Inflatable Penile Prostheses (IPP) implantation is a surgical treatment for patients desiring definitive treatment for erectile dysfunction. While this procedure has proven to be effective, it also carries its own set of unique risks that need to be carefully considered. The article reviews the current understanding of complications associated with penile prosthetic surgery and provides strategies to mitigate these adverse events. This article covers various aspects of IPP implantation, including the risks of infection, bleeding, injury to nearby structures, glans ischemia, and device malfunction. It also discusses the importance of careful preoperative screening to identify risk factors and the implementation of infection reduction strategies such as antimicrobial prophylaxis, skin prep, and operative techniques. In addition, it emphasizes the need for postoperative vigilance and prompt management of any complications that may arise. Overall, the article provides a comprehensive overview of the risks and strategies for mitigating complications associated with IPP implantation. Our recommendations are given based on the current consensus in the field and highlight the importance of careful planning, attention to detail, and effective communication between healthcare providers and patients. Despite the potential risks, this review underscores the fact that complications following penile prosthesis implantation are relatively rare.

Introduction: Artificial Intelligence (AI) has witnessed significant growth in the field of medicine, leveraging machine learning, artificial neuron networks, and large language models. These technologies are effective in disease diagnosis, education, and prevention, while raising ethical concerns and potential challenges. However, their utility in sexual medicine remains relatively unexplored. Objective: We aim to provide a comprehensive summary of the status of AI in the field of sexual medicine. Methods: A comprehensive search was conducted using MeSH keywords, including "artificial intelligence," "sexual medicine," "sexual health," and "machine learning." Two investigators screened articles for eligibility within the PubMed and MEDLINE databases, with conflicts resolved by a third reviewer. Articles in English language that reported on AI in sexual medicine and health were included. A total of 69 full-text articles were systematically analyzed based on predefined inclusion criteria. Data extraction included information on article characteristics, study design, assessment methods, and outcomes. Results: The initial search yielded 905 articles relevant to AI in sexual medicine. Upon assessing the full texts of 121 articles for eligibility, 52 studies unrelated to AI in sexual health were excluded, resulting in 69 articles for systematic review. The analysis revealed AI's accuracy in preventing, diagnosing, and decision-making in sexually transmitted diseases. AI also demonstrated the ability to diagnose and offer precise treatment plans for male and female sexual dysfunction and infertility, accurately predict sex from bone and teeth imaging, and correctly predict and diagnose sexual orientation and relationship issues. AI emerged as a promising modality with significant implications for the future of sexual medicine. Conclusions: Further research is essential to unlock the potential of AI in sexual medicine. AI presents advantages such as accessibility, user-friendliness, confidentiality, and a preferred source of sexual health information. However, it still lags human healthcare providers in terms of compassion and clinical expertise.

This study aims to evaluate the association between antimicrobial practices, including oral antibiotics, intravenous antibiotics, antifungal prophylaxis, and infection outcomes in patients undergoing primary or revision inflatable penile prosthesis surgery. We conducted a multicenter, retrospective cohort study of 5,261 patients who underwent primary or revision inflatable penile prosthesis surgery at 16 specialized centers across the United States, Europe, and Korea from July 2016 to July 2021. Patient data included demographic and clinical characteristics, antibiotic and antifungal administration, and infection outcomes. The primary outcome was infection following inflatable penile prosthesis placement. Univariable and multivariable regression analyses were performed to identify predictors of infection. The overall infection rate was 1.9% (n=102), with higher rates among diabetic patients (p=0.023), those with prior inflatable penile prosthesis infection (p<0.001), or undergoing revision surgery (p<0.001). Multivariable analysis identified diabetes (OR=1.68, p=0.022) and previous inflatable penile prosthesis infection (OR=4.67, p<0.001) as independent risk factors for infection. Perioperative intravenous antifungal use was significantly associated with a lower infection risk (OR=0.22, p24 hours) (p=0.2) did not demonstrate protective effects. Pre- and postoperative oral antibiotics were not associated with a statistically significant reduction in infection after adjustment for confounding variables. This large multicenter study highlights a significant association between perioperative antifungal prophylaxis and lower infection risk in inflatable penile prosthesis surgery while demonstrating the limited utility of preoperative and postoperative oral antibiotics and prolonged intravenous prophylaxis. These findings support evidence-based antimicrobial stewardship to optimize outcomes and minimize complications, including antibiotic resistance.

To report the incidence of the reoperation surgeries of nearly all the Rigicon Infla10® implants performed since device introduction in 1/2019. Inflatable penile prosthesis (IPP) has some of the highest survival from revision surgery of any medical device implanted in humans. [1] We expand on previous Rigicon Infla10® research, adding more patients and increasing follow-up duration. [2] METHODS/MATERIALS: 535 patients had Rigicon Infla10® devices implanted from 1/2019 to 8/2022. 103 surgeons from 26 centers in 15 countries participated in the study. Patient Information Forms (PIF's) were analyzed from virtually all implantations. Explantation or revision surgery for mechanical failure, infection, other medical reasons, and patient dissatisfaction were cataloged. SPSS 25.0 (IBM) was used for the statistical analysis of Kaplan Meier survival statistics. Mean follow-up was 24.2 months [7-43 months]. Mean patient age was 56 years. Reoperation was necessary for 3.5% of subjects. Revision for mechanical failure occurred in 2.24% (12/535). The rate of explant for patient dissatisfaction was 0.56% (3/535). Revision for component out of place was 0.37% (2/535) with an infection rate and unsuccessful Peyronie's correction being 0.19% (1/535). Survival from requiring another corrective surgery at 1, 2, and 3 years was 96.4%, 95.0 %, and 94.0 % respectively. These initial survival rates compare favorably to devices currently available, which have been repeatedly enhanced to improve reliability. In its first 2-3 years of availability, The Rigicon Infla10® IPP shows freedom from revision comparable to existing enhanced devices that have been on the market for decades.

Ischemic priapism is a urological emergency which may lead to irreversible erectile dysfunction. One of the accepted treatments is penile prosthesis implantation. Given the scarcity of studies directly comparing timing of penile prosthesis insertion after ischemic priapism, consensus remains elusive. We aim to compare different studies in the literature concerning advantages and disadvantages of early versus delayed inflatable penile prosthesis following ischemic priapism. We analyzed 8 articles that investigated immediate and delayed inflatable penile prosthesis placement after ischemic priapism. Early inflatable penile prosthesis placement is associated with better outcomes, including pain relief, priapism resolution, penile shortening prevention, and quicker sexual activity resumption. However, it still carries a high risk of complications like edema, infection, and distal perforations. Delayed inflatable penile prosthesis insertion poses surgical challenges due to the potential for extensive corporal fibrosis. Comparative analyses have shown elevated complication rates in patients with ischemic priapism who undergo delayed inflatable penile prosthesis insertion, as opposed to those with early insertion. In studies reporting complications rates, the total complication rate in the early group was 3.37%, significantly lower than the delayed group (37.23%). Most studies support the superiority of early inflatable penile prosthesis placement following ischemic priapism over delayed placement. Further research is, however, needed to establish a global consensus on timing of prosthesis insertion.

Implantation of penile prosthesis is considered when conservative measures fail or are unacceptable to patients’ wishing treatment for erectile dysfunction. In the United States (US), inflatable penile prostheses are more often used than malleable penile prostheses (MPP). Outside the US, the reverse is true because third-party reimbursement is not available, and MPP is considerably cheaper. Two American manufacturers make MPP; presently, a new manufacturer, Rigicon (Ronkonkoma NY), has recently begun to sell its MPP worldwide. Patient information forms submitted to the manufacturer between March 1, 2019, and December 8, 2022, were used to conduct an initial safety study for 605 first-time patients implanted with Rigicon10® by 46 physicians in 15 countries with a mean follow-up of 21.6 months. It has the same configuration of trimmable, paired silicone rods containing a twisted stainless-steel wire for bendability. However, it is available in six widths with hydrophilic coating compared to three widths offered by competitors. Revision or explantation was needed in 6 of 605 patients (0.99%) with half of those being removed for dissatisfaction (0.50%). Two (0.33%) suffered device infection and one (0.16%) required removal for erosion. Kaplan–Meier’s statistical analysis showed three-year implant survival from revision = 99.2%. It demonstrated a comparable safety record with less than 1.00% of patients requiring reoperation.