الفهرس 
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Abstract
Our study is a prospective clinical study included 42 patients, with severe ED, with mean age 54.5±7 years with severe ED, who attended the outpatient andrology and urology clinic at Minia university hospital and urology & nephrology university hospital in the period from (December 2012 to December 2016).
We initially evaluate the entire patients with erectile dysfunction by medical and sexual history, SHIM questionnaire for ED, and physical examination carried out for all men in the office during the first visit, by this initial evaluation we distinguished patients who had severe ED and failed non-surgical treatment for further evaluation, all patients were underwent to the following:
Laboratory evaluation done in the form of CBC, LFT, RFT, blood sugar, HbA1c (for diabetic patients), and testosterone (free and total testosterone).
Twenty eight patients has subjected to ICI test, ICI response was ≤ 3
Pharmacologic Penile duplex ultrasound done in all patients, twenty four patients (24/42) had arterial insufficiency, and eighteen patients (18/42) had venous leakage.
Based on data of history, physical examination, and investigation we have drawn the following data about our patients:
The duration of ED before surgery ranged (3-9) years, mean duration was (4.6± 2.3)
Phosphodiesterase type 5 inhibitors and traditional treatment were tried by all (100%) patients before penile prosthesis implantation and failed.
The most prevalent risk factor was smoking (32/42), (12/42) patients was diabetic, 4patients was hypertensive and Peyronie’s disease detected in 9 patients three of these patients has DM also.
Each patient received a detailed explanation about any possible risk related to the procedure, and a specific informed consent was obtained.
Inclusion criteria (Patients candidate for penile prosthesis implantation):
Complaining of severe organic (SHIM <7) ED for at least the past 6 months despite being involved in a stable marital relationship.
Patient with refractory psychogenic ED
Patient had refractory ED secondary to refractory priapism
Failed medical treatment including phosphodiesterase 5 inhibitors and/or Intracavernosal injections therapy.