• Less Expensive
• Less chance of wear-induced failure
• Easier placement
• More appropriate for men who are anticoagulated
• Better at holding condom catheter in place
• More difficult to conceal, as is always firm
• No change in penile girth
• No change in penile length

• Will not recreate length of patient's natural erection
• More pronounced gladular end provides support for condom catheter
• Preferred in SCI or men with neurologic disease, due to their decreased/lacking penile sensation
• Avoids the greater risk of erosion seen with semirigid prothesis

Three-Piece Inflatable Prosthesis

• Will not recreate length of patient's natural erection
• Allows most control over erection
• Provides most natural appearance when not in use
• Can add girth with inflation
• Higher chance of mechanical failure
• Patient needs good manual dexterity to work scrotal pump

Ideal Penile Prosthesis

• Cosmetically resembles natural erection
• Resembles natural flaccid state
• Is convenient and easy to use
• Allows for spontaneity
• Does not distort natural penile shape
• For the majority of men this ideal is a three-piece inflatable prosthesis

Contraindications to Surgery

• UTI
• Active infection anywhere on the body, but particularly on the groin and perineal area
• Elevated glycosolated hemoglobin in diabetic patients is not a contraindication, unless it is greater than 11.5%

Preoperative Evaluation

• Manual Dexterity
  • Less of an issue with malleable prosthesis
  • Important that patient be able to manage scrotal pump
• Personal Hygiene
  • Patient must have access to living conditions that support his need to keep incision clean
  • Patient must be able to comprehend need to keep incision site clean

Preoperative Patient Counseling

• Any prosthesis creates erections that are approximately 1/2 to 1" shorter than patient's natural erection
• Effective preoperative education is also important in order to prevent unrealistic expectations after the surgery.

Postoperative Management

• Since the reasons for this surgery are usually kept quiet by patient, he may receive little support while in the hospital or during the initial post-operative perion
  • Nursing staff will have important support role, especially with patient who is not involved in a relationship
  • Provide opportunities for patient to discuss feelings regarding surgery itself and recovery

Immediate Postoperative Care

• Sexual activity should be avoided prior to initial postoperative visit
• Use of the prosthesis prior to proper healing of the incisions could cause damage to the incision, and potential damage to the prosthesis; it also increases the risk of infection
• Dr. Schoenfeld will advise when it is safe to resume sexual activity

Follow-Up

• Reported improvement in self-image
• Increased satisfaction with intercourse and orgasm
• Increased frequency of intercourse
• Rejection by partner (illustrates why it is vital to include patient and partner in decision making/ education)
• Carry prosthesis identification card or MedicAlert bracelet at all times
  • Prevents misinterpretations of pelvic x-ray
  • Prevent misdiagnosis of priaprism in the case of the semi-rigid prosthesis

Overall Satisfaction Rate

Overall satisfaction rate comparing Viagra with Penile Prosthesis.

• 82% overall satisfaction with Viagra
  
  
• 95-97% overall satisfaction with penile prosthesis