Penis prosthesis

Sexual medicine Treatments

Erectile dysfunction: Penis prosthesis

Without a doubt, the development of prosthetic devices for the penis has opened a whole new way to definitively treat the very common and disabling erectile dysfunction or ED. It is a surgical treatment, yes, but one that has been shown to be effective and safe as well as amazingly natural. In this article we will address the most important aspects.

Erectile dysfunction

Table of Contents

DEFINITION

What is a penile prosthesis?

A penile prosthesis (also known as a penile implant) is nothing more than a high-tech, surgical-applied medical device that has structural components capable of producing states of erection that are rigid enough to allow intercourse and other sexual practices.

According to our own criteria, penile prostheses are by far the only definitive solution to erectile dysfunction and that, according to statistics, already one in five Spanish men over 18 years of age suffers from it and limits it to the hour to enjoy sex without worry.

Until now, erectile dysfunction had been managed clinically with suction devices (or vacuum pumps) and phosphodiesterase 5 inhibitors (better known as sildenafil-like retardants). These treatments have helped many men with ED, however, they are impractical and require prior preparation (not to mention that they may sometimes be insufficient).

The main advantage of penile prostheses is naturalness since they do not affect the shape of the penis and induce firm erections for as long as the patient wants (except flexible prostheses).

Types of penile prostheses

As we will see below, there are mainly two types of penile implants and each one of them has different implications in its mechanism of operation and use by the patient who wears them.
1) Malleable prostheses

This type of prosthesis has a fairly simple operation and although the foundation is almost always the same, there are some subtypes such as the one consisting of a silicone bar with an elongated and metallic element inside, so the man could place the penis in the that I would like. For example, put it on “erection” or “flaccidity” whenever you want.

The main problem with this is that the penis would be persistently erect, which could be somewhat uncomfortable for the man who wears it.

Other subtypes of even more malleable penile prostheses (Flexirod®) consisted of a silicone rod with an internal joint, so the penis could have a more natural flaccid state.

Over time, even newer subtypes of these implants have emerged. For example, there are implants with an internal “lead” activator system. Basically, when the man wants it, he flexes the penis at an angle of 120 ° and the penis goes into “erection” and, to deactivate it, the procedure would be similar but in the other direction. Of the malleable ones, these are the most widely used today (Omniphase® and Duraphase®).

Advantage

Malleable prostheses, since they are made of silicone and have a metallic element inside (arranged like a braid), allow the penis to be bent almost 70 °, which helps to hide persistent rigidity.

Disadvantage

The main drawback of this system is that for patients with long and thick penises (more than 14 cm in length and 4 cm in diameter) they could be uncomfortable. The penis may bend very much and cause discomfort or pain.

2) Hydraulic prostheses

These types of penile implants are by far the most popular today in urological surgery to treat erectile dysfunction and improvements are increasingly appearing.

There are hydraulic prostheses with one body (already in frank disuse), two bodies and three bodies. The difference between the latter two is that the second (three-body penile prosthesis) has a reservoir of saline solution similar to a small balloon located behind the pubic bone. Said fluid is pumped from a tiny device in the scrotum to the two intracavernous cylinders.

The first (two-body penile prosthesis) consists solely of a balloon in the scrotum that is activated manually, that is, it is a reservoir and a pump at the same time.

Advantage

In general, its operation is very comfortable for patients since they can control the intensity and time of the penis erection themselves by means of a small device hidden inside the scrotum. It is the most effective and aesthetic type of penile prosthesis.

Two-body prostheses (Excel Resist® or AMS Ambicor®) are cheaper and do not require the abdominal placement of a reservoir, which makes them more comfortable and natural (since the penis will never enter states of extreme flaccidity or rigidity) .

Three-body prostheses are not only the most popular today for their excellent results, achieving incredibly powerful erections, therefore, they generate states of flaccidity and erection that are as close to reality as possible.

Disadvantage

Single-body penile prostheses were somewhat complicated to use. The two-body can only be used on penises smaller than 13 cm and there is a risk that the scrotum will look very enlarged. Three-body penile implants are the best and have very few downsides, frankly.

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andromedi implante de pene sustitucion cuerpos cavernosos 01
Corpus cavernosa replacement penile implant 01
andromedi implante de pene sustitucion cuerpos cavernosos 02
Corpus cavernosa replacement penile implant 02

How do they work?

Although they seem complicated at first glance, penile prostheses have quite similar mechanisms of operation to each other very simple. They basically consist of hollow rods of a soft and elastic material (such as silicone) that are surgically inserted into the penis, specifically in the corpora cavernosa that are responsible for erection.

Once inside, these hollow silicone rods can be hardened by various means. Some prostheses are in constant “erection” because they have a malleable material inside (such as a metallic braid) while others contain a system of “cables” that join one end to another and, depending on how they flex, they can be raised or made flaccid.

However, the most modern types of penile prostheses (and therefore more widely used) consist of a liquid filling system, almost always saline solution.

Fluid is stored in one site when the penis is required to be flaccid (most of the time to avoid inconvenience) and a small hand pump propels the fluid into the hollow center of the intracavernous rods for erection.

Treatment summary

PENILE IMPLANT

Here you can find the process summary for this treatment, from booking an appointment to the medical discharge.

Consultations Needed

Two previous consultations for penile prosthesis surgery will be necessary, one to examine the problem and the other for preoperative evaluation.

Hospital Stay

The patient can leave the clinic 24 hours after the intervention, the hospital stay can be extended to 48 if there is a risk factor.

Anesthesia Type

Epidural anesthesia only for the area of surgery and mild or moderate sedation so that the patient is calm and relaxed.

Operation Time

Suele ser bastante rápida y sencilla. El paciente muy pocas veces excede los 60 minutos dentro del quirófano.

Post-Operative

The post-operative period after penile implant surgery does not require special care but rather relative rest and wound care.

Resuming Sex Life

After four or five weeks of rest and after a medical consultation, the patient can return to enjoy sexual relations.

Reasons to consider a penile implant

Many men are afraid of just imagining having a device inside the most noble organ of the human body of the male: the penis, but the reality is very different.

Penile prostheses are very advanced medical devices that offer surprising results in severe cases of erectile dysfunction in which those who suffer from it no longer want to worry about taking a pill 30 minutes before sexual intercourse or worse, using a pump vacuum to inflate the penis (it should be noted that the latter has been shown to damage the delicate blood vessels of the penis and worsen the prognosis of erectile dysfunction).

High levels of patient satisfaction
More than 90 percent of patients undergoing a penile prosthesis implantation express strong satisfaction with the results obtained. Erectile dysfunction (ED) almost completely disappears and sex life can be restored.
Minimum recovery time

The recovery time after surgery is variable and will depend on each patient, however, after a week or earlier, the patient can return to their work activities without any problem.

It is a surgery performed with the highest precision, it leaves quite small operative wounds that heal very quickly and do not leave visible marks. In fact, the device itself is not visible and is almost unnoticeable.

Profitable for a long time

On average, and based on the estimates of the urological surgeons who perform the intervention, each penile prosthesis can be functional for approximately 10 years.

It sounds little but it is a decade of unconcern for issues related to the limp erections of before. Now, many will ask, is it possible to replace old prostheses after 10 years? And the answer is yes.

There are cases of patients who have tried not just one but up to two or three different types of penile implants for erectile dysfunction (ED) when the previous ones have already expired without any problem. In these cases, a more careful preoperative evaluation is required (to examine the integrity of the tissues into which the previous devices were inserted).

Security

The current penile prostheses are much more modern than those of 20 or 30 years ago and as expected, they are much more comfortable, discreet and safe. The possibility of infections or ruptures is minimal and the most modern models of penile implants have a special antibacterial coating, which reduces the risk of developing these types of complications to almost zero.

They are high-tech materials and friendly to the tissues of the corpora cavernosa.

It is not noticeable, it is discreet

Although it may seem strange, penile prostheses can go completely unnoticed with the naked eye. Technically, it is very difficult to distinguish between a prosthetic erection and a natural penile erection.

The operation of the prosthesis is initiated by the patient himself when he considers it appropriate and can take even less than a minute if done properly.

No more shots, no blue pills, no vacuum pumps

Penile prostheses are a definitive treatment that does not require the patient to continue taking retardant drugs such as sildenafil, taladafil or vardenafil to enhance erections since the same device will take care of this task in the same place: the penis.

Drugs to treat erectile dysfunction do not produce immediate effects, and vacuum pumps are cumbersome and sometimes cause pain and bruising on the penis.

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Why is it such a special treatment?

Penile prostheses are by themselves the only definitive treatment for erectile dysfunction because the other treatments (drugs such as sildenafil, intracavernous injections of vasoactive substances or vacuum pumps, etc.) only help to modify the physiology erection but, as is known, this process is quite complex because it involves many different vascular, emotional and hormonal mechanisms.

Penile prostheses completely eradicate the root problem. Technically, each patient can produce erections or flaccid states at will and in the intensity they want (in the case of hydraulic models).

With penile implants, the patient can forget about taking erectile dysfunction medications, go to the doctor to have drugs injected into the penis with a syringe, or even insert his penis into a vacuum device prior to sexual intercourse. He will only have to take a minute to inflate the penis with the pumping device into the scrotum and in no time his penis will be firm. At the end of sexual intercourse, the man can deflate the device and the penis will return to its original shape.

The satisfaction rates for a penile prosthesis are among the highest of all erectile dysfunction therapies. There have even been case follow-up studies and 5 years after having implanted the penile prosthesis, 92.5% of the men stated that they had sexual intercourse more frequently than 1.7 times a week.

The Penile Implant: Procedure

Although it seems complex, a penile prosthesis implantation surgery can be relatively quick and with few implications. To facilitate understanding of this amazing surgical task, this section will address the most important aspects of surgery: before, during and after it.

How should I prepare for the procedure?

Before surgery, the patient must undergo a pre-surgical evaluation that includes a thorough physical examination, review of chronic diseases (if the patient is diabetic or hypertensive, for example) and tests of sensitivity to anesthesia to rule out risks of allergies.

Also, the doctor may order blood and urine tests (urine cultures) and take measurements of the penis. This is the ideal time for the patient to ask questions of the doctor, this will allow him to remain more calm and confident throughout the process.

Among the contraindications to surgery (that is, reasons why you should wait a while) are:

It is recommended that the patient attend the surgery accompanied and that, in addition, adequate hygiene of the genital area has been carried out (including shaving the pubic hair with an electric razor).

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The surgery, how is it?

First of all and with the patient under anesthesia in the operating room, the surgeon performs a careful disinfection of the genital area with antiseptic substances that do not irritate the skin of the penis, this will minimize the risk of post-surgical infection. A urinary catheter may also be inserted to make urination easier before and after surgery.

There are several surgical techniques to insert the prostheses into the corpora cavernosa (and everything will depend on the type of prosthesis) but in general terms, the route of choice is usually the penoscrotal route in which small cuts are made at the base of the penis on its ventral side.

Through them, the surgeon can insert the cylinders into the corpora cavernosa of the penis, the pump and the reservoir, avoiding injuring the neurovascular bundle located in a dorsal position.

Semi-rigid prostheses (better known as malleable) do not require prior preparation, but hydraulic prostheses do require certain steps. For example, they must be prefilled with sterile saline before inserting into the scrotal or pubic cavity.

Upon completion of the implantation, the surgeon carefully closes the surgical wounds and the surgery is complete. Then, the patient goes to an observation and recovery room and will have to stay for as long as the doctor indicates (almost always a couple of days).

Post-surgery care

The next day, the patient must be subjected to the removal of the urinary catheter to urinate again on his own. In addition, the doctor will empty the filled cylinders of the prosthesis (because that is how they were inserted into the corpora cavernosa) to accustom the erectile tissues.

The patient must be careful not to swell the prosthesis until 4 or 6 weeks after surgery and also maintain a treatment with analgesics and anti-inflammatory drugs (there may be some pain in the scrotal area).

Recovery time

After 4 to 6 weeks after surgery, the patient can initiate sexual activity taking care of the handling of the prosthesis and evaluating its functioning. With the passage of time, the patient becomes accustomed to the use of prostheses and develops the ability to manipulate them masterfully.

Results of implantation of prosthesis in the penis

Despite being a definitive and invasive treatment, penile prostheses are by far the most definitive and effective treatment for erectile dysfunction when the patient seeks precisely that, naturalness and confidence, without having to think about conventional previous treatments: pills, intracavernous injections, psychological treatment, or use of penile vacuum pumps.

The simple fact that more than 92% of men with penile prostheses say that they have on average almost 2 sexual intercourse per week five years after surgery shows a significant (and not negligible) improvement, especially when they have experienced in first person the emotional and social consequences of suffering from erectile problems.

It should never be forgotten that a patient with erectile dysfunction not only has their sexual life affected, but that as a consequence of this, alterations arise in almost all facets of their life, both affective, self-esteem and work performance. Many men see them lose their relationships because they cannot please their partners sexually.

Frequently Asked Questions

¿Es doloroso tener el implante puesto?
No, debido a que los materiales con los que se fabrican las prótesis son suaves y elásticos. No generan (bajo condiciones normales) compresión de estructuras nerviosas y por ende, no deberían ser una causa de dolor crónico en el pene. Incluso, muchos hombres con prótesis de pene dicen “olvidar” que los llevan puesto. No obstante, es probable que durante las primeras semanas después de la cirugía de implantación de prótesis de pene algunos hombres sientan algunas molestias o dolor. A menudo, esto puede controlarse gracias a analgésicos y antiinflamatorios no esteroideos (AINES).
¿En cuánto tiempo puedo volver a tener relaciones sexuales?
Es probable que muchos hombres que recién han sido sometidos a este tipo de cirugías deseen comenzar a ver resultados inmediatos como volver a tener relaciones sexuales con el “nuevo aparato” pero la realidad es que es necesario esperar unas 4 o 6 semanas (el tiempo puede variar) antes de probar el sistema por primera vez antes de una relación sexual.
¿Esas erecciones son muy diferentes a las naturales? ¿Existe alguna diferencia entre ambas?
La realidad es que son muy similares. Sin embargo, las erecciones inducidas artificialmente con prótesis de pene pueden hacer que el miembro sea un poco más frio. Esto se debe en parte porque la irrigación sanguínea no es igual que en una erección natural.
¿Existen riesgos asociados a las prótesis de pene?

Dentro de las complicaciones más notificadas por las cirugías de implantación de prótesis de pene se encuentran las infecciones y el dolor pero son poco frecuentes, afortunadamente. De acuerdo a las estadísticas, el 6 % de los pacientes desarrollan algún tipo de infección leve o moderada y, 2 % de dolor por rotura de la prótesis.

En la mayoría de casos, los pacientes manifiestan satisfacción por la prótesis y consideran que han mejorado notablemente su rendimiento sexual. Las complicaciones pasan a un segundo plano y se consideran poco apreciables, aunque si surgen, deben recibir atención médica de urgencias.

Dr. Natalio Cruz

Author

Dr. Natalio Cruz


El Dr. Cruz, con 25 años de experiencia médica, ha sido hasta 2016 Jefe de la Unidad de Andrología en el Servicio de Urología del Hospital Virgen del Rocío de Sevilla, Coordinador Nacional de Andrología de la Asociación Española de Urología (AEU) y Secretario General de la ESSM, cargos que ha delgado para centrarse de lleno en el ilusionante proyecto de ofrecer una consulta médica privada de alto nivel en Sevilla.

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