Penile prosthesis implantation in Chinese patients with severe erectile dysfunction: 10-year experience. Asian J Androl 2013;15:658-61.  Back to cited text no. 18
    
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