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Penile prosthesis implantation (PPI) is becoming increasingly popular for treatment of erectile dysfunction that will not respond to medical treatment. However, reasons for dissatisfaction with PPI, decreased penile size was among the reasons stated by the patients, quoting “it got small, the prosthesis is short, it does not have enough thickness, it does not get to the front”. Aim of Study: To evaluate patient and partner’s impression of penile length when implanting penile prosthesis with cylinder length determined in the erect state, compared to regular implantation as per the flaccid stretched length. Patients and Methods: A 3-piece girth expanding penile prosthesis was implanted in 38 patients: 16 patients with cylinder length sized in the erect state, induced by intra-cavernosal injection of vasoactive material (ICI) (study group), compared to regular implantation as per the flaccid stretched length (control group; n=22). Patients in the study group were educated as to signs of pending perforation and instructed to seek urgent consultation if such signs set in. Patients were followed up for 20-24 months. Complications and patients/partner impression of post-operative erect length compared to their recall of erect length before ED had set in. Results: In the study group, 6.2% of patients and 12.5% of partners reported shorter length, compared to 81.9% of patients and 95.5% of partners in the control group (p<0.001). One case (6.3%) in the study group showed signs of pending anterior perforation by the ninth month post-operatively. Re-operation was performed, removing a 1 cm rear tip extender from each cylinder. Conclusion: Implantation of an inflatable penile prosthesis with cylinder length determined in the erect state is both safe and effective in preserving impression of penile length, provided the benefits outweigh the slightly higher risk of anterior perforation, and that pending perforation is detected early enough in which case the implant can be shortened.

Oversizing Penile Prosthesis Length as per the Erect Length by Intra-Cavernosal Injection of Vasoactive Material