Penile prosthesis in the organ transplant recipient

Objectives. To determine whether pelvic organ transplant recipients are at a higher risk of developing complications after placement of a penile prost hesis relative to those receiving a penile prosthesis who did not undergo p elvic organ transplantation. Methods. Two hundred eleven men underwent placement of a penile prosthesis by a single urologist at our institution between July 1994 and March 2000. Of these, 46 patients had undergone pelvic organ transplantation before pla cement of the penile prosthesis. The average time from transplantation was 43 months. The average follow-up after prosthesis placement was 23 months. These patients were monitored for various complications, including infectio n, malfunction, autoinflation, and injury to the prosthesis. They were comp ared with a cohort of men who had had a prosthesis placed but had not recei ved pelvic organ transplantation. Results. The overall complication rate was significantly higher in the tran splant patients (22%) than in the nontransplant patients (7.9%) receiving p rostheses (P <0.01). Infection was seen in 2 transplant patients (4.3%) and in 7 nontransplant patients (4.2%) (P <1). Malfunction occurred in 4 of th e transplant patients (8.7%) and 6 of the nontransplant patients (3.6%) (P <0.2). In those patients with a prosthesis malfunction, 9 of 10 involved a three-piece prosthesis. All four malfunctions in the transplant group occur red in three-piece prostheses. The difference in the rate of malfunction wa s statistically significant (P <0.001) when comparing the three-piece prost hesis in the transplant and nontransplant patients (P <0.001). Surgical inj ury to the retroperitoneal reservoir occurred in 4 transplant patients (8.7 %) (all with three-piece prostheses) and in none of the nontransplant patie nts (P <0.001). Conclusions. The risk of infection after insertion of penile prostheses in patients with pelvic organ transplantation was similar to that in nontransp lant patients. The risk of malfunction and injury to the prosthesis (three- piece) was higher in transplant patients. The overall complication rate was significantly higher in patients after transplantation and can be attribut ed to the reservoir complications related to three-piece prostheses. In pat ients with a prosthesis that did not have a retroperitoneal reservoir, no s ignificant difference in the overall complication rate was observed. Pelvic organ transplant recipients in whom traditional conservative therapy for e rectile dysfunction fails should be considered candidates for penile prosth esis placement. However, three-piece prostheses should be avoided, as these patients are best served with prostheses that do not require a retroperito neal reservoir. UROLOGY 57: 138-141, 2001. (C) 2001, Elsevier Science Inc.