Few people actually develop priapism from utilizing these medications. Despite these drugs being very effective, not everyone will respond to them, and there are some patients who are not able to use them at all.
For patients such as these, penile prostheses are available. A penile prosthesis is a device that is surgically inserted into the erectile bodies of the penis. Some of these devices are inflatable and also contain a small pump mechanism that requires the pump to be manually activated to obtain an erection and a deactivation maneuver to deflate the prosthesis.
Other models are malleable rods that are implanted and then manipulated into an upright “erect” position for sexual relations, and then after being used are positioned into the “non-erect” position. The market for penile prosthesis is controlled by two manufacturers, American Medical Systems and Coloplast (formerly Mentor).
Over the years technology has progressed significantly and many modifications to these devices have occurred. The fist prosthesis that was ever performed utilized a graft from a rib. The first inflatable prostheses were developed in the early 1970s by Drs. Scott and Bradley.
The early models were associated with a high failure rate and an associated high revision rate. In the formative years fairly high infection rates were associated with the implantation of these devices, but advances in antibiotic therapy and surgical technique have significantly decreased these infections.
In the upcoming weeks, I will begin to discuss the pros and cons of prosthetic implantation, and the various models that are currently available.