Indication and results of semirigid penile prostheses in spinal cord injury patients: long-term followup.

During the last 7 years semirigid intracorporeal penile prostheses were inserted in 36 spinal cord injury patients between 21 and 58 years old (average age 38.5 years). An operation was done 1 to 32 years after the initial injury (average 10 years). Surgical intervention was intended to provide an adequate body to the penile shaft so as to hold an external urinary drainage device in 11 patients, for treatment of sexual dysfunction only in 17 and for an external urinary drainage device plus treatment of sexual inadequacy in 8. Although a number of complications causing extrusion or removal of the prosthesis occurred in 6 patients (16.5 per cent), as well as an aborted operation in 1 (19.5 per cent), there were no permanent sequelae. Because of loss of sensation and vasomotor control, and pressure produced by the penile prosthesis spinal cord injury patients represent a higher operative risk than other patients without neurological or vascular impairments. In addition, urinary tract infection should not be overlooked as another major risk factor. Penile prostheses were most successful in maintenance of external urinary appliances in patients with a short or retractile penis. Whenever the prosthesis was intended for sexual intercourse an important prerequisite to a successful surgical outcome was the retention of some reflexogenic or psychogenic erection over and above the rods. Careful individual preoperative assessment is advised if a satisfactory result is to be achieved.