Why Penile Implant Surgery?
Penile implants are devices placed inside the penis to allow men with severe erectile dysfunction (ED) to achieve a 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, a penile prosthesis can also be concomitantly used in the treatment of Peyronie’s patients with ED and curvature. Most patients are very happy with the use of the device and the satisfaction rate is 90 % of men and 95 % of their partners.
When should I consider penile implant surgery?
Penile implants are typically recommended in patients not responding to oral treatment alternatives. A penile implant is a permanent solution to erectile dysfunction.
What elements should a full medical evaluation include?
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The international index of erectile function (IIEF) or other validated questionnaires to objectively assess the severity of ED and subsequent postoperative outcome
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Combined injection-stimulation test
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Penile color Doppler sonography with intracorporal pharmacologic injection
How does a penile implant work?
There are two types of penile implants: Flexible implants, and inflatable implants.
Flexible implants (Coloplast Genesis) 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 (Coloplast Titan Touch Bioflex) are devices filled with fluid that consist of two inflatable cylinders placed in the erection chambers of the penis, a hand-controlled pump placed in the scrotum, and a reservoir that 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. Afterward, the pump is also used to move the fluid back to the reservoir.
References
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Coloplast. Data on file.
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Sadeghi-Nejad H. Penile prosthesis surgery: A review of prosthetic devices and associated complications. J Sex Med. March 2007;4(2):296-309.
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Pritchard C, et al. Comparison of AMS 700 CX and Coloplast Titan Inflatable Penile Prosthesis Cylinders Subjected to In Vitro Cyclic Buckling.
References:
1. Wolter CE, Hellstrom WJ. The hydrophilic-coated inflatable penile prosthesis: 1-year experience. J Sex Med. 2004 Sep;1(2):221-4.
2. Wilson SK, Salem EA, Costerton W. Anti-Infection Dip Suggestions for the Coloplast Titan Inflatable Penile Prosthesis in the Era of the Infection Retardant Coated Implant. J Sex Med 2011;8:2647-54.
How the Internal Penile Prosthesis Pump™ Works During Sexual Activity?
When a man is sexually aroused, all he has to do is squeeze the pump between the thumb and index finger, and an erection occurs. The penis looks and feels so normal (because of our minimally invasive surgical scrotal technique) that many patients report that even after sexual activity, a new partner could not tell that an Internal Penile Prosthesis Pump™ was present. Our surgical approach allows us to hide all of the components of the penile pump into the scrotal sac and the incision is concealed by the midline raphe of the scrotal skin.
When the erection is no longer desired, the patient squeezes and holds the pump, which releases the fluid back into the reservoir and brings the penis back to a flaccid state. The patient controls the duration of the erection. If a patient has an orgasm too quickly, the erection is not lost, and the patient is able to maintain it until his partner is satisfied.
What to expect during the penile implant treatment process?
Before penile/penile prosthesis surgery:
Medical history:
Your doctor will ask you some questions about your past and present health status. The surgeries you have had, the medications you have used, and the treatments you have used for erectile dysfunction before will be noted. All these questions and answers will remain confidential.
Physical examination:
To decide that a Penile/Penile prosthesis is the most suitable treatment for you, you must undergo a comprehensive urological examination. Patients who have been given a prosthesis decision should not have an active skin disease before surgery, especially in the genital area.
Before the operation, in patients who have decided to have penile/penile prosthesis surgery,
- Controlling sugar in diabetic patients
- Quitting smoking
- It is important for those who use blood thinners to discontinue their medication under the supervision of a doctor and, if necessary, to use another medication with the recommendation of a doctor.
- After the patient is hospitalized for the operation, intravenous antibiotics will be given to prevent pre-operative infection and the genital area will be cleaned immediately before the operation to reduce the risk of infection.
Penile/penile prosthesis surgery:
General anesthesia or regional (spinal anesthesia) can be applied for the surgery. Which type of anesthesia will be applied; It is generally decided by the operating team, taking into account the medical needs and the preference of the patient, the anesthesiologist, and the physician who will perform the surgery.
The duration of the surgical procedure can usually vary between 45 minutes and 1 hour. Postoperatively, a urinary tract catheters and surgical drains can be applied to the patients. The catheter is usually removed the next day, and the surgical drain is removed in 2-3 days.
The maximum stay in the hospital is 2 days.
After penile/penile prosthesis surgery:
Antibiotics and painkillers will be prescribed for you to use when you are discharged from the hospital.
During the recovery period, the penile/penile prosthesis is left semi-inflated and remains like this until 1 week after you go to the doctor's control.
When you go to the control after 1 week, your doctor will teach you to operate the pump and you will be asked to inflate and deflate until the day you have intercourse.
Athletic suspension panties are worn for 10 days.
You are allowed to take a bath 2-3 days after the operation.
The stitches do not need to be removed as they will dissolve on their own.
There may be mild pain and swelling in the penis and scrotum for 1-2 weeks after the surgery. Again, heavy exercises and heavy lifting should be avoided for 6 weeks after the surgery.
After penile prosthesis, sexual intercourse is allowed after 4-6 weeks.
Ejaculation and orgasm similar to physiological conditions are provided in patients with penile/penile prosthesis as in normal sexual intercourse.
