What is Penile Prosthesis?

The history of ED surgery began with the development of penile prosthesis, which was introduced by Scott and Bradley in the year of 1974. Penile prosthesis is an option for men to get rid of from ED. A penile prosthesis is a medical device implanted in a penis during a surgical procedure to enable an erection for satisfactory and satisfying sexual; intercourse. Penile prosthesis is not only used in men to get rid of ED (impotence), but it is also used in the final stage of plastic surgery phalloplasty to complete female to male gender reassignment surgery, as well as during total phalloplasty for adult and child patients that need male genital modification because of congenital anomalies, iatrogenic, accidental or intentional penile trauma, and micropenis.

Techniques of Penile Prosthesis:

A penile prosthesis is an artificial support for the penis. These supports can be either external or internal.

• External supports can be bought from sex shops and mail-order organisations that deal in sex aids. They include ‘cock cages’ – sheath-like devices which slip over the penis and support it – and artificial phalluses, which the man wears over his organ.
• Internal supports are much more complicated. They have to be inserted by a urological surgeon, by means of a delicate operation.

Internal supports

Most men who have problems getting an erection (erectile dysfunction) can be treated without surgery.

The new oral drugs that are available have helped millions. Sometimes psychotherapy and other non-surgical measures are also helpful. But in a minority of cases, the solution may be to have a support implanted inside the penis.

No one should consider this procedure until the other methods have been considered carefully. It is advisable to start by consulting your GP, who should investigate the possible underlying cause of your erectile dysfunction.

How Penile Implant Surgery is done?

Penile implant surgery is conducted on patients who have exhausted all other areas of treatment. The semirigid device consists of two rods that are easier and less expensive to implant than the inflatable cylinders. Once implanted, the semirigid device needs no follow-up adjustments, however it produces a penis which constantly remains semi-erect. The inflatable cylinders produce a more natural effect. The patient is able to simulate an erection by using a pump located in the scrotum.

With the patient asleep under general anesthesia, the device is inserted into the erectile tissue of the penis through an incision in the fibrous wall. In order to implant the pump for the inflatable implant, incisions are made in the abdomen and the perineum (area between the anus and the genitals). A fluid reservoir is inserted into the groin and the pump is placed in the scrotum. The cylinders, reservoir, and pump are connected by tubes and tested before the incisions are closed.

Today, penile prostheses have proven to be both reliable and durable, with approximately 20,000-30,000 devices implanted annually worldwide. In a 1996 survey, approximately 21,000 prostheses were implanted in North America, with another 5000 worldwide. With new social awareness regarding ED, many experts believe that future device implantations will become more prevalent because of failing medical therapy.

How Does the Penile Prosthesis Work?

The inflatable penile prosthesis consists of two cylinders - a reservoir and a pump - which are placed surgically in the body. The two cylinders are inserted in the penis and connected by tubing to a separate reservoir of fluid. The reservoir is implanted under the groin muscles. A pump is also connected to the system and sits under the loose skin of the scrotal sac, between the testicles.

To inflate the prosthesis, the man presses on the pump. The pump transfers fluid from the reservoir to the cylinders in the penis, inflating them and causing an erection. Pressing on a deflation valve at the base of the pump returns the fluid to the reservoir, deflating the penis and returning it to the normal flaccid state.

Who should undergo Penile Prosthesis?

• Men who may be suitable for this type of surgery include those who have:
• sustained injury to the erectile tissue within the penis
• sustained damage caused by repeated injection treatment, which causes fibrosis within the erectile tissue
• been damaged by previous surgery, e.g. for cancer
• Peyronie’s disease, which causes fibrosis within the erectile tissue
• unsuccessfully tried all other treatments for loss of erection
• Is the Prosthesis easily recognized?

While men who have had the prosthesis surgery can see the small surgical scar where the bottom of the penis meets the scrotal sac, other people probably will be unable to tell that a man has an inflatable penile prosthesis. Most men would not be embarrassed in a locker room or public restroom, for example.

How Prosthesis affects Sex Life?

When the penis is inflated, the prosthesis makes the penis stiff and thick, similar to a natural erection. Most men rate the erection as shorter than their normal erection; however, newer models have cylinders that may increase the length, thickness, and stiffness of the penis.

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. Men usually cannot get an erection without inflating the implant. If the implant is removed, the man may never again have natural erections.

How effective is Prosthesis?

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.

Is the Prosthesis Safe?

No surgery is totally free of possible complications. Complications associated with penile implants include:

• Uncontrolled bleeding after the surgery possibly leading to re-operation
• Infection
• Scar tissue formation
• Erosion (tissue around the implant may break down) requiring removal
• Mechanical failure leading to re-operation and removal

Does Insurance provide any Coverage for Penile Prosthesis?

Insurance coverage for these operations is often good, as long as a medical cause of ED is established. Medicare covers the surgery, but Medicaid does not.

Risk Factors with Penile Prosthesis:

With any implant, there is a slightly greater risk of infection. The implant may irritate the penis and cause continuous pain. The inflatable prosthesis may need follow-up surgery to repair leaks in the reservoir or to reconnect the tubing.