Date Published: May 29, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Humberto G. Villarreal, LeRoy Jones.
Objective. To determine the outcomes of and satisfaction with the multi-component inflatable penile prosthesis (IPP) in the elderly male (age >71). Methods. Using a chart review and telephone survey, we retrospectively assessed patients who underwent IPP or combined IPP/artificial urinary sphincter (AUS) from 2004–2006. Results. We identified 56 patients that underwent IPP (48) or IPP/AUS (8). The age range was 71–86 (mean 74.3) at the time of surgery, with a follow-up range of 0.5–2.4 years (mean 1.5). The overall complication rate was 3.8% (2 of 56) with one device removed for infection and a second patient requiring exploration for a postoperative hematoma. The telephone interview was conducted with 35 of 56 patients. Patients rated ease of use (a scale from 1–5, 5 meaning very easy) and overall satisfaction (a scale of 1–5, 5 meaning very satisfied) at an average of 4.1 and 4.3, respectively. IPP usage varied from 0–7 times per month (mean 3.3). 32 of 35 patients (91%) said they would undergo the procedure again. Conclusion. Our review demonstrates that the IPP is well tolerated in the elderly male population, who report a high degree of satisfaction and ease of use with this device.
Erectile dysfunction is highly prevalent in our society and this prevalence will increase with age. Life expectancy continues to increase with US men now living greater than 75 years . It is estimated that up to 70% of males aged 70 have erectile dysfunction. The advent of oral phosphodiesterase type 5 inhibitors has allowed many men to regain normal sexual function and has placed the treatment of erectile dysfunction at the forefront of men’s health issues. When conservative therapy fails or when patients are not candidates for oral therapy, the multicomponent inflatable penile prosthesis (IPP) remains the gold standard of treatment. The safety and efficacy of the IPP has been well documented, but in spite of this, urologists may be reluctant to offer an IPP to older patients due to various concerns, including those regarding impaired dexterity of older patients and their ability to operate an inflatable device. There is little published data specifically examining results of the IPP in elderly men. The objective of this study was to determine the outcome and satisfaction of the inflatable penile prosthesis in the elderly male (age >70 years).
We conducted a single-center, two-phase analysis of patients over age 70 that underwent either IPP or combined IPP/Artificial Urinary Sphincter (AUS) from 2004 to 2006. All patients received routine preoperative counseling regarding risks, benefits, and realistic expectations of the surgery. Preoperative medical clearance was obtained if deemed necessary by the surgeon. All penile implants were from the AMS 700 series with Inhibizone and tactile pump. Our routine is to administer intravenous cefazolin preoperatively and perform a 10-minute surgical prep with betadine. However, since conclusion of this study, we have modified our surgical prep to chlorhexidine gluconate due to its recently proven superiority to povidone-iodine for surgical site antisepsis . All implants were performed by a single experienced prosthetic surgeon (LAJ). The initial phase consisted of a retrospective chart review and data collection with regards to patient age at implantation, type of surgery (IPP or dual IPP/AUS implantation), length of follow-up, and complications. The second phase involved a voluntary telephone survey conducted by a neutral party to assess ease of use and overall satisfaction (see the Appendix).
We identified 56 men that underwent either IPP (48) or IPP/AUS (8). Age ranged from 71 to 86 (mean 74.3) years of age at time of surgery. The postoperative follow-up range was 0.5–2.4 years (mean 1.5). In this group of patients, one device (IPP only patient) was removed for infection 8 months after implantation (infection rate 1.7%). Another patient had a postoperative hematoma requiring exploration, resulting in an overall complication rate of 3.4% (2 of 56). The telephone interview was performed on 35 of the 56 patients for a response rate of 62%. One patient had died and the remaining patients were unable to be contacted resulting in a nonresponse rate of 38% (21 of 56). No patient declined participation. Patients rated ease of use (on a scale from 1 to 5, with 5 meaning very easy to use) at an average of 4.1 (Figure 1) with difficulty inflating the device sited as a particular issue impairing use. Patients also rated overall satisfaction (on a scale from 1 to 5, with 5 meaning very satisfied) at an average of 4.3 (Figure 2). 28 of 35 patients (80%) rated their overall satisfaction 4 or 5. 32 of 35 patients (91%) rated their overall satisfaction 3 or higher. The most common complaint was dissatisfaction with penile length, reported by 3 of the responding patients, which is a complaint consistent with other previously published studies in the urologic literature . Patients reported frequency of use of the IPP at 0–7 times per month (mean 3.3) (see Figure 3). 32 of 35 patients (91%) said that they would choose to undergo the procedure again. Those declining noted poor rigidity (2) or partner dissatisfaction (1). 29 of 35 patients (83%) stated that they would recommend this procedure to a friend.
The safety and efficacy of the IPP has been well documented with long-term follow-up. Carson and associates from the AMS 700 CX study group evaluated patient satisfaction outcomes in 372 men . They found that at a median follow-up of 47 months, 79% used their prosthesis at least twice monthly and that 88% would recommend this procedure to others. The mean age of their population was 57.6 years. Levine et al. reviewed 131 men with a mean age of 56.8 years implanted with the 2-piece Ambicor inflatable penile prosthesis . They report an overall satisfaction rate 90% of patients and 82% of partners using the Erectile Dysfunction Inventory of Treatment (EDITS) questionnaire. 93% of their patients and 90% of partners would recommend the implant to others. A prospective approach using pre- and postoperative EDITS as well as IIEF scores was by Mulhall and colleagues who evaluated 96 men with a mean age of 56 years . They confirmed statistically significant improvement over baseline in both inventories at 12 months after IPP placement.
Implantation of the inflatable penile prosthesis should not be avoided in elderly males based solely on the age of the patient. Our paper demonstrates that the IPP is well tolerated in this patient population, who report a high degree of satisfaction and ease of use with this device.