Abstract and Introduction
Abstract
Before the introduction of sildenafil for the treatment of erectile dysfunction (ED), penile implants were recognized as the most effective, though most invasive, therapy with a high satisfaction rate. We compared and evaluated trends in penile prosthesis procedures at a tertiary referral center before and after the introduction of sildenafil. We retrospectively reviewed the clinical records of 561 implant procedures over the past 10 years to categorize the operations (eg, simple/"virgin" implant, replacement, revision, removal) and to establish the duration, severity, and complexity of the ED. No significant change was found in the number of penile implant procedures done annually. Both complexity of the procedures and severity of illness increased. A downward trend was seen in the number of simple penile prostheses implanted. Our data suggest that, with an aging population both aware of and requesting therapy for ED, the number of penile implantations will remain stable or increase, especially at centers specializing in ED treatment.
Erectile dysfunction (ED) has been defined as the persistent inability to attain or maintain an erection adequate to permit satisfactory sexual performance. This disease affects between 20 and 30 million men in the United States. Treatment of ED usually begins with the least invasive approach, eg, oral medications, and then progresses to more invasive treatments, eg, intracavernosal injections, transurethral delivery of alprostadil (prostaglandin E1), and ultimately penile prostheses.
Before the introduction of sildenafil in March 1998, and currently, penile implants have had the distinction of being the most effective treatment for ED, with a relatively high satisfaction rate. However, the question arises as to the future status of penile prostheses in an era when new oral agents are about to enter the market. The availability of effective noninvasive methods for addressing ED may conceivably reduce the number of patients choosing intracavernosal injections, vacuum devices, and implants for treating impotence. However, as articulated by a number of ED authorities, the success rate of sildenafil is between 50% and 80%, and its introduction has conservatively tripled the number of men seeking treatment for impotence. Therefore, it may be anticipated that the use of implants will remain prevalent as those in whom sildenafil fails seek out other therapies.
We compared and evaluated the trends in penile prosthesis procedures over the past decade, both before and after the introduction of oral sildenafil. Specifically, our aim was to extrapolate from data to determine whether the number of penile prosthesis procedures will increase, decrease, or remain constant in the future with the introduction of newer, safer, and more efficacious oral medications for the treatment of ED.