Authors' objectives:

Based on the state of current knowledge, this study sought to assess the efficacy, effectiveness and safety of penile prostheses in the treatment of male erectile dysfunction (ED), draw up selection criteria for candidate patients, and put forward recommendations on the application of such criteria in our healthcare context.

Authors' results and conclusions: A total of 52 papers were selected. The overall prosthesis survival rate at five years was 78%-91% and the surgical complication rate was 3%-8%. There were fewer mechanical failures and lower infection percentages in semi-rigid than in inflatable prostheses, with high levels of postoperative satisfaction among patients and partners alike, higher indeed than for the rest of the currently available treatments.

Authors' recommendations: Treatment of ED should be staged, with penile prostheses being reserved for those cases of dysfunction of an organic nature in which previous treatments have failed or not been accepted by the patient, or in cases of complex malformations of the penis. Despite the dearth of studies of methodological quality, it is nevertheless undeniable that information accumulated in recent years from numerous observational studies attests to the marked effectiveness of current penile prostheses, with high percentages of complication-free survival and successful achievement of erections adequate for the purpose of coitus. Hence, penile prostheses should be considered part of the erectile-dysfunction therapeutic arsenal, albeit as the last stage when all other possible alternatives have been exhausted. Furthermore, these prostheses afford high levels of postoperative satisfaction -higher indeed than any of the remaining ED treatments available- and also enhance patients' self-esteem as well as the couple's' emotional relationship and quality of life per se. This therapeutic option must be performed at facilities staffed by multidisciplinary teams that adopt an integrated approach ED, with proper protocolling of the entire process being essential to ensure the greatest possible efficiency. Proper selection of candidate patients and prostheses to be implanted is indispensable and should invariably be done on a case-by-case basis. Patients must receive adequate briefing without fail, not only as to the benefits that they hope to enjoy, but also as to the foreseeable consequences of the intervention and the frequent, infrequent and personalised risks, both short- and long-term, which may arise. Society's keen concern about erectile function, coupled with the availability of effective medical drugs for dysfunction, renders it likely that there will be a future increase in demand for penile prosthesis implants among patients who are highly motivated yet resistant to less invasive treatments.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.sergas.es/MostrarContidos_N3_T02.aspx?IdPaxina=60056&uri=http://www.sergas.es/gal/Servicios/docs/AvaliacionTecnoloxias/INFORME_PROTESIS.pdf&hifr=750&seccion=0

Year Published: 2005

URL for published report: http://www.sergas.es/MostrarContidos_N2_T01.aspx?IdPaxina=60056

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Scientific Advice Unit, avalia-t; The Galician Health Knowledge Agency (ACIS)

Contact Address: Conselleria de Sanidade, Xunta de Galicia, San Lazaro s/n 15781 Santiago de Compostela, Spain. Tel: 34 981 541831; Fax: 34 981 542854;

Contact Name: avalia-t@sergas.es

Contact Email: avalia-t@sergas.es

Copyright: Galician Agency for Health Technology Assessment (AVALIA-T)