History of Prosthetics & Erectile Dysfunction Treatment
The history of erectile dysfunction treatment and penile prosthetics traces an arc from ancient aphrodisiacs and spiritual remedies through the landmark mechanical inventions of the 1970s to the pharmacological revolution of the late 1990s. The inflatable penile prosthesis — first implanted in 1973 — remains one of the most elegantly engineered devices in all of surgery, and its story is inextricably linked to the concurrent development of the artificial urinary sphincter by the same inventor. Across the same decades, the vacuum erection device, intracavernosal injection therapy, and ultimately oral PDE5 inhibitors transformed a condition once managed only surgically into a tiered pharmacological and procedural discipline.
Ancient and Pre-Modern Treatments
Erectile dysfunction has been recognized and treated since antiquity, with approaches ranging from the empirically grounded to the frankly magical.
Ancient Egypt (Ebers Papyrus, c. 1550 BC): Prescriptions for impotence included preparations of baby crocodile hearts dissolved in fat, applied topically to the penis. Internal remedies employed dried beetle preparations and sesame oils.
Ancient Greece and Rome: Galen described impotence as arising from excess "cold, moist humors." Pliny the Elder (Naturalis Historia, 77 AD) catalogued botanical and zoological aphrodisiacs including hippocampus fat, hyena genitalia, and wolf liver. Dioscorides described orchid tubers (Orchis) — simulacra of testes — as erectile remedies, among the earliest examples of sympathetic magic in medicine.
Medieval Islamic Medicine: Avicenna (Ibn Sina, 1025 AD) in The Canon of Medicine described impotence from psychological, vascular, and neurological perspectives — a classification system remarkably close to the modern one. He prescribed compound preparations including theriac, nutmeg, and clove.
Renaissance Europe: Ambroise Paré (1575) described erection physiology and recommended ligatures around the penile base in cases of vascular insufficiency — a concept ancestral to modern constrictor ring therapy.[1]
19th and Early 20th Century: Physical Devices
Vacuum Erection Devices — Early Origins
The vacuum erection device has origins in 19th-century American medicine. Dr. John King first applied vacuum technology for erectile purposes in 1874. Dr. Otto Lederer developed a more elaborate vacuum machine in 1913 combining compression and suction. Neither achieved clinical traction, and the concept lay dormant until commercially revived in the 1960s.
Early Penile Prostheses
Bogoras (1936): The Russian surgeon N.A. Bogoras is credited with the first reported penile reconstruction using a rib cartilage graft implanted into a phallic construct — published in Zentralblatt für Chirurgie (1936). He used the bone of the os penis of other mammals as his anatomical model. This established the principle that internal rigid support could restore function after traumatic penile loss.[2]
Goodwin and Scott (1952): The first published use of a synthetic material for penile implantation — an acrylic rod positioned beneath Buck's fascia as an "artificial baculum."
Goodwin WE, Scott WW. "Phalloplasty." J Urol. 1952;68:903–908.
Harvey Lash (1964): Described the first silicone penile prosthesis series.
G.E. Beheri (1966): Egyptian plastic surgeon Beheri was the first to describe placement of paired intracorporeal polyethylene rods within the corpora cavernosa — the pivotal anatomical shift that all future designs would follow. He published results of over 700 such procedures. Because he published in plastic surgery rather than urology journals, the technique initially gained little traction in urology.[3]
Pearman (1967): Expanded on Lash's silicone work, describing placement beneath Buck's fascia on the dorsum of the penis.
The Modern Era of Penile Prosthesis Surgery (1973–present)
AUA 1973: The Dual Announcement
At the 1973 Annual Meeting of the American Urological Association, two groups simultaneously presented prototype penile prostheses — one inflatable, one semi-rigid — in what would become a watershed moment in reconstructive urology:
- Baylor College of Medicine (Scott, Bradley, Timm): The inflatable penile prosthesis
- University of Miami (Small, Carrion): The semi-rigid malleable prosthesis
The simultaneous development reflected the zeitgeist: a growing understanding of erectile physiology, improved silicone manufacturing, and the impetus from post-prostatectomy and post-priapism patients with no other options.
Scott, Bradley, and Timm — The Inflatable Penile Prosthesis (1973)
F. Brantley Scott, William E. Bradley, and Gerald W. Timm at Baylor College of Medicine built on Scott's concurrent work developing the artificial urinary sphincter. The conceptual innovation: a hydraulic mechanism could restore penile tumescence by fluid transfer between internal reservoirs, mimicking the natural hemodynamics of erection.
The three-component device:
- Two inflatable cylinders implanted within the corpora cavernosa
- A saline reservoir implanted in the space of Retzius (prevesical space)
- A scrotal pump to transfer fluid, with a deflation valve
Fewer than 15 devices were implanted from February 1973 to August 1974. Scott, Bradley, and Timm had co-founded American Medical Systems (AMS) in Minnetonka, Minnesota, in 1972 to commercialize the device.
Scott FB, Bradley WE, Timm GW. "Management of erectile impotence. Use of implantable inflatable prosthesis." Urology. 1973;2(1):80–82. [PMID: 4766860][4]
Small and Carrion — The Semi-Rigid Prosthesis (1973/1975)
Michael P. Small and Hernan M. Carrion (University of Miami) described a simpler, paired sponge-filled semi-rigid silicone-covered rod prosthesis — implanted via a perineal approach, available in four lengths (12–15.8 cm) and two diameters. The penis remained in a permanently semi-rigid state. By December 1977, 260 patients had undergone insertion with minimal complications. The Small-Carrion represented the first widely reproducible, commercially marketable prosthesis.
Small MP, Carrion HM, Gordon JA. "Small-Carrion penile prosthesis: new implant for management of impotence." Urology. 1975;5(4):479–486. [PMID: 1093303][5]
Device Evolution: AMS Inflatable Prostheses (1973–2006)
| Year | Device | Innovation |
|---|---|---|
| 1973 | AMS prototype | First three-piece IPP; dual pump mechanism |
| 1983 | AMS 700 Series | Three-layer cylinders; simplified single inflation/deflation pump; became dominant device |
| 1983 | AMS 600M | Malleable prosthesis with stainless steel wire core and silicone exterior |
| 1985 | AMS Hydroflex | First two-piece self-contained inflatable; saline-filled non-distensible chambers |
| 1987 | AMS 700 CX | Three-ply cylinder (inner silicone / Dacron-Lycra woven fabric / outer silicone); controlled radial expansion; reduced aneurysmal dilation |
| 1990 | AMS 700 CXM | CX design in smaller diameter (9.5–14.2 mm) for smaller anatomy |
| 1990 | AMS Ultrex | First cylinder providing both length and girth expansion; higher initial mechanical failure rates; 1993 modification significantly improved reliability |
| 1994 | AMS Ambicor | Two-piece design; reservoir integrated into scrotal pump |
| 2001 | InhibiZone coating | Minocycline/rifampin surface impregnation; up to 50% reduction in infection rates; FDA cleared efficacy claims 2009 |
| 2006 | AMS 700 LGX | Combined post-1993 Ultrex cylinder improvements with 700 series; length and girth expansion; preserves penile length |
Coloplast Titan
Mentor/Coloplast introduced the Titan inflatable prosthesis with a hydrophilic coating that absorbs antibiotic solution applied intraoperatively and reduces bacterial adherence — a distinct infection-prevention strategy from AMS's incorporated antibiotic approach. The Titan Zero Degree (improved pump geometry) and Titan OTR (Touch Pad deflation mechanism) represent subsequent refinements.[6]
Modern three-piece IPP devices demonstrate mechanical survival exceeding 90% at 5 years and patient satisfaction rates of 90–95%.
Mulcahy Salvage Technique for Infected Prosthesis (1991)
Prior to 1991, infected penile prostheses required explantation with delayed reimplantation weeks to months later — a significant psychological and logistical burden. John Mulcahy described immediate prosthesis salvage:
- Device removal
- Copious sequential irrigation ("Mulcahy washout"): kanamycin/bacitracin → dilute H₂O₂ → dilute betadine → saline → vancomycin/gentamicin, then reversed
- Immediate reimplantation
Long-term infection-free success: 82–93%. This technique transformed the management of the most feared prosthesis complication.
Mulcahy JJ. "Penile prosthesis salvage: a historical look at the Mulcahy technique." Int J Impot Res. 2022. [PMID: 35027720][7]
The Artificial Urinary Sphincter
Scott, Bradley, and Timm — AMS AS721 and AMS 800 (1972–1983)
The artificial urinary sphincter (AUS) was developed in parallel with the IPP by the same Baylor College of Medicine team. The motivating problem: post-prostatectomy urinary incontinence. The same hydraulic principle applied — a circumferential cuff occluding the urethra under controlled pressure, deflated by scrotal pump for voiding.
- 1972: AMS founded; prototype AUS designed
- 1973: First human implantation of the AS721 — the first implanted AUS commercially available
- 1974: AMS 761 introduced — incorporated the pressure-regulating balloon (PRB) reservoir that limited cuff pressure to a preset level, dramatically reducing erosion rates from unregulated urethral compression
- 1983: AMS 800 introduced — the refinement that has remained the gold standard for over 40 years with iterative engineering improvements
Scott FB, Bradley WE, Timm GW. "Treatment of urinary incontinence by an implantable prosthetic urinary sphincter." J Urol. 1974;112(1):75–80. [PMID: 4600662]
Over 150,000 AMS 800 devices have been implanted worldwide. The AMS 800 (now marketed by Boston Scientific) remains the only FDA-approved AUS for male stress urinary incontinence.[8]
Intracavernosal Injection Therapy (1982–1983)
Virag — The Accidental Discovery (1982)
Ronald Virag (Paris) discovered the vasoactive effect of papaverine by accident during an arterial epigastric-cavernous anastomosis procedure when inadvertent intracavernosal injection of papaverine produced a rigid erection lasting 2 hours. He reported this in a landmark letter:
Virag R. "Intracavernous injection of papaverine for erectile failure." Lancet. 1982 Oct 23;2(8304):938. [PMID: 6126784]
Virag subsequently published the expanded clinical series: Virag R, et al. Angiology. 1984;35(2):79–87. [PMID: 6696289][9]
Giles Brindley — The AUA 1983 Demonstration
One of the most extraordinary moments in urological history occurred on April 18, 1983, at the 78th Annual Meeting of the AUA in Las Vegas. British neurophysiologist Professor Giles Brindley (Medical Research Council, London) gave a lecture on cavernosal adrenergic blockade — and demonstrated the efficacy of intracavernosal phenoxybenzamine by injecting himself in his hotel room before the lecture, then lowering his trousers before the audience to display the resulting erection and inviting inspection.
Brindley GS. "Cavernosal alpha-blockade: a new technique for investigating and treating erectile impotence." Br J Psychiatry. 1983;143:332–337. [PMID: 6414479]
The dramatic demonstration galvanized the field. Together, Virag and Brindley established intracavernosal injection as a practical pharmacological treatment for ED — the first effective non-surgical alternative to prosthesis implantation.[10]
Subsequent pharmacological developments:
- Zorgniotti (1985): Papaverine/phentolamine combination for improved efficacy
- Adaikan and Ishii (1986): Prostaglandin E1 (PGE1/alprostadil) as intracavernosal agent
- FDA approval of intracavernosal alprostadil (Caverject): 1996. Pivotal trial: Linet OI, Ogrinc FG. N Engl J Med. 1996;334(14):873–877.
- MUSE (Medicated Urethral System for Erection — intraurethral alprostadil suppository): FDA approved 1997. Padma-Nathan H, et al. N Engl J Med. 1997;336(1):1–7.
Vacuum Erection Devices — Modern Era
Geddings Osbon and the ErecAid (1960s–1982)
Geddings David Osbon (1901–1986), Augusta, Georgia — a tire businessman with no formal education beyond 5th grade — experienced erectile dysfunction as a side effect of cardiac medication. Drawing on his knowledge of vacuum physics from tire retreading, he self-developed a vacuum-based erection device he called the "Youth Equivalent Device," spending two decades refining it and navigating FDA regulatory requirements.
On October 5, 1982, Osbon received FDA approval for the ErecAid — the first FDA-approved non-invasive treatment for impotence, 22 years after he was first told nothing could be done for him.
The first formal clinical validation appeared in:
Nadig PW, Ware JC, Blumoff R. "Noninvasive device to produce and maintain an erection-like state." Urology. 1986;27(2):126–131. [PMID: 3946035]
Of 35 men with organic impotence studied, 32 achieved rigidity sufficient for penetration; 24 of 30 followed long-term reported regular use and satisfaction. By 1991, VEDs were the most commonly prescribed treatment for erectile dysfunction in the United States.[11]
The VED remains a first-line non-surgical option for ED and is central to penile rehabilitation protocols after radical prostatectomy.
The Sildenafil (Viagra) Revolution (1989–1998)
Accidental Discovery
Pfizer chemists in Sandwich, UK, synthesized compound UK-92,480 (sildenafil citrate) in 1989 as part of a program developing selective PDE5 inhibitors for angina and hypertension.
Under the direction of Dr. Ian Osterloh, Phase I clinical trials revealed the drug had minimal effect on angina but produced marked, consistent penile erections as a side effect. Clinical trial nursing staff observed male subjects lying face-down to conceal erections. Pfizer pivoted development entirely toward erectile dysfunction.
By 1997, over 4,500 subjects had been enrolled across 21 clinical trials. The pivotal publication:
Goldstein I, Lue TF, Padma-Nathan H, et al. "Oral sildenafil in the treatment of erectile dysfunction." N Engl J Med. 1998;338(20):1397–1404. [PMID: 9580646]
FDA approval: March 27, 1998. Sildenafil became one of the fastest-selling pharmaceutical products in history.
Mechanism: PDE5 degrades cyclic GMP (cGMP), which mediates smooth muscle relaxation in cavernosal tissue. Sildenafil blocks PDE5, potentiating the nitric oxide/cGMP pathway — but only in the context of sexual stimulation. This physiological selectivity distinguished it from non-selective vasoactive agents.
Subsequent PDE5 inhibitors: vardenafil (Levitra, 2003), tadalafil (Cialis, 2003 — with unique 36-hour duration and daily-dose indication), avanafil (Stendra, 2012).[12]
Peyronie's Disease Surgery
First Description: François de la Peyronie (1743)
François Gigot de la Peyronie (1678–1747), personal physician to King Louis XV of France and co-founder of the Académie Royale de Chirurgie, provided the first systematic clinical description of the condition bearing his name in 1743. He described three patients with "rosary beads of scar tissue" causing upward penile curvature and painful, distorted erection. (Earlier anatomists Fallopius and Vesalius had noted penile curvature in passing c. 1561, but Peyronie provided the first purposeful clinical account.)
de la Peyronie F. "Sur quelques obstacles qui s'opposent à l'éjaculation naturelle de la semence." Mém Acad R Chir. 1743;1:425–434.[13]
Nesbit Corporoplasty (1965)
Reed M. Nesbit (University of Michigan) described excision of elliptical wedges of tunica albuginea opposite the curvature to correct penile deviation in three patients with congenital curvature. The technique was subsequently extended to Peyronie's disease and prosthesis-associated curvature.
Nesbit RM. "Congenital curvature of the phallus: report of three cases with description of corrective operation." J Urol. 1965;93:230–232. [PMID: 6538238]
The Nesbit corporoplasty remains the most widely referenced plication technique for Peyronie's disease and has spawned multiple modifications (Pryor 1979, Essed-Schroeder 1985, Yachia 1990, Lue "16-dot" 2002).[14]
Plaque Incision and Grafting
Tom Lue (UCSF) and El-Sakka pioneered length-preserving approaches via tunica incision with saphenous vein grafting for severe curvature — advancing the concept of correction without penile shortening. Multiple graft materials have been evaluated subsequently: saphenous vein, small intestinal submucosa, cadaveric pericardium, bovine pericardium, dermis, and human dura mater.[15]
Xiaflex (Collagenase Clostridium Histolyticum) — FDA Approval (2013)
On December 6, 2013, the FDA approved collagenase clostridium histolyticum (CCH, Xiaflex/Xiapex) — the first and only FDA-approved pharmacological treatment for Peyronie's disease. Approval was based on the IMPRESS I and IMPRESS II Phase III trials (n=832 adult males, four treatment cycles), demonstrating a mean 34% improvement in penile curvature (−17.0 ± 14.8°) versus 18.2% reduction in the placebo group.[16]
Urinary Catheters
Benjamin Franklin's Flexible Catheter (1752)
Benjamin Franklin (1706–1790) designed a flexible silver coil catheter in 1752 for his brother John, who suffered from kidney stones requiring daily bladder catheterization. Working with a local silversmith, Franklin created a more flexible jointed design than the rigid silver tubes then in use — an early application of engineering ingenuity to a urological problem.[17]
The Foley Balloon Catheter (1935/1937)
Frederic Eugene Basil Foley, MD (1891–1966), a urologist at Ancker Hospital in St. Paul, Minnesota (trained at Johns Hopkins, graduated 1918), designed the self-retaining balloon catheter bearing his name. Working with rubber chemist R.A. Lees, Foley created prototypes with an inflatable balloon near the catheter tip — retaining catheter position inside the bladder without external taping or strapping. Foley and Lees presented at the AUA national convention in 1935.
Foley FEB. "A hemostatic bag catheter: one-piece latex rubber structure for control of bleeding and drainage following prostatic resection." J Urol. 1937;38:134–139. [PMID: 35435012 — biographical review]
Foley lost a patent dispute with the Davol Company but the catheter permanently carries his name. C.R. Bard Company of New Jersey began commercial distribution as the "Foley catheter."
The Foley catheter is the most widely used urological device in the world — billions of catheter-days are placed annually across all medical and surgical specialties.[18]
Penile Vascular Surgery
Vaclav Michal — First Penile Revascularization (1973)
Dr. Vaclav Michal (Czechoslovakia) described the first microvascular arterial bypass for penile revascularization in 1973, anastomosing the inferior epigastric artery directly to the corpus cavernosum (Michal I procedure). Subsequent modifications added anastomosis to the dorsal penile vein (Michal II) and dorsal penile artery. Irwin Goldstein trained under Michal and has been a leading proponent of penile revascularization surgery since 1981.[19]
Penile Reconstruction and Phalloplasty
RFFF Phalloplasty — Chang and Hwang (1984)
The modern era of phalloplasty began with Chang and Hwang (China, 1984), who described the radial forearm free flap (RFFF) for total phallic construction — providing thin, pliable, sensate skin in an ideal geometry for the complex requirements of phalloplasty. The RFFF phalloplasty became, and remains, the workhorse procedure for gender-affirming male genitalia construction and penile reconstruction after traumatic loss.
Chang TS, Hwang WY. "Forearm flap in one-stage reconstruction of the penis." Plast Reconstr Surg. 1984;74(2):251–258. [PMID: 6462420][20]
Key Landmark Publications
| Year | Author(s) | Contribution | PMID |
|---|---|---|---|
| 1937 | Foley FEB | Balloon catheter publication | — |
| 1952 | Goodwin WE, Scott WW | First acrylic penile prosthesis | — |
| 1966 | Beheri GE | First intracorporeal rods (700+ cases) | — |
| 1973 | Scott FB et al. | IPP — inflatable prosthesis | 4766860 |
| 1974 | Scott FB et al. | AUS — artificial urinary sphincter | 4600662 |
| 1975 | Small MP et al. | Small-Carrion semi-rigid prosthesis | 1093303 |
| 1982 | Virag R | Papaverine ICI discovery | 6126784 |
| 1983 | Brindley GS | Cavernosal alpha-blockade | 6414479 |
| 1984 | Chang TS, Hwang WY | RFFF phalloplasty | 6462420 |
| 1986 | Nadig PW et al. | Vacuum erection device validation | 3946035 |
| 1996 | Linet OI, Ogrinc FG | Intracavernosal alprostadil | — |
| 1998 | Goldstein I et al. | Sildenafil Phase III trial | 9580646 |
| 2022 | Mulcahy JJ | Prosthesis salvage technique review | 35027720 |
References
1. Gurtner K et al. "Erectile Dysfunction: A Review of Historical Treatments With a Focus on the Development of the Inflatable Penile Prosthesis." Am J Mens Health. 2017. [PMC5675239]; Lizza EF, Rosen RC. "Definition and classification of erectile dysfunction." Int J Impot Res. 1999;11(3):141–143. [PMID: 10436673].
2. Bogoras NA. "Ueber die volle plastische Wiederherstellung eines zum Koitus fähigen Penis." Zentralbl Chir. 1936;63:1271–1276. Goodwin WE, Scott WW. "Phalloplasty." J Urol. 1952;68:903–908.
3. Rodriguez KM et al. "A history of penile implants." Transl Androl Urol. 2017. [PMC5715175; PMID: 29238664]. Mulcahy JJ. "The Evolution and Utility of the Small-Carrion Prosthesis." J Sex Med. 2015. [PMID: 26565570].
4. Scott FB, Bradley WE, Timm GW. "Management of erectile impotence. Use of implantable inflatable prosthesis." Urology. 1973;2(1):80–82. [PMID: 4766860]. Bradley WE. "Early history of inflatable penile prosthesis surgery." Asian J Androl. 2015. [PMC4650450; PMID: 25432494].
5. Small MP, Carrion HM, Gordon JA. "Small-Carrion penile prosthesis: new implant for management of impotence." Urology. 1975;5(4):479–486. [PMID: 1093303].
6. Chung E, et al. "Penile prosthesis implant: scientific advances and technological innovations over the last four decades." Transl Androl Urol. 2017. [PMC5313299]. Mulcahy JJ (ed). "Celebrating 50 years of penile implants." Int J Impot Res. 2023. [PMC10622314].
7. Mulcahy JJ. "Penile prosthesis salvage: a historical look at the Mulcahy technique." Int J Impot Res. 2022. [PMID: 35027720].
8. Scott FB, Bradley WE, Timm GW. "Treatment of urinary incontinence by an implantable prosthetic urinary sphincter." J Urol. 1974;112(1):75–80. [PMID: 4600662]. Review: "AMS 800 artificial urinary sphincter: 50-year narrative review." [PMC11399039].
9. Virag R. "Intracavernous injection of papaverine for erectile failure." Lancet. 1982;2(8304):938. [PMID: 6126784]. Virag R, et al. Angiology. 1984;35(2):79–87. [PMID: 6696289]. Burnett AL et al. "A comprehensive history of injection therapy for erectile dysfunction, 1982–2023." Sex Med Rev. 2024;12(3):419. [PMID: 38644056].
10. Brindley GS. "Cavernosal alpha-blockade: a new technique for investigating and treating erectile impotence." Br J Psychiatry. 1983;143:332–337. [PMID: 6414479]. Krane RJ. "The hour lecture that changed sexual medicine — the Giles Brindley injection story." J Sex Med. 2012;9(2):337–342. [PMID: 22296605].
11. Nadig PW, Ware JC, Blumoff R. "Noninvasive device to produce and maintain an erection-like state." Urology. 1986;27(2):126–131. [PMID: 3946035]. Augusta Medical Systems historical overview of Osbon and ErecAid: augustams.com.
12. Goldstein I, Lue TF, Padma-Nathan H, et al. "Oral sildenafil in the treatment of erectile dysfunction." N Engl J Med. 1998;338(20):1397–1404. [PMID: 9580646]. Boolell M et al. "Sildenafil: from angina to erectile dysfunction to pulmonary hypertension and beyond." Nat Rev Drug Discov. 2020. [PMC7097805].
13. de la Peyronie F. "Sur quelques obstacles qui s'opposent à l'éjaculation naturelle de la semence." Mém Acad R Chir. 1743;1:425–434. History review: Oxford Academic SMR 2025, doi:10.1093/smr/qeaf064.
14. Nesbit RM. "Congenital curvature of the phallus: report of three cases with description of corrective operation." J Urol. 1965;93:230–232. [PMID: 6538238]. Review: PMC4582476.
15. Lue TF, El-Sakka AI. "Venous patch graft for Peyronie's disease. Part I: technique." J Urol. 1998;160(6 Pt 1):2047–2049. [PMID: 9817322]. Twenty-year grafting review: PMC6523061.
16. Gelbard M et al. "Clinical efficacy, safety and tolerability of collagenase clostridium histolyticum for the treatment of Peyronie disease in 2 large double-blind, randomized, placebo controlled phase 3 studies." J Urol. 2013;190(1):199–207. [PMID: 23376148]. FDA approval December 6, 2013.
17. Franklin B. Letter to John Franklin, 1752. Reprinted in: Bell RD. "Benjamin Franklin's catheter." Urol Dig. 1975. Review: Feneley RC, et al. "Urinary catheters: history, current status, adverse events." J Med Eng Technol. 2015;39(8):459–470. [PMID: 26383070].
18. Foley FEB. "A hemostatic bag catheter." J Urol. 1937;38:134–139. Biographical review: Bloom DA et al. "Frederic Eugene Basil Foley (1891–1966) and the Foley-type Balloon Catheter." J Urol. 2022. [PMID: 35435012].
19. Michal V, et al. "Vascular surgery in the treatment of impotence: its present possibilities and prospects." Czech Med. 1977;1:213–217. Review: PMC3739123.
20. Chang TS, Hwang WY. "Forearm flap in one-stage reconstruction of the penis." Plast Reconstr Surg. 1984;74(2):251–258. [PMID: 6462420]. Review: Monstrey S et al. Plast Reconstr Surg. 2009;124(2):510–518. [PMID: 19644265].