title: AMS three-piece inflatable implants for erectile dysfunction: a long-term multi-institutional study in 200 consecutive patients.
abstract: OBJECTIVE
  The aim of this study was to assess the longterm mechanical reliability of AMS (American Medical Systems) three-piece inflatable implants and their impact on patient-partner satisfaction in 200 consecutive patients with erectile dysfunction who underwent surgery in five different institutions.
  
  
  METHODS
  Patient charts included in the study were collected and extensively assessed to record pre- and intraoperative data and postoperative complications. 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 questioned about function of the device and its impact on the couple's sexual life.
  
  
  RESULTS
  At the long-term follow-up, 185 patients (92.5%) were still engaging in sexual intercourse with a mean frequency of 1.7/week. Patients and partners 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 excellent, 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%) subjects. Complications requiring surgical exploration included infection in 12 patients (6%) and mechanical failure in 8 patients (4%). Kaplan-Meier estimates demonstrated significantly decreased mechanical survival for the Ultrex 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, postoperative 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, mechanically speaking, CX cylinders seem to be more reliable than the Ultrex ones.
authors.affiliation: Divisione di Urologia, Ospedale San Raffaele, Milano, Italia. montorsi.francesco@hsr.it
authors.forename: F
authors.initials: F
authors.lastname: Montorsi
authors.forename: P
authors.initials: P
authors.lastname: Rigatti
authors.forename: G
authors.initials: G
authors.lastname: Carmignani
authors.forename: C
authors.initials: C
authors.lastname: Corbu
authors.forename: B
authors.initials: B
authors.lastname: Campo
authors.forename: G
authors.initials: G
authors.lastname: Ordesi
authors.forename: G
authors.initials: G
authors.lastname: Breda
authors.forename: P
authors.initials: P
authors.lastname: Silvestre
authors.forename: B
authors.initials: B
authors.lastname: Giammusso
authors.forename: G
authors.initials: G
authors.lastname: Morgia
authors.forename: A
authors.initials: A
authors.lastname: Graziottin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003075:Coitus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010410:Penile Erection; D015917:Penile Prosthesis; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D013997:Time Factors