A Systematic Review of Penile Prosthesis Insertion in Patients With Spinal Cord Injury

Karl H Pang; Asif Muneer; Hussain M Alnajjar

doi:10.1016/j.sxmr.2022.01.004

A Systematic Review of Penile Prosthesis Insertion in Patients With Spinal Cord Injury

Sex Med Rev. 2022 Jul;10(3):468-477. doi: 10.1016/j.sxmr.2022.01.004. Epub 2022 Feb 24.

Authors

Karl H Pang¹, Asif Muneer², Hussain M Alnajjar³

Affiliations

¹ Institute of Andrology, Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
² Institute of Andrology, Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; UCL Division of Surgery and Interventional Science, London, UK; NIHR Biomedical Research Centre, UCLH, London, UK.
³ Institute of Andrology, Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK. Electronic address: [email protected].

PMID: 35221231
DOI: 10.1016/j.sxmr.2022.01.004

Abstract

Introduction: A penile prosthesis (PP) may be inserted for erectile dysfunction (ED) and/or urinary management in men with spinal cord injury (SCI). This group of patients is considered high risk for complications due to their reduced mobility and sensation.

Objectives: To identify the complication and satisfaction rates following PP insertion in patients with SCI.

Methods: A systematic review of the literature was performed according to the PRISMA checklist. The Medline/PubMed and EMBASE databases were searched up to July 27th 2021. Studies on men ≥18 years who had a PP inserted for ED secondary to SCI were included. Two reviewers independently screened all articles, assessed for risk of bias and performed data extraction.

Results: Eleven studies including 475 men with SCI were included for analysis. The overall complication rate was 4.2-61.1%. Specific complications included infection, 0-16%; erosion, 3.7-11.1% and mechanical failure, 0-16.7%. The explantation rate was 2.1-16.7% and the revision rate was 2.7-44.4%. Overall, 79.2-92.9% of men were satisfied with their PP and, 36-86.1% were having satisfactory sexual intercourse. In those who used the PP for urinary management ± ED, 86.5--92.8%% were satisfied. Men with SCI had higher rates of complications compared to those without SCI (infection, 2.1-9.1% vs non-SCI, 0.8-5.7%; erosion, 2.1-8.3% vs non-SCI, 0%; explanation, 2.1-8.3% vs non-SCI, 0.8-5.7%).

Conclusion: PP is an option for SCI patients for the management of end-stage ED or urinary function, but the rate of infection, erosion and implant explantation is higher compared with men without SCI. Inflatable penile prosthesis (IPP) is the preferred PP due to the lower risk of erosion, however, they are prone to mechanical failure and require good hand dexterity. A thorough pre-operative counselling is essential. Pang KH, Muneer A, Alnajjar HM, et al. A Systematic Review of Penile Prosthesis Insertion in Patients With Spinal Cord Injury. Sex Med Rev 2022;10:461-470.

Keywords: Erectile Dysfunction; IPP; Inflatable Penile Prosthesis; Malleable Penile Prosthesis; Neurogenic; Neurogenic Erectile Dysfunction; Penile Prosthesis; Spinal Cord Injury.

Publication types

Review
Systematic Review

MeSH terms

Erectile Dysfunction* / etiology
Erectile Dysfunction* / surgery
Humans
Male
Patient Satisfaction
Penile Implantation* / adverse effects
Penile Prosthesis* / adverse effects
Penis / surgery
Spinal Cord Injuries* / complications
Spinal Cord Injuries* / surgery