Injectable semi rigid penile prosthesis: study in rabbits and future perspectives

Salvador Vilar Correia Lima; Humberto Montoro Chagas; Caio Cesar Paes Monteiro; Rafaela Siqueira Ferraz-Carvalho; Amanda Vasconcelos Albuquerque; Anderson Arnaldo Silva; Mariana Montenegro de Melo Lira; Fábio Oliveira Vilar

doi:10.21037/tau-20-1128

Injectable semi rigid penile prosthesis: study in rabbits and future perspectives

Transl Androl Urol. 2021 Feb;10(2):841-850. doi: 10.21037/tau-20-1128.

Authors

Salvador Vilar Correia Lima¹, Humberto Montoro Chagas², Caio Cesar Paes Monteiro³, Rafaela Siqueira Ferraz-Carvalho¹, Amanda Vasconcelos Albuquerque¹, Anderson Arnaldo Silva⁴, Mariana Montenegro de Melo Lira⁵, Fábio Oliveira Vilar⁶

Affiliations

¹ Nucleus for Experimental Surgery, Post-graduate Program in Surgery, Department of Surgery, Health Sciences Center, Federal University of Pernambuco, Recife, Brazil.
² Department of urology, Federal University of Alagoas, Maceio, Brazil.
³ Federal University of Pernambuco, Recife, Brazil.
⁴ Departament of Anatomy, Biosciences Center, Federal University of Pernambuco, Recife, Brazil.
⁵ Departament of Patology, Health Sciences Center, Federal University of Pernambuco, Recife, Brazil.
⁶ Head of Urology Department, Federal University of Pernambuco, Recife, Brazil.

Abstract

Background: Penile prostheses are the third option in the treatment of erectile dysfunction, however, despite their proven effectiveness, the occurrence of infections, advanced age of patients and comorbidities are the main limiting factors for this treatment modality. In the continuous search for biointegrated, clinically durable and minimally invasive treatment options, a possible model of penile prosthesis was sought through the use of intracavernous bacterial cellulose (BC) gel, in an experimental model of orchiectomized rabbits.

Methods: Thirty adult New Zealand rabbits were equally distributed into three groups: BC; vehicle and control. Each group was then subdivided according to the follow-up time of 3 and 6 months. Bilateral orchiectomy was performed 3 weeks before injection in the BC and vehicle groups. Pachymetry measurements of the penile axis, diameter and length were performed in situ. Histomorphometry analyzes of the corpora cavernosa (CC), thickness of the tunica albuginea, cell density, collagen and elastic fibers post-injection were also performed, in addition to immunohistochemistry for newly formed vessels.

Results: The implant of BC increased both the length and thickness of the penis three and six months after the last injection, with a consequent increase in the diameter of the CC. On the other hand, the filling effect was not observed in the control and vehicle groups, confirming the degradation of this tissue after orchiectomy and the effectiveness of BC as a filling agent. Histomorphometry analyzes corroborate the mass effect of BC integrated into the tissue, permeated by predominantly lymphomononuclear inflammatory infiltrate, multinucleated giant foreign body cells, fibroblasts, elastic fibers and newly formed vessels, without degradation or loss of volume, even after six months of implantation.

Conclusions: Biocompatibility and biointegration to the host tissue make BC a prosperous penile filling material, with local application and minimally invasive.

Keywords: Erectile dysfunction; bacterial cellulose (BC); biopolymer; penile prosthesis.