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Comment on: Technological advances in penile implants: past, present, future

International Journal of Impotence Research (2023)Cite this article

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Penile implant surgery is a developing procedure that requires further research to achieve better results, as mentioned by May et al. [1]. However, we emphasize to the readers how this procedure can positively impact the functional and psychological aspects of erectile dysfunction patients. The surgical implantation of a penile prosthesis is the recommended therapy for those patients who are not suitable for different pharmacotherapies, prefer a definitive therapy, or do not respond to other treatment modalities [2]. It has also proven beneficial in patients who experience erectile dysfunction after prostate cancer therapy or ischemic priapism [3,4,5]. This therapy represents an alternative that holistically impacts the patient’s health. It has been reported that patients increase their sexual quality of life after penile implant surgery, which is associated with better relationship satisfaction and stability [6]. Also, penile implant surgery improves the sexual quality of life of patients’ partners [6, 7]. Restoring patients’ ability to practice sexual intercourse has multiple beneficial impacts on their physical and mental health outcomes, such as reduced stress levels and decreased rates of depression and anxiety [8].

Furthermore, penile implant surgery positively impacts a neglected group: the transgender male. Female-to-male gender affirmation surgery aims to correlate the patient’s physical and functional characteristics with their male gender identity; in this process, genital masculinization plays a crucial role [9]. It has been shown that after the procedure, transgender men experience improved body image, sexual satisfaction, mental health, and overall happiness and have equivalent quality-of-life scores to cis-gendered men [9]. Penile implant surgery provides a unique alternative to accomplishing an overall benefit in sexual and mental health because it allows transgender patients to achieve the quality of stiffness necessary for penetrative intercourse, allowing them to have a physique consistent with their gender identity and fulfilling the functions of a cisgender man [10]. However, as May et al. mentioned, this surgery reports a higher percentage of complications in transgender patients [1, 10], possibly because many surgeries are performed in conjunction with other more complex procedures such as a neophallus and neourethra [10]. Therefore, urologists and physicians must develop technologies and tools that will allow us to reduce these complication rates and keep improving the quality of life for this historically neglected population. Also, we must improve education about penile implants. Patient satisfaction after the procedure depends on factors such as expectations of the results and misinformation about the surgery [1, 6, 11]. The physician must perform a complete preoperative evaluation that addresses the most common concerns and misconceptions about surgery for each patient, such as enlargement of the penis, lack of sensibility after the procedure, and quality of rigidity [12, 13]. Other sexual disorders, such as ejaculatory or orgasmic disorders, should be screened, and the doctor should clarify that these pathologies require specific treatment. We might achieve a higher patient satisfaction rate if we consistently carried out this education before surgery. In our experience, another factor that significantly impacts patient satisfaction after the procedure is the partner’s inclusion throughout the entire process. A strong association between postoperative partner sexual satisfaction and patient satisfaction has been demonstrated [11]. Erectile dysfunction is a challenging pathology with a high influence of social and cultural factors that generate stigma in patients affected by it. Limiting the approach of this pathology to obtaining good genital function is insufficient. But by broadening the approach to this pathology to a relational context and including the psychological variables that constitute sexual satisfaction and quality of life for the patient and his or her partner, we will achieve superior outcomes [12]. Therefore, a preoperative conversation to identify their needs and acquire communication skills is crucial. The penile implant is a surgery in development, but it also offers unique advantages to the people who undergo it; in some cases, it represents the only alternative for patients. Education and research should be our pillars as a scientific community to offer a global approach to patients who require this procedure. We must inform patients about this procedure in the pre-surgical consultation to resolve their doubts and fears and to achieve realistic expectations. Also, we encourage the scientific community to continue searching for ways to improve this procedure. If we perfect this procedure, we will help the LGBTIQ+ community, patients exposed to radical prostatectomy, and patients with erectile dysfunction refractory to treatment to improve their sexual health, have better self-perception and self-esteem, and improve their relationship with their partner.

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References

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Authors and Affiliations

  1. Department of Urology, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia

    Sandra García

  2. Urology research assistant, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia

    Sebastián Peña Rodríguez

  3. Medical Student, Universidad de Los Andes, Bogotá, Colombia

    Juan Camilo Alarcon

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  1. Sandra García
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  3. Juan Camilo Alarcon
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JCA. Designed the work that led to the submission, acquired data. Drafted the manuscript. Approved the final version. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SPR. Conceived and designed the work that led to the submission, acquired data. Revised the manuscript. Approved the final version. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SG. Conceived the work that led to the submission. Revised the manuscript. Approved the final version. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Sandra García.

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García, S., Peña Rodríguez, S. & Alarcon, J.C. Comment on: Technological advances in penile implants: past, present, future. Int J Impot Res (2023). https://doi.org/10.1038/s41443-023-00720-6

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