Penile prosthetic surgery consists of the implantation of a device inside the corpus cavernosum of the penis. The aim of the penile prosthesis is to give the necessary rigidity to be able to have satisfactory sexual intercourse. The implant does not influence libido (desire), ejaculation or orgasm.
Initially, one of the problems that limited the expansion of these devices was their unreliability in the short and medium term. However, this has been reduced as technology has progressed to rates of less than 5% in 5 years. For this reason, the prostheses are guaranteed for life by some commercial companies, due to their high reliability.
Currently we have a wide variety of penile prostheses. Generally speaking, they can be classified in two groups, the flexible and malleable ones and the hydraulic or inflatable prostheses:
1. Flexible and malleable prosthesis
They consist of two cylinders that are placed inside each corpus cavernosum and keep the penis rigid all the time, without increasing its circumference or length. It always maintains the same size and consistency and it is the patient who bends the prosthesis or places it in the desired position to have intercourse.
Advantages: they have a lower cost, low incidence of mechanical failure, greater ease of placement and less surgical time, which decreases the rate of infections.
Disadvantages: Continuous stiffness may cause an aesthetic problem in some patients. Occasionally it could hinder explorations via the urethra such as bladder endoscopy, a necessary test for the treatment and surveillance of bladder tumors.
2. Hydraulic prostheses
These are the most technologically complex prostheses. They consist of flexible cylinders that are placed in the corpora cavernosa and are connected to a system that allows the pumping of liquid inside the cylinders that are housed in the penis. In this way, an artificial erection is produced according to the person’s desire, maintained for as long as required.
Depending on the components that make up the prosthesis, they are classified into two or three-component devices. The two-component device consists of the cylinders that are housed in the penis and the pump that activates them, which is implanted in the scrotum. The three-component device adds a reservoir that is implanted at the abdominal level. The latter are the most used and best considered at present, given the “naturalness” they offer, both in flaccidity and erection.
Indications for a penile prosthesis
Penile prosthesis is a good therapeutic option in patients with erectile dysfunction who either do not respond to different pharmacological treatments, or when these cause unacceptable side effects, if the erectile dysfunction is associated with Peyronie’s disease (penile incurvation), or when penile fibrosis appears after priapism (undesired and maintained erection that can produce irreversible changes in erectile tissue). In other words, it is indicated in individuals affected by organic alterations when other types of treatment (drugs, vacuum devices, etc.) have failed. In these cases it can be affirmed that the possibility of implanting a penile prosthesis constitutes a real therapeutic success for erectile dysfunction.
The implantation of a penile prosthesis is an irreversible treatment. They are therefore reserved for well-informed patients who have undergone previous treatment steps without success, as well as for other less frequent indications. It is therefore very important to assess and clarify the patient’s expectations prior to placement, because this will influence subsequent perceived satisfaction.
It is also essential to offer this surgery only to properly selected patients and to correctly choose the prosthesis model available on the market to meet the needs of each patient. For example, patients often have unrealistic expectations about the future length of their penis that are impossible to achieve. It is imperative that the patient knows that the length of his penis after prosthetic implantation will be less than it was when he was achieving satisfactory erections. It will usually be similar to that of the stretched penis in flaccidity, since the objective of the prosthesis is for the patient to regain sufficient rigidity to be able to penetrate.
Candidates for penile prosthesis implantation should meet the following ISSM criteria:
– good health
– failure or contraindication of medical treatment for erectile dysfunction.
– psychological stability
– be fully informed of the procedure and its possible complications
– signature of the informed consent for the surgery.
If these precepts are met, penile prosthesis offers the highest satisfaction rates among ED treatments (between 92 and 100%).