The penile prosthesis is a permanent solution for erectile dysfunction that allows you to have an erection at the desired time and for the desired length of time.
What is a penile prosthesis and how does it work?
The penile prosthesis or penile implant is a device that is implanted inside the penis in order to give it the ability to have rigidity and maintain sexual intercourse with penetration.
It consists of two cylinders that are inserted into the interior of the corpora cavernosa and act as the latter to achieve a state of erection.
Penile Prosthesis Surgery
The implantation of a penile prosthesis is performed through a surgical procedure under anesthesia, and since once implanted it is not possible to revert to other treatments, it is considered the last resort among therapeutic options for erectile dysfunction.
There are several ways of inserting the prosthesis and the choice of prosthesis depends on the surgeon and the type of prosthesis. The incision can be made
- Subpubic approach: behind the pubis.
- Subcoronal approach: under the glans penis.
- Penoscrotal approach: between the base of the penis and the scrotum.
After the operation, the patient is given a compressive bandage that is changed after 24 hours. The patient spends some time in the post-anaesthesia recovery unit before going to his or her room, where he or she will be admitted for a very short period of time, or in many cases, none at all.
In the days following the operation, the penis should be blocked and pain should be relieved with painkillers prescribed by the doctor.
Among the complications that can occur after the operation are urinary retention, the appearance of haematomas or oedemas or, in cases of serious complications, prosthetic infection, which affects 1-8% of cases and can lead to the removal of the prosthesis. Once the first month has passed, the possibility of infection decreases drastically and sexual activity can be resumed.
Its implantation by expert centres and surgeons reduces the complications associated with the procedure. ROC Clinic’s urology group is recognised by the Spanish Ministry of Health as one of the two groups accredited in Spain to perform these procedures.
Types of penile prostheses
Malleable penile prostheses
These consist of two silicone cylinders with a rigid but malleable skeleton (usually silver) inside. Each cylinder is inserted into the corpora cavernosa after an incision has been made in the corpora cavernosa. This gives the penis the necessary consistency for penetration. The disadvantage of these prostheses is that the penis remains constantly rigid and can only change its position. However, they have two great advantages: they are cheaper and easier to use, as they do not need to be activated and deactivated. The postoperative period and recovery are also usually quicker.
Hydraulic penile prostheses
They are characterised by the fact that the cylinders are hollow and, by means of a hydraulic mechanism, they are filled with serum to achieve an erection. Depending on the complexity of the mechanism, they are divided into:
- (a) Two-component prostheses: The cylinders are connected to a pump that is housed in the scrotum. In this way, when the patient presses the pump, the serum will pass into the inflatable cylinders, thus achieving rigidity. To deflate the prosthesis, simply press on the corpora cavernosa until it is completely emptied.
- b) Three-component prostheses: these are the most functional. They resemble a natural erection and achieve an almost physiological state of flaccidity. In addition to the cylinders, they consist of a pump (placed in the scrotum) and a reservoir (behind the pubis) connected to each other. This pump has two buttons for emptying and filling the cylinders. During the emptying phase, the serum remains in the reservoir. They are, on the other hand, the most cost-effective.
Penile prosthesis results
Satisfaction after insertion of a penile prosthesis is among the highest of all described therapies for erectile dysfunction. The prosthesis does not interfere with sexual desire, the sensation of orgasm, or ejaculation. However, the patient should be aware that the length of the penis is not increased, in some cases a shortening of 1-2 cm is observed.
Patients with three-component hydraulic prostheses achieve the highest degree of satisfaction. Some studies report that 92.5% of cases had at least 1.7 intercourse per week at 5 years after surgery.
The mechanical failure rate at 5 years is approximately 10%.