IMPLANTATION OF PENILE PROSTHESIS IN MEN 35 YRS AND YOUNGER: A CASE SERIES

Erectile dysfunction (ED) is traditionally viewed as a condition affecting older men, with insertion of a penile prostheses (PP) reserved for refractory cases. However, there has been a notable increase in the incidence of ED amongst younger males, leading to an increased need for PPs in men aged 35 yrs and younger.

Between August 2007 and February 2024, all patients aged 35 yrs and younger undergoing virgin implantation of a PP were collected. Patients undergoing PP implantation secondary to phalloplasty were excluded.

A total of 56 men aged 35 yrs or younger received a PP, with a mean age of 29 yrs (±4 yrs, range 18-35 yrs). Indications for implantation included priapism (19/56, 33.9%), psychogenic ED (17/56, 30.4%), and vasculogenic or neurogenic ED (20/56, 35.7%). Notably, 17 patients (30.4%) reported lifelong ED, having never experienced a spontaneous erection suitable for penetration.

Among the 17 patients with psychogenic ED, 64.7% (11/17) had previously engaged with clinical psychology, and 58.8% (10/17) had received a formal psychiatric diagnosis.

A malleable prosthesis was implanted in 17 patients (30.4%), while 39 (69.6%) received a three-piece inflatable prosthesis. Overall, 75% (42/56) of patients expressed satisfaction with their prosthesis, with dissatisfaction primarily attributed to perceived short length. Patient satisfaction in the inflatable prosthesis group (33/39, 84.6%) was higher than in the malleable prosthesis group (9/17, 52.9%). The revision rate at five years was 32.1% (18/56), with 33.3% (6/18) of these patients undergoing conversion from a malleable to an inflatable prosthesis. There was only 1 (1.8%) case of implant infection which necessitated removal and subsequent delayed re-implantation.

This case series highlights the growing prevalence of treatment-resistant ED in men aged 35 yrs and younger requiring PP insertion. Our findings indicate that a substantial proportion of these cases are psychogenic in nature, emphasising the need for comprehensive psychological evaluation prior to surgical intervention. The high satisfaction rates among patients with inflatable prostheses suggest that, despite the challenges posed by younger patients, effective outcomes can be achieved with appropriate selection and management.

Nil to declare.