Who is a candidate for a penile prosthesis

Penile prostheses are usually placed in men with organic ED. In men with psychogenic erectile dysfunction, extensive counseling should be administered and other treatment options should be exhausted before a penile prosthesis is considered. For all other patients, extensive patient and partner counseling should take place before placement of a prosthesis; the expectations, indications, and risks need to be discussed clearly, as well as other currently available and future options.

A penile prosthesis is rarely the first-line therapy for ED. In my practice, when I discuss penile prostheses with patients, I equate the procedure for its surgical placement with crossing over a rickety bridge that collapses once the prosthesis is implanted. You cannot go backward once the prosthesis is placed; if it is removed because of infection, malfunction, or dissatisfaction, other options of treatment are unlikely to work. Although there have been reports of the vacuum device and injection therapy working in some individuals after removal of a prosthesis, these instances are not common. For all these reasons, it is best to try all available therapies and determine whether they are successful and satisfactory before placement of a prosthesis occurs.

Indications for a penile prosthesis include the following:

• The patient's unwillingness to consider, failure to respond to, or inability to continue with other forms of treatment, such as oral therapy, injection therapy, MUSE, and the vacuum device

• Postinjection therapy penile fibrosis

• Peyronie's disease and erectile dysfunction

• Postpriapism erectile dysfunction

• Sex-change operations in women who undergo surgical creation of a penis

• Penile amputations in men, who then undergo surgical creation of a penis

• Psychogenic erectile dysfunction, after extensive counseling and evaluation

• Neurogenic bladders requiring condom catheters for urinary drainage

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