Chronic pain associated with penile prostheses may persist despite revision or explantation

Authors

DOI:

https://doi.org/10.5489/cuaj.7391

Keywords:

Penile Prosthesis; Chronic Pain; Erectile Dysfunction

Abstract

Introduction: Inflatable penile prosthesis (IPP) implantation is the gold standard treatment for medically refractory erectile dysfunction. New chronic pain after IPP implantation is rarely discussed and the optimal treatment is unclear. We evaluated whether IPP re-operation for a primary indication of chronic pain improves patients’ symptoms. Our secondary aim was to explore factors associated with resolution or persistence of pain after IPP reoperation.

Methods: We conducted a retrospective analysis of 315 patients who had an IPP revision or explantation at two high-volume prosthetic centers between May 2007 and May 2017. We excluded patients who had device malfunction, pain for <2 months, pain associated with infection or erosion, and patients without long-term followup data. Persistent pain was diagnosed based on patient self-report.

Results: A total of 31 patients met our criteria for having undergone a surgical revision (n=18) or explantation (n=13) for pain relief. Eighteen (58%) patients had persistent pain despite surgical intervention. Only patients who had pain secondary to a device malposition improved after re-operation (n=13). A prior diagnosis of a chronic pain syndrome was associated with persistent pain despite intervention. Pain improvement was not associated with age, comorbid conditions, duration of implant, or the number of surgical revisions performed.

Conclusions: Surgical intervention for chronic penile prosthesis pain is unlikely to relieve symptoms, particularly for patients with chronic pain disorders. Patients should be counselled that IPP reoperative procedures as a treatment for pain should be avoided unless the device is identified to be malpositioned, and consideration of alternative therapeutic options may be more beneficial.

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Author Biographies

Jeffrey D. Campbell

Department of Surgery, Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON., Canada; The James Buchanan Brady Urological Institute and Department of Urology, the Johns Hopkins School of Medicine, Baltimore, MD, USA

Ernest Pang Chan, Western University

Department of Surgery, Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

Andrew Di Pierdominico

Department of Surgery, Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

Serkan Karakus

The James Buchanan Brady Urological Institute and Department of Urology, the Johns Hopkins School of Medicine, Baltimore, MD, USA.

Bruce Trock

The James Buchanan Brady Urological Institute and Department of Urology, the Johns Hopkins School of Medicine, Baltimore, MD, USA

Gerald B. Brock

Department of Surgery, Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

Arthur L. Burnett

The James Buchanan Brady Urological Institute and Department of Urology, the Johns Hopkins School of Medicine, Baltimore, MD, USA

Published

2021-09-24

How to Cite

Campbell, J. D., Chan, E. P., Di Pierdominico, A. ., Karakus, S. ., Trock, B. ., Brock, G. B., & Burnett, A. L. (2021). Chronic pain associated with penile prostheses may persist despite revision or explantation. Canadian Urological Association Journal, 16(2), 42–6. https://doi.org/10.5489/cuaj.7391

Issue

Section

Original Research