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Also known as
Mesh-enhanced penile prosthesis cylinder, Mesh-fixed penile prosthesis, Mesh-wrapped penile prosthesis, Modified malleable prosthesis with fixed mesh, Ghattas technique prosthesis
Definition
An ensheathed penile prosthesis cylinder is a specialized modification of a standard penile prosthesis device in which the cylinder is covered with material such as polypropylene mesh to increase its diameter.1 This technique, known as the Ghattas technique, involves constructing a polypropylene mesh sheath that surrounds and is fixed to a standard penile prosthesis cylinder, typically 13 mm in diameter.1 The number of mesh layers can be adjusted to fit the apparent size of the corporal body, providing a customized solution for patients with larger corporal dimensions who require a prosthesis diameter greater than standard available sizes.1 This modification enhances stability of the implant within the corporal body and reduces complications like penile floppiness and prosthesis breakage that can occur when standard-sized prostheses are used in patients with larger corporal dimensions.1 The mesh is fixed to the prosthesis using polypropylene stitches, creating a durable enhancement that maintains the functional properties of the original prosthesis while addressing the specific needs of patients with larger anatomical requirements.1
Clinical Context
Ensheathed penile prosthesis cylinders are primarily used in the clinical management of erectile dysfunction (ED) that is refractory, unsatisfactory, or contra-indicated for other approved medical or mechanical options.1 This specialized technique is particularly valuable for patients with large corporal bodies who would otherwise experience unsatisfactory outcomes with standard-sized prostheses.
Patient selection criteria include those with organic erectile dysfunction who have failed or rejected other treatment options (oral medications, intracavernous self-injection, or vacuum devices) and who have larger corporal dimensions that would benefit from a prosthesis diameter greater than the standard 13 mm.1 The technique may also be beneficial in cases of poor hand dexterity, posttraumatic “hostile” pelvis, neobladders, prior bilateral hernia surgery, major fibrosis of the corpus cavernosum, complex anatomies, or infection after salvage surgery.2
The surgical procedure involves a ventral incision to reveal both corpora cavernosa, followed by corporotomy incision and dilation. After measuring intracorporal dimensions, a sheath of polypropylene mesh is constructed and wrapped around a 13-mm penile prosthesis cylinder, with the number of layers adjusted to fit the corporal body size. The mesh is then fixed to the prosthesis using polypropylene stitches, and the ensheathed cylinder is placed within the corporal body.1
Clinical outcomes have shown significant improvement in erectile function, with mean IIEF-5 scores increasing from 8.3 to 24.6 (P < 0.001) and high patient satisfaction (mean EDITS score of 94.9).1 No major complications were reported in the initial study, suggesting the technique is safe and effective for selected patients.1 Long-term studies are still needed to confirm these results and evaluate the durability and potential complications of this approach over time.1