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Penile Prostheses

What is a penile implant?

-Penile implants are devices placed inside the penis to allow men with severe erectile dysfunction (ED) to achieve rigid erection. These devices have been utilized since 1973.

Most of these men have tried oral medication (PDE-5 inhibitors-tadalafil, sildenafil etc) prior to placement of a penile prosthesis.  In addition, penile prosthesis can also be concomittently used in the treatment of the Peyronie’s patients with ED and curvature. Most patients are very happy with the use of the device and the saticfaction rate is 90 % of men and 95 % of the partner.

Penile implants can also be used to treat severe cases of a condition that causes scarring inside the penis, leading to curved, painful erections (Peyronie’s disease). Peyronie’s patients with ED also candidates implantation of penile prosthesis.

 

When should I consider penile implant surgery?

-Penile implants are typically recommended in patients not responding to oral treatment alternatives. Penile implant is permenant solution of erectile dysfunction. 

 

What elements should a full medical evaluation include?

  • The international index of erectile function (IIEF) or other validated questionnaires to objectively assess severity of ED and subsequent postoperative outcome

  • Combined injection-stimulation test

  • Penile colour Doppler sonography with intracorporal pharmacologic injection

 

How does a penile implant work?

-There are two types of penile implants: semirigid, noninflatable implants and inflatable implants.

Semi-rigid implants consist of two bendable rods that are implanted in the erection chambers of the penis. They can be bent into position during sexual activity. With this type of implant, the penis is always semi-rigid, which may be difficult to conceal.

Inflatable penile implants are devices filled with fluid which consist of two inflatable cylinders placed in the erection chambers of the penis, a hand-controlled pump placed in the scrotum, and a reservoir which stores fluid when the penis is not erect. The device is inflated by squeezing the pump several times to move the fluid from the reservoir to the cylinders. Afterwards, the pump is also used to move the fluid back to the reservoir. Two companies, American Medical Systems (AMS) and Coloplast manufacture three-piece hydraulic penile implants.

Two piece (Ambicor) penile implant consists of a pair of fluid filled cylinders implanted in the penis and a pump implanted in the scrotum. During prosthesis recycling, the pump transfers the solution from small reservoirs located at the proximal end of each cylinder, into each cylinder shaft, thereby causing an erection. It provides controlled length and girth expansion through its bidirectional wave. American Medical Systems (AMS) manufacture two-piece penile implant

LGX prosthesis: this three piece implant has the ability to expand in length and girth. AMS 700 LGX is a safe and reliable prosthesis for patients with ED and is effective in preventing penile shortening in patients undergoing IPP implantation, with high patient satisfaction rate. Hovewer, the price is more expensive compared to standard inflatable penile prosthesis.

The penile prosthesis implanted by a one hour surgery into the corpora cavernosa. Both types of implants are placed completely inside the body. Inflatable implants are used more often because they mimick a natural erection on the other hand with mallable devices the penis is not as soft as in the flaccid state. Semi-rigid devices is only indicated in patients with manual dexterity. Discuss the choice between the two implants with your urologist.

 

The procedure;

-For penile implant surgery, you will receive either general or spinal anaesthesia. Urinary catheter will also be indwelled, which can be removed the day after surgery. Once you are under anaesthesia, the doctor will make a small incision either just above the penis or between the penis and the scrotum. The incision exposes the erectile chambers, and the surgeon measures the length of the chambers in order to implant appropriate size prosthesis.       

Once the cylinders are in place, the reservoir is placed behind the abdominal wall, and the pump is placed in the scrotum between the testicles to conceal the pump.

Finally, all elements of the implant are connected and the incision is sutured. The wounds are cleaned and a compressive bandage is applied. Most surgeons choose to leave the penile implant inflated for one day. Some surgeons prefer to leave a drain which is then usually removed one or two days after the procedure.

 

How to prepare

-Your doctor will advise you in detail about how to be prepared for the procedure. You must not eat, drink, or smoke for eight hours before surgery to prepare for the anaesthesia. If you are taking any prescribed medication, discuss it with your doctor. You may need to stop taking it several days before surgery.

 

Is it painful?

-Most patients experience mild pain after the surgery due to inflammation.  This is generally short lasting.  Once the pain resolves, the patient can be trained to inflate and deflate the device. Most patients and their partners are very happy with the penile prosthesis after learning how to use it.

 

After surgery

-After penile implant surgery, you’ll likely need to take medications to ease pain. Mild pain might persist for several days. You might also need to take antibiotics for one week to prevent infection.

Your doctor will provide specific instructions about when you can resume normal activities. Most men can resume strenuous physical activity and sexual activity about four to six weeks after surgery. Absorbable sutures are used therefore you don’t to return to your doctor to have your stitches removed.

 

Penil prostheses implantation: complications

-Most common complications after implantation of penile prosthesis are infection and disruption of the hydraulic system. In recent years, complications of penil prosthesis implantation have been reduced significantly bacuse of the technical developments. In order to reduce the prosthetic infection rate, the penile prosthesis is covered with antibiotics, or special material which provide the antibiotic molecules in the solution to bind on prosthesis surface.  According to these developments penil prosthesis infection rates reduced <1% from 3-5%. Also, mechanical deterioration rates decreased to around 5% because of development in material technology.

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