A penile prosthesis a surgical treatment option for men with erectile dysfunction. Some consider it the “last ditch” option for men suffering from impotence. We at PERITO UROLOGY respectfully disagree. A penile implant can be placed in any patient with a clear medical cause for ED. Most of these problems fail to resolve spontaneously with non-surgical treatments. Existing non-surgical treatments for ED temporize the inevitable treatment decision: sex with an implant or no sex at all. Sometimes a penile prosthesis is implanted to reconstruct the penis when scarring has caused erections to curve (Peyronie’s disease) precluding sex.
How Does the Penile Prosthesis Work?
Penile implants are either malleable (bendable) or inflatable. There are various companies around the world that design and produce penile prostheses but here at PERITO UROLOGY we choose to utilize those implants with licensing here in the United States, regardless of our operative venue.
Malleable Implant - The simplest type of penile prosthesis consists of a pair of malleable rods surgically implanted within the erection chambers of the penis, also known as the corpora. With this type of implant the penis is always rigid and may be moved into any desired position determined by the patient. Because the implant is always hard, the malleable penile prosthesis is difficult to conceal. Far from physiologic, this was the first penile implant and has been a reliable form of treatment for ED for nearly 50 years.
The Inflatable Implant – This penile prosthesis consists of three components: two inflatable cylinders, a reservoir and a pump. All components are concealed in the body. The two cylinders are inserted into the same erection chambers as the malleable penile prosthesis but they are connected by tubing to a separate reservoir of fluid. The reservoir is implanted in or behind the abdominal wall. A pump is also connected to the system and sits in the scrotal sac, between the testicles. There is a 2-piece inflatable penile prosthesis that consists of only two components but this is not utilized by PERITO UROLOGY. To inflate the prosthesis, the man presses on the pump in the scrotum thus transfering fluid from the reservoir to the cylinders in the penis causing an erection. The more firmly one compresses the pump, the “harder” the erection. There is a deflation valve on the pump allowing fluid to return to the reservoir, deflating the penis and returning it to the normal flaccid state. Because a patient with a three piece implant is able to fully deflate the prosthesis, others are unable to tell that he has a penile prosthesis. Most men would not be embarrassed in a locker room, public restroom, pool or beach for example. Patients must have reasonable dexterity to manipulate the pump.
What Is Sex Like With an Inflatable Penile Prosthesis?
When the penis is inflated, the prosthesis makes the penis rigid, similar to a natural erection. A penile prosthesis does not change sensation on the skin of the penis or a man’s ability to reach orgasm. Ejaculation is not affected. Once a penile prosthesis is put in, however, it may destroy the natural erection reflex thus resulting in a loss of that “blood rushing to the penis” effect. The implant renders one with a penetrating penis, it does not cause swelling (tumescence) of the head (glans) of the penis.
What is Life Like with an Inflatable Penile Prosthesis?
We at PERITO UROLOGY have yet to find a hobby, sport or past-time by which the implant precludes your participation. We have rock climbers, equestrians, motorcyclists, body builders and many more patients who have successfully undergone placement of the penile prosthesis. The implant does not set off security alarms at airports or guarded buildings. Our patients, once healed, proceed with a normal active lifestyle if so desired.
Risks of implant surgery include:
- Infection. As with any surgery, infection is a possibility. Our infection rate at PERITOUROLOGY is consistently less than 1%. You may be at an increased risk of infection if you have a spinal cord injury or diabetes. Men who need surgery to adjust or replace an implant (revision surgery) are at higher risk of infection than they were with the first surgery. Infection risks can be significantly reduced when the patient complies with the pre and post operative instructions provided. Infections can be treated with either removal or salvage (immediate wash-out and replacement). Our most recent years data base revealed only 5 infections out of 525 with all five being successfully salvaged.
- Implant problems. Surgery is necessary to remove, repair or replace a broken implant. Our 15 year device survival rate approaches 90%.
- Internal erosion. Like a hernia of your intestines through the abdominal wall, an implant may try to erode through the skin. These are generally treated like hernias by reinforcing the tissues with suture.
The most common complaints following penile prosthesis include:
- “Loss of penile length.” The perceived loss of penile length is not due to the placement of the penile implant. In fact, placement of the implant stops the atrophy process and with proper rehabilitation can result in the patient regaining some of his lost penile length.
- “The pump is too hard.” All pumps become hard at end filling. Think of a bicycle pump; as the tire gets firm the pump requires more force. We teach our patients to use both thumbs to inflate in order to maximize the erection rigidity.
- “The implant in the deflated position looks unnatural.” True, the penis does look different when deflated. With a couple of small pumps you can usually obtain a suitable appearance for public display. I tell my patients I am not in the business of making penises pretty while flaccid. We create hard physiologic erections for the patient.
- “I feel tubing around my cylinders.” At PERITO UROLOGY we do everything we can to conceal tubing but some anatomy requires cylinders where small amounts of tubing may be palpated under the skin.
- “The head of the penis does not get hard.” True. Once again, the implant does not cause swelling of the glans of the penis. At PERITO UROLOGY our surgical technique limits the amount of soft glans we previously say with aggressive dilation of the spongy tissues of the penis. Viagra like medications and/or urethral creams can be used to treat this complaint.
How Effective Are the Implants?
About 90%-95% of inflatable prosthesis implants produce erections suitable for intercourse. Satisfaction rates with the prosthesis are very high, and typically 80%-90% of men are satisfied with the results and say they would choose the surgery again.