POSTGRADUATE RESIDENT AT THE MAYO CLINIC AT ROCHESTER, MINNESOTA Professor of Urology, University of Costa Rica, San José, CR Member of American Urologic Association Tel. (506)233-1514 Fax(506)290-3106 Home(506)232-0993 P.O. Box 8040-1000 San José, Costa Rica corlich@sol.racsa.co.cr

Penile Implants Our Urology practice has been implanting penile prosthesis for men with organic impotence since 1975. I recommend now the Mentor Alpha 1 inflatable penile prosthesis as the very best device on the market today. This is a three-piece hydraulic prosthesis that consists of an abdominal fluid reservoir, a scrotal pump, and paired cylinders made of bioflex, a polyurethane polymer. The current version is called the Alpha 1 inflatable penile prosthesis and comes in six cylinder lengths: 12 cm; 14 cm; 18 cm; 20 cm; and, 22 cm. The ideal candidate for implantation is a man with organic impotence... however, men with psychogenic impotence can also be considered for implantation if they have failed sex therapy. Some causes of organic impotence are vascular problems secondary to atheroesclerosis, diabetes mellitus, neurogenic problems like spinal cord injury, Peyronies Disease which is a disease with fibrous plaques in the shaft that causes penile curvatures or deviations, impotence secondary to priapism or prolonged erections, medications, and liver disease related to alcohol intake; and, cigarette smoking. It has been estimated that ten million American males have impotence.

The operation is performed through a small incision where the penis joins the sac covering the testis. Two tunnels are made on the corpora cavernosa on each side of the penis and the cylinders are placed here, the reservoir contains the fluid to the system and is placed behind the pubic bone and the pump is placed in the scrotum in a place where the patient can easily inflate and deflate the device; the fluid goes back and forth in the cylinders and this causes the erection, which can last as long as wanted.

Goldstein reports that 89% of the men claim fulfilled expectations. This Alpha 1 prosthesis has been found markedly improved over earlier inflatable prostheses. A 2.5% mechanical failure rate and a 6.9% reoperation rate has been reported. The risk of infection is 2.8% and this is the most common complication necessitating device explantation. There is a life-time policy guarantee on the device.

The patient is hospitalized only for one day in most of the cases. The entire cost for the operation and the device is much lower in Costa Rica than in the USA (about half of the cost). Our practice obtains better rates on the cost of the device, which is passed along to the patient... as well as economical hospitalization costs and medical fees.

References:

1. Goldstein I., Et al.: Safety and efficacy outcome of Mentor Alpha 1 inflatable penile prosthesis implantation for impotence treatment. Journal of Urology, 157:833-839, 1997.

2. Montague. D. Penile Prosthesis. In: A. Bennett. Impotence. Diagnosis and management of erectile dysfunction., W.B. Saunders Co.: 257-296, 1994.

[Dr. Claudio R. Orlich Homepage]