Ambicor 2-Piece Inflatable Penile Prosthesis: Who and How?

Background: Currently the Ambicor is the only 2-piece inflatable penile prosthesis (IPP) available in the United States. By eliminating the separate reservoir, this provides certain advantages for patient and surgeon. Nevertheless, it composes a small percentage of all IPPs implanted in the United States. Aim: To detail the surgical technique for implantation, describe the ideal patient candidates best suited for the Ambicor, and discuss the most common and some rare complications with a review of the available published literature in combination with our clinical experience. Methods: A PubMed literature search was performed to obtain all peer-reviewed articles published in English specifically on the Ambicor 2-piece IPP. We also reviewed our clinical experience with the Ambicor during the past 2 decades. Results: The published data remain limited, because few articles on the Ambicor have been published in the past 10 years. Overall complication rates were 2.1% to 9.5%. Patient satisfaction rates were 75% to 96.4%, with similar partner satisfaction rates. Relative contraindications for implantation include patients with significant penile deformities, long narrow phalluses, or short phalluses. Strengths and Limitations: Despite the limited available published data with short follow-up periods, this review provides a comprehensive discussion on the technical aspects and relevant perioperative counseling recommended for Ambicor implantation. Conclusion: The prosthetic urologist should offer the Ambicor 2-piece IPP to patients with erectile dysfunction whose non-surgical treatment has failed. Certain implanters might want to avoid the blind retropubic reservoir placement that occurs with 3-piece IPPs and might not be comfortable with an ectopic approach and therefore prefer using a 2-piece device. We believe the ideal Ambicor candidate is a patient with a current or future pelvic organ transplant, decreased manual dexterity, in need of complete phallic reconstruction, or with known extensive prior abdominopelvic surgery.