Prótese peniana insuflável de três componentes - análise retrospectiva e comparativa

: Inflatable penile prosthesis implantation is the third-line treatment in erectile dysfunction (ED).Objective: To evaluate, in a retrospective and comparative analysis, the results of the placement of inflatable penile prostheses in the Department of Urology of São João Hospital Center in a five-year period (January 2008/December 2012).Material and methods: 49 patients underwent placement of inflatable penile prosthesis 3 components through penoscrotal approach during the referred period: Coloplast Titan in 20 patients; AMS 700 CX in 28; AMS 700 CXR in one. Etiology of erectile dysfunction: secondary to radical prostatectomy in 20 patients; diabetes mellitus in 12; other vasculogenic causes (cardiovascular disease, hypertension, metabolic syndrome, dyslipidemia) in 11; peripheral neurogenic (colorectal surgery, radical cystectomy) in 2; Peyronie's disease in 3; priapism in one. Patients had a mean age of 61.3years and the mean postoperative follow-up was 19.3months.Results: 43 patients (85.7%) have functioning prosthesis without complications. The overall satisfaction rate of patients with a functioning graft is 93%; in the subgroups of patients with prosthetic Titan Colopast and AMS 700 is, respectively, 88% and 95%. Have occurred the following complications: 3 cases (6%) of mechanical failure with need for surgical revision; 3 cases (6%) of infection and 1 case (2%) of urethral erosion combined with infection, all requiring prosthesis withdrawal. All complications (infection and mechanical failure) occurred in the subgroup of patients with Titan Colopast penile prosthesis, ie, there was 35% of complication rate in this subgroup. Correlating complications by subgroups, we found that there are statistically significant differences between the two types of prosthesis (p = 0.001 - Fisher's exact test). The median postoperative follow-up in both groups was, however, substantially different: 24months for the subgroup of Titan Coloplast subgroup and 12 for the AMS. Making an analysis of survival by Kaplan- Meier methodology, we found that there are statistically significant differences in survival free of mechanical failure or infection of prosthetic devices among the two subgroups (p = 0.033 - Log Rank test).Conclusions: The implantation of 3 components inflatable penile prosthesis is a treatment with a high rate of satisfaction for patients, with an acceptable complication rate. Our results show an overall complication rate slightly above the values found in the literature. Furthermore, in comparative analysis by subgroup, the subgroup of patients with Titan Colopast prosthesis has an abnormally high rate of complications (35%), rather than the absence of complications recorded in the subgroup of patients with AMS 700 prosthesis - this fact is dissonant with other published studies that point to similar results and complications between the two types of prosthesis. The plausible reasons for this occurrence may be: small sample size; less surgical experience during the placement of the Titan Colopast prosthesis, since in our series were the first to be placed; significantly longer follow-up Titan Colopast prosthesis, with consequently greater likelihood of complications.© 2014 Associação Portuguesa de Urologia. Published by Elsevier España, S.L.U. All rights reserved