Perioperative therapies and techniques to enhance penile dimensional and functional outcomes following inflatable penile prosthesis implantation: a contemporary 10-year systematic review

Implantation of inflatable penile prosthesis should be considered as a definitive treatment of erectile dysfunction. However, the sole procedure might not allow for optimal dimensional and functional outcomes. The aim of this study was to systematically review the literature and present the findings on the optimal choice of perioperative methods, surgical techniques, and pharmacotherapy to improve penile length, curvature, and erectile function. Fifteen studies and 697 men were included. Nine studies focused on intraoperative techniques only, while 6 described intra- and postoperative methods. Regarding the outcomes, curvature of the penis was reported in 12 studies, penile length in 5 studies, penile girth in 2 studies, and the International Index of Erectile Function-5 (IIEF-5) score in 7 studies. According to this systematic review, extreme angulation can be reduced using plaque/corporal incisions and grafting with collagen fleece, as well as "scratch" technique with postoperative vacuum therapy. Also, among patients with preoperative curvature of approximately 30°-40°, penile plication, corporoplasty, tunica expansion procedure, manual, and at-home modeling can provide good results. In addition, corporal incisions plus grafting, as well as postoperative vacuum therapy might be the most beneficial in terms of length improvement. Importantly, penile implant in combination with the sealing, daily, and early prosthesis activation proved to improve length. Moreover, postoperative vacuum therapy has also been shown to greatly increase penile circumference. Finally, penile implant in combination with the sealing, corporal incisions plus grafting, "scratch" technique, vacuum therapy, and phosphodiesterase-5 inhibitor are all associated with major improvements in sexual function.