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The Implant of Penile Prostheses (Silicone, Malleable, Inflatable) represents an efficient solution for patients affected by Erectile Dysfunction (ED) and penetrating incapacity who do not respond to the other treatment modalities (PDE5i, PGE1, Vacuum Systems). Patients with penile prostheses regain the spontaneity of intercourses without having to assume drugs, to introduce mechanically medical substances or to activate complex mechanisms. Just like the whole field of prosthetic surgery, introducing into the organism a “foreign body” can lead to complications connected to the patient, the inserted matter, the inserting surgical procedure and the after-care. A “relevant” complication which almost always leads to the removal of the implant and thus to the failure of the surgeon’s treatment and to the extreme disappointment of the patient’s expectations -can often be considered as result of an initially “small” complication, which could be faced and solved (with drugs or a minor surgery) without having to resort to removal. The authors present a variety of medical and surgical procedures, derived from their over 34-year experience (1984-2018) in Penile Prosthesis Surgery (PPS), which may be implemented to avoid implant failure. Plenty of other complications are possible and have been registered in Medical Literature. They are often caused by reactions of the penile tissues, by vascular or hemorrhagic phenomena, by modifications in the penile or glans sensibility. in prosthetic surgery [7], difficult to cure with usual antibiotic therapy [8]. The use of new IPP such as AMS 700 with InhibiZone, (antibiotic surface treatment), or Coloplast hydrophilic coating (which absorbs and releases antibiotic) has led to a significant reduction, but not eradication, in the rate of infections [9,10]. The mechanical breakdown of Inflatable Penile Prostheses (IPP) [11], which can cause them to malfunction is another possible complication. In such a case, the implant must be removed and replaced with a similar system. Leading Manufacturers guarantee their replacement in the event of malfunction. However, the emotional effects and the financial cost of a new surgical procedure, often not covered by Health Insurance, are negative factors for patients [12]. In some cases, the surgical maneuvers performed to create a space for the reservoir in the peritoneal cavity o in the peri vesical space could provoke intestinal herniation, torsion or perforation, hematoma of the abdominal wall and bladder perforation [11,13]. AMS and Coloplast have recently introduced new reservoirs which are easier to insert and more adaptable, (Conceal and Cloverleaf) [13-16]. A frequent complication is determined by the incorrect sizing of the cavernous spaces, which can lead to the insertion of inadequate cylinders which could erode or perforate the corpora cavernosa or affect the symmetry of the penis (SST effect) [17]. In general, many complications encountered with penile surgery are highly dependent on the surgeon’s experience [18]. Diabetes, Urinary Tract Infections, Blood Coagulation disorders, immunodepression often present in this kind of patients such as duration of hospitalization, Review aRticle

Penile Prosthesis Surgery in Italy: Personal Experiences, Complications and Considerations after 552 Cases