AMS three-piece inflatable implants for erectile dysfunction: A long-term multi-institutional study in 200 consecutive patients

Objectives: The aim of this study was to assess the longterm mechanical rel iability of AMS (American Medical Systems) three-piece inflatable implants and their impact on patient-partner satisfaction in 200 consecutive patient s with erectile dysfunction who underwent surgery in five different institu tions. Methods: Patient charts included in the study were collected and extensivel y assessed to record pre- and intraoperative data and postoperative complic ations. All patients and 120 partners were then seen often in the office at a mean follow-up of 59 months (range 6-130) and they were extensively ques tioned about function of the device and its impact on the couple's sexual l ife. Results: At the long-term follow-up, 185 patients (92.5%) were still engagi ng in sexual intercourse with a mean frequency of 1.7/week. Patients and pa rtners reported prosthetic erections as excellent, satisfactory or poor in 96 (48%), 100 (50%) and 4 (2%) cases, and in 20 (17%), 80 (66%) and 20 (17% ) cases, respectively. Postoperative sexual activity was considered excelle nt, satisfactory or poor by 140 (70%), 44 (22%) and 16 (8%) patients and by 34 (28%), 81 (68%) and 5 (4%) partners, respectively. Reasons for patients ' complaints included postoperative penile shortening in 60 (30%) cases and poor glandular engorgement in 40 (20%) cases. Partners' main complaint was unnaturalness of the prosthetic erection, a factor reported by 30 (25%) su bjects. Complications requiring surgical exploration included infection in 12 patients (6%) and mechanical failure in 8 patients (4%). Kaplan-Meier es timates demonstrated significantly decreased mechanical survival for the Ul trex type of cylinders compared to the CX type of cylinders. Conclusions: AMS three-piece inflatable implants provide an overall patient and partner satisfaction rate of 92 and 96%, respectively. However, postop erative penile shortening and poor glandular engorgement were the causes of some complaints among the patient population as well as the unnaturalness of prosthetic erection among female partners. In the long-term, mechanicall y speaking, CX cylinders seem to be more reliable than the Ultrex ones. Cop yright (C) 2000 S. Karger AG. Basel.