For years, men suffering from impotence or erectile dysfunction would turn to urologists, surgeons specializing in what were considered to be men's problems, including urinary difficulties brought on by a large prostate gland, prostate and testicular cancer, and impotence. Focusing on ways to alleviate the mechanical problems of acquiring and maintaining an erection, urologists devised ingenious methods to allow impotent men to enjoy sex once again. They developed silicone penile prostheses and vacuum devices and were at the forefront in the implementation of penile injection therapy. All these modes of treatment are discussed in the next three chapters. Chapter 18 provides information on penile implants. Penile injection therapy is reviewed in Chapter 19, and vacuum devices are the subject of Chapter 20.
Surgical implantation of penile prosthetic devices has been and is still an accepted means of restoring erectile capability in impotent men. In 1989, U.S. surgeons implanted an estimated 27,500 penile prostheses. That number has declined only somewhat since the advent of penile injection and MUSE therapy. The fate of penile prosthesis surgery after Viagra remains to be determined. However, since about 30 to 35 percent of impotent men who try Viagra do not respond well enough to resume sexual intercourse, there will always be a sizable number of impotent men who will want to have penile prosthesis surgery or some other erection assistance to help them enjoy sex again.
Dr. William Scott of the Johns Hopkins Medical School and Dr. Michael Small, professor of urology at the University of Miami Medical School, and his associate Dr. H. M. Carrion are recognized as the patron saints of modern penile prosthesis implant surgery. Dr. Scott fashioned a silicone inflatable penile prosthesis (IPP), which he first implanted in early 1973. Drs. Small and Carrion developed their unit shortly thereafter. The Scott and Small-Carrion devices are the prototype for most of today's penile prostheses.
The original Scott prosthesis, a multicomponent device, had a fluid reservoir implanted in the lower abdomen. A tube from this reservoir was con