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Penile and Urethral Implants
Bryan R. Foster, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Erectile dysfunction (ED)
            • Artificial urinary sphincter (AUS)
            • Inflatable penile prosthesis (IPP)
          • Synonyms

            • Penile prosthesis
          • Penile Implant

            • Implanted mechanical device used to restore or improve erectile function
            • Peak implant rates were in 1990s prior to introduction of pharmacologic therapy for ED
              • After dropping precipitously, implant rates have slowly increased to plateau of about 28,000 per year worldwide
            • Device types
              • 3-piece IPP
                • Composed of 2 fluid-containing, expandable cylinders placed in corpora, reservoir placed in perivesical space, and pump placed in scrotum
                • Rear tip extenders are attached to proximal end of cylinders and are placed far posterior in corpora for anchoring and are rigid (do not inflate)
                • Tubing attaches 3 components and runs through inguinal canal
                • Inflation and deflation is achieved by activation of scrotal component, sending fluid from reservoir to cylinders and vice-versa
              • 2-piece IPP
                • Similar to 3-piece but reservoir is eliminated and fluid is stored in proximal tips of cylinders
              • Semirigid system
                • Malleable metallic device that is always rigid and can be bent into position to achieve penetration
          • Urethral Bulking Agents

            • Injectable material placed in periurethral tissues
              • Delivered with needle placed transurethral or periurethral
              • Injected between bladder neck and mid urethra
            • Generally used in women with stress urinary incontinence
              • Less risk than more invasive treatments (i.e., mesh) but lower treatment success rates
              • Can be used in men with incontinence after prostatectomy
            • Material adds bulk to weak urethral sphincter and goal is to coapt lumen to prevent incontinence during times of ↑ abdominal pressure
            • Several devices available for use in United States
              • Pyrolytic carbon-coated beads: Promote collagen formation
              • Silicone elastomer material
              • Calcium hydroxylapatite
              • Many other agents (collagen, ethylene vinyl alcohol, hyaluronic acid, etc.) have been used historically but have been discontinued in United States
          • Artificial Urinary Sphincter

            • Limited to treatment of male incontinence
            • Similar design to 3-piece inflatable penile implant consisting of pump, reservoir, and cuff
              • Reservoir placed in perivesical soft tissue
              • Inflatable cuff is placed surrounding bulbar urethra
                • When inflated, urethra is coapted and continence is maintained
              • Valve is placed in scrotum
                • Activation of valve deflates cuff and opens urethra allowing for voiding

          IMAGING

          • Penile Prothesis

            • Urethral Bulking Agents

              • Artificial Urinary Sphincter

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    CLINICAL ISSUES

                    • Demographics

                      • Natural History & Prognosis

                        DIAGNOSTIC CHECKLIST

                        • Consider

                          • Image Interpretation Pearls

                            Selected References

                            1. Ramanathan S et al: Imaging of the adult male urethra, penile prostheses and artificial urinary sphincters. Abdom Radiol (NY). 45(7):2018-35, 2020
                            2. Chulroek T et al: Can magnetic resonance imaging differentiate among transurethral bulking agent, urethral diverticulum, and periurethral cyst? Abdom Radiol (NY). 44(8):2852-63, 2019
                            3. Lakhoo J et al: MRI of the male pelvic floor. Radiographics. 39(7):2003-22, 2019
                            4. Sekhar A et al: Imaging of the female urethra. Abdom Radiol (NY). 44(12):3950-61, 2019
                            5. Gaines N et al: Radiographic misdiagnoses after periurethral bulking agents. Female Pelvic Med Reconstr Surg. 24(4):312-4, 2018
                            6. Khatri G et al: Postoperative imaging after surgical repair for pelvic floor dysfunction. Radiographics. 36(4):1233-56, 2016
                            7. Mulcahy JJ: The development of modern penile implants. Sex Med Rev. 4(2):177-89, 2016
                            8. Bridges MD et al: Urethral bulking agents: imaging review. AJR Am J Roentgenol. 185(1):257-64, 2005
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Imaging

                                • Top Differential Diagnoses

                                  • Diagnostic Checklist

                                    TERMINOLOGY

                                    • Abbreviations

                                      • Erectile dysfunction (ED)
                                      • Artificial urinary sphincter (AUS)
                                      • Inflatable penile prosthesis (IPP)
                                    • Synonyms

                                      • Penile prosthesis
                                    • Penile Implant

                                      • Implanted mechanical device used to restore or improve erectile function
                                      • Peak implant rates were in 1990s prior to introduction of pharmacologic therapy for ED
                                        • After dropping precipitously, implant rates have slowly increased to plateau of about 28,000 per year worldwide
                                      • Device types
                                        • 3-piece IPP
                                          • Composed of 2 fluid-containing, expandable cylinders placed in corpora, reservoir placed in perivesical space, and pump placed in scrotum
                                          • Rear tip extenders are attached to proximal end of cylinders and are placed far posterior in corpora for anchoring and are rigid (do not inflate)
                                          • Tubing attaches 3 components and runs through inguinal canal
                                          • Inflation and deflation is achieved by activation of scrotal component, sending fluid from reservoir to cylinders and vice-versa
                                        • 2-piece IPP
                                          • Similar to 3-piece but reservoir is eliminated and fluid is stored in proximal tips of cylinders
                                        • Semirigid system
                                          • Malleable metallic device that is always rigid and can be bent into position to achieve penetration
                                    • Urethral Bulking Agents

                                      • Injectable material placed in periurethral tissues
                                        • Delivered with needle placed transurethral or periurethral
                                        • Injected between bladder neck and mid urethra
                                      • Generally used in women with stress urinary incontinence
                                        • Less risk than more invasive treatments (i.e., mesh) but lower treatment success rates
                                        • Can be used in men with incontinence after prostatectomy
                                      • Material adds bulk to weak urethral sphincter and goal is to coapt lumen to prevent incontinence during times of ↑ abdominal pressure
                                      • Several devices available for use in United States
                                        • Pyrolytic carbon-coated beads: Promote collagen formation
                                        • Silicone elastomer material
                                        • Calcium hydroxylapatite
                                        • Many other agents (collagen, ethylene vinyl alcohol, hyaluronic acid, etc.) have been used historically but have been discontinued in United States
                                    • Artificial Urinary Sphincter

                                      • Limited to treatment of male incontinence
                                      • Similar design to 3-piece inflatable penile implant consisting of pump, reservoir, and cuff
                                        • Reservoir placed in perivesical soft tissue
                                        • Inflatable cuff is placed surrounding bulbar urethra
                                          • When inflated, urethra is coapted and continence is maintained
                                        • Valve is placed in scrotum
                                          • Activation of valve deflates cuff and opens urethra allowing for voiding

                                    IMAGING

                                    • Penile Prothesis

                                      • Urethral Bulking Agents

                                        • Artificial Urinary Sphincter

                                          • Imaging Recommendations

                                            DIFFERENTIAL DIAGNOSIS

                                              CLINICAL ISSUES

                                              • Demographics

                                                • Natural History & Prognosis

                                                  DIAGNOSTIC CHECKLIST

                                                  • Consider

                                                    • Image Interpretation Pearls

                                                      Selected References

                                                      1. Ramanathan S et al: Imaging of the adult male urethra, penile prostheses and artificial urinary sphincters. Abdom Radiol (NY). 45(7):2018-35, 2020
                                                      2. Chulroek T et al: Can magnetic resonance imaging differentiate among transurethral bulking agent, urethral diverticulum, and periurethral cyst? Abdom Radiol (NY). 44(8):2852-63, 2019
                                                      3. Lakhoo J et al: MRI of the male pelvic floor. Radiographics. 39(7):2003-22, 2019
                                                      4. Sekhar A et al: Imaging of the female urethra. Abdom Radiol (NY). 44(12):3950-61, 2019
                                                      5. Gaines N et al: Radiographic misdiagnoses after periurethral bulking agents. Female Pelvic Med Reconstr Surg. 24(4):312-4, 2018
                                                      6. Khatri G et al: Postoperative imaging after surgical repair for pelvic floor dysfunction. Radiographics. 36(4):1233-56, 2016
                                                      7. Mulcahy JJ: The development of modern penile implants. Sex Med Rev. 4(2):177-89, 2016
                                                      8. Bridges MD et al: Urethral bulking agents: imaging review. AJR Am J Roentgenol. 185(1):257-64, 2005