Penile Prosthesis, surgical treatment for Erectile Dysfunction (ED)
When a man experiences Erectile Dysfunction (ED), he may feel a range of physical and emotional effects. There are common physical feelings associated with ED such as inability to achieve an erection or reduced sexual desire. A part of physical, a man could have emotional and psychological feelings due to low self-esteem. When joining a group of men’s activity, they can feel frustration or embarrassment when talking about men’s health. These can lead a man to anxiety and depression.
What are the recommended treatments for Erectile Dysfunction (ED)?
Given the wide range of treatments currently available for erectile dysfunction (ED), selecting the most appropriate one can be complex. It is important to note that while there are many options, not all treatments are suitable for every individual patient. Common ED treatments can be categorized into non-surgical and surgical options.
There are various non-surgical treatments which urologists will recommend to you after investigations such as oral medications, injection therapy, urethral suppositories, hormone therapy, vacuum constriction device and shockwave therapy.
Is Penile Prosthesis surgery suitable for Erectile Dysfunction (ED)?
Penile prosthesis is a valuable option for men with ED who have not had success with other treatments, it is the surgical insertion of inflatable or semi-rigid devices into the penis offering a long-term solution to achieve and maintain an erection.
There are two main types of penile prosthesis, inflatable and semi-rigid. Each type works differently and has various pros and cons. It is important that you must fully understand this procedure before making a decision undergoing penile prosthesis surgery including risk possibilities, complications and after care or follow-up care.
1. Inflatable 3-piece penile prosthesis, the most common type of penile prosthesis can be inflated to create an erection and deflated at other times. The 3-piece inflatable penile prosthesis uses a fluid-filled reservoir implanted under the abdominal wall, a pump and a release valve placed inside the scrotum and two inflatable cylinders inside the penis.
To achieve an erection, you pump the fluid which is salt water from the reservoir into the cylinders. Afterward, you release the valve inside the scrotum to drain the fluid back into the reservoir.
The 2-piece model works in a similar way, but the fluid reservoir is part of the pump implanted in the scrotum. In both devices, the reservoir is filled with salt water the day of surgery and remains in the device.
2. Semi-rigid penile prosthesis is always firm. The penis can be bent away from the body for sexual activity and toward the body for concealment.
A positionable penile prosthesis is a semi-rigid device with a central series of segments held together with a spring on each end. It can maintain upward and downward positions better than other semi-rigid rods can.
Other special designs can fit a shortened penis or one that’s larger than average. Inflatable penile prosthesis is also available with antibiotic coatings which might help reduce the risk of infection and coatings to reduce friction possibly lengthening the life of the penile prosthesis.
Inflatable 3-piece penile prosthesis
Pros
- Creates the most natural, rigid erection.
- Provides flaccidity when deflated.
Cons
- Has more parts that could malfunction than does any other implant.
- Requires a reservoir inside the abdomen or underneath the abdominal muscles.
Semi-rigid penile prosthesis
Pros
- Has a low chance of malfunction due to the small number of parts.
- Is easy to use for those with limited mental or manual dexterity.
Cons
- Results in a penis that is always slightly rigid.
- Puts constant pressure on the inside of the penis, which can cause injury.
- Can be difficult to conceal under clothing.
“Why it is done” for Penile Prosthesis surgery!
For most men, erectile dysfunction can be successfully treated with medications or use of a penis pump (vacuum constriction device). You might consider penile prosthesis if you aren’t a candidate for other treatments or you can’t get an erection sufficient for sexual activity by using other methods. Penile prosthesis can also be used to treat severe cases of a condition that causes scarring inside the penis, leading to curved painful erections (Peyronie’s disease).
As you may be aware of penile prosthesis surgery that isn’t for every individual patient. Therefore, urologist might caution against penile prosthesis if you have:
- An infection, such as a pulmonary infection or urinary tract infection.
- Diabetes that isn’t well controlled or significant heart disease.
While penile prosthesis allows men to achieve an erection, they don’t increase sexual desire or sensation. Penile prosthesis also won’t make your penis any larger than it is at the time of surgery. In fact, with prosthesis, your erect penis might seem slightly shorter than it used to be.
It’s a must for you to understand the whole Penile Prosthesis procedure.
Before the surgery starts.
Penile implant surgery is usually done at a hospital. The surgery is typically performed under general anesthesia or spinal anesthesia. IV antibiotics are recommended to help prevent infection. The surgery site will also be washed with an alcohol-based antibiotic solution and shaved before surgery to reduce the risk of infection.
In the operating theater.
A tube (catheter) might be inserted into your bladder via your penis to collect urine at some point during surgery. Prosthesis surgeon will make an incision at the base of the penis. Next, stretch the spongy tissue in the penis that would normally fill with blood during an erection. This tissue is inside each of two hollow chambers called the corpora cavernosa. Surgeon will select the correct size prosthesis and place the prosthesis cylinders inside your penis. All sizes are customized to your body measurements.
If your surgeon is implanting a 3-piece inflatable device, a pump and valve are placed inside the scrotum and will also implant a fluid reservoir above or under the abdominal wall using the initial incision. Sometimes a second incision in the abdomen is used. Penile prosthesis surgery usually takes 60-90 minutes.
After the surgery (Post-operative)
After penile prosthesis surgery, you’ll likely need to take medications to ease pain. Often a long-acting injection is given into the scrotum to help reduce pain for 48 to 72 hours. Mild pain might persist for several weeks. You might be given an antibiotic to be taken by mouth for 2 weeks. Normally, most men can resume strenuous physical activity and sexual activity about 6 weeks after surgery.
How to use the device?
Usually, after 3 to 6 weeks after surgery, the urologist will provide to you the instructions on how to inflate and deflate inflatable penile prosthesis. You need to practice using it and stretch the area surrounding the cylinders.
Risks and Complications:
As with any surgery, there are risks, including infection, implant malfunction, and internal erosion or adhesion. However, these are relatively rare when the procedure is performed by an experienced prosthesis surgeon.
- You might be at an increased risk of infection if you have a spinal cord injury or diabetes.
- New penile prosthesis designs are reliable but in rare cases the implants malfunction. Surgery is necessary to repair or replace a broken implant, but a broken device can be left in place if you don’t want another surgery.
- In some cases, an implant might stick to the skin inside the penis or wear away the skin from inside the penis. Rarely, an implant breaks through the skin. These problems are sometimes linked to an infection.
Treating an Infection:
Infections after penile prosthesis surgery typically occur within the first three (3) months of surgery. Surgery to remove the implant often is necessary to treat an infection.
Self-preparation for surgery:
1.Pre-operative consultation:Discuss with a urologist about your medical history, the types of implants available, and which might be the best option for you. Ensure all your questions are answered.
2.Medical evaluation: You may need to undergo several tests such as blood tests, urine tests, and an electrocardiogram (EKG) to ensure you are fit for surgery.
3.Medications: Inform urologists about any medications or supplements you are taking. You may need to stop taking certain medications such as blood thinners at least 7-10 days before surgery.
4.Fasting: You are advised not to eat or drink anything after midnight on the night before the surgery.
5.Hygiene: Follow any specific instructions given by your surgeon regarding showering or cleansing the surgical area before the procedure.
6.Post-operative care planning: Arrange for someone to drive you home after the surgery (a day after the surgery) and assist you for the first few days as you recover. Prepare your home to ensure a comfortable and easy recovery.
By thoroughly understanding the procedure, preparing adequately and following your surgeon’s instructions, you can increase the likelihood of a successful outcome and smooth recovery from penile prosthesis surgery. Although penile implants are the most invasive treatment for erectile dysfunction most men who have them and their partners report satisfaction with the devices. In fact, penile prosthesis has the highest rate of satisfaction of all erectile dysfunction treatments.
If you have any further questions or need additional information, consult with Dr. Niti Navanimitkul, sexual dysfunction specialist and penile prosthesis surgeon who performed more than 60 cases with a reported 99.99% success rate. You can ensure to receive personalized guidance and recommendations.