Introduction and History Impotence, or in modern terms erectile dysfunction

Introduction and History Impotence, or in modern terms erectile dysfunction

(ED), has afflicted human males since ancient times, if not since the very beginning of human existence. External supports intended to aid the inadequate erection, a precursor of the modern prosthesis, were known in the Ancient World. In the Roman theatre, actors wore oversized cases made of leather or wood, which were fastened to the actors’ hips to produce the appearance of a large penis. These external devices originated in China and Japan. Ambroise Parée, the famous surgeon of the Renaissance, designed one of the first exterior penile prostheses. It was intended for disabled war veterans. Its advan- tage was to enable the user to micturate in an upright position. It was also popular with obese men whose penis was partially covered or totally hidden by pre- pubic and infra-pubic fat. Another device, dating to the turn of the 20 th century, was a box for support, which provided the patient with something like an erection, the ejaculate being drained off by a separate tube.

The internal prosthesis is a copy from nature: some animals are equipped with a penile bone or baculum. Men whose ED followed trauma or partial penile amputation were the original target group for this treatment method. In a pioneering report of 1936, Bogoras [1] described his technique in a patient after traumatic penile amputation. Reconstruction was achieved with the help of a pedicled skin flap, which was supported by a piece of costal cartilage. If we believe him, the patient thereafter was able to repro- duce. Somewhat later in time, Bergmann [2] implanted costal cartilage between the existing rem- nants of the proximal cavernous bodies, hiding the cartilage in a tubed flap. He reported normal micturi- tion and satisfactory sexual intercourse by four months postoperatively. Other reports by various authors followed; however, long-term results of

these techniques were not good. There was a slow resorption of the cartilage and insufficient rigidity of the phallus to permit coitus [3]. Therefore, there was

a need for better material. In 1952 Goodwin [4] was among the first to implant two acrylic rods in the reconstructed penis after amputation. He published four case reports, two of which had to be explanted during a two-year follow-up period because of patients’ intolerance to the rods. Later on, the acrylic rods were implanted outside the cavernous bodies [5] in patients with an intact penis but with ED due to priapism. Meanwhile, in the 1960s, more and more patients began to complain of ED and the demand for

a durable penile device grew. In 1966, Beheri [6], an Egyptian surgeon, made a major advance in the field by using the intracavernosal spaces for implantation of a penile prosthesis. His pioneering idea was to implant polyethylene rods, which are more flexible and can be fashioned to the anatomy of the corpora cavernosa, in order to lower the risk of perforation that occurred with acrylic material. Beheri performed 700 implantations; subsequently, other investigators substituted silicone for poly- ethylene to reduce the risk of perforation [7,8]. Penile prostheses underwent continual improve- ment over a period of many years [9–12], with eventual improvement in the appearance of tume- scence and detumescence.

The development of the hydraulic penile prosthesis–a far better copy of nature–in 1973 by Scott [13] represented a landmark in penile pros- thetics. These new prostheses subsequently under- went several modifications, but the underlying principle however remained the same.