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SEXUAL MEDICINE TREATMENTS

Penile Prosthesis

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

  • DEFINITION

What is a penile prosthesis?

A penile prosthesis (also known as a penile implant) is nothing more than a high-tech medical device that is surgically applied that has structural components capable of producing erection states 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, according to statistics, already one in five Spanish men over the age of 18 suffers from it and limits it to one hour. to enjoy sexual intercourse without worry.

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

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 of them has different implications in its mechanism of operation and use by the patient who wears them.

  • 1) Inflatable Penile Prosthesis 

    Rigicon offers the Infla10® three-piece inflatable penile prostheses for men who need surgical intervention to treat erectile dysfunction (ED). Infla10® X cylinders offer girth expansion, providing satisfactory axial stiffness while providing natural flaccidity.

    Infla10® AX cylinders, in addition to circumferential expansion, also offer up to 25% length expansion depending on the patient’s anatomy.

  • 2) Malleble Penile Prosthesis

    Flexible Rod Technology™ allows the rod to reach a flexion angle of up to 135 degrees while simulating a more natural erection sensation. Rigi10™ Hydrophilic incorporates a hydrophilic coating that may facilitate implantation of the device.

How Does the Penile Prosthesis Work?

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

Once inside, these hollow silicone bars can be made hard by various means. Some prostheses are constantly «erected» because they have a malleable material inside (such as metal braiding) while others contain a system of «wires» that join one end to the other and, depending on how they flex, can be erected or made. flaccid.

However, the most modern types of penile prostheses (and therefore more widely used) consist of a fluid-filled system, almost always saline.

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

Reasons to Consider a Penile Implant

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

Penile prostheses are highly advanced medical devices that offer amazing results in severe cases of erectile dysfunction in which sufferers no longer want to worry about taking a pill 30 minutes before intercourse or worse, using a pump. vacuum to inflate the penis (it should be noted that the latter has been shown to injure 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 penile prosthesis implantation express strong satisfaction with the results obtained. Erectile dysfunction (ED) almost completely disappears and sexual life can be recovered.
Minimal recovery time

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

It is a highly precise surgery that leaves quite small surgical wounds that heal very quickly and leave no visible marks. In fact, the device itself is invisible and almost imperceptible.

Profitable for a long time

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

It doesn’t sound like much, but it’s a decade of insouciance about issues related to the weak erections of the past. Now, many will wonder, 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 (to examine the integrity of the tissues into which the previous devices were inserted) is required.

Safety

Today’s 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 are minimal and the most modern models of penile implants have a special antibacterial coating, which reduces the risk of developing this type of complications to almost zero.

Son materiales de alta tecnología y amigables con los tejidos de los cuerpos cavernosos.

It is not noticeable, it is discreet

Strange as it may seem, penile prostheses can go completely unnoticed with the naked eye. Technically, it is very difficult to distinguish between an erection with a prosthesis and an erection of the natural penis.

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

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

No more injections, no blue pills, no vacuum pumps

Penile prostheses are a definitive treatment that does not require the patient to continue taking delaying drugs such as sildenafil, tadalafil or vardenafil to enhance erections since the same device will take care of that 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.

Why is it such a special treatment?

Penile prostheses are by themselves the only definitive treatment for erectile dysfunction because 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 states of flaccidity at will and with the intensity they want (in the case of hydraulic models).

With penile implants, the patient can forget about taking erectile dysfunction drugs, go to the doctor to have drugs injected into the penis with a syringe, or even insert their penis into a vacuum device prior to sexual intercourse. He will only have to take a minute to insufflate 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 will be able to deflate the device and the penis will return to its original shape.

Satisfaction rates for a penile prosthesis are among the highest of all ED therapies. Case follow-up studies have even been carried out and 5 years after implanting the penile prosthesis, 92.5% of men stated that they had sexual intercourse more frequently than 1.7 times per week.


The Penile Implant: Procedure

Although it may seem complex, penile prosthesis implantation surgery can be relatively quick and with few implications. To facilitate the 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 intervention?

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 anesthesia sensitivity tests 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 the doctor questions, this will allow him to remain calmer and more confident throughout the process.

Surgery, how is it?

Before everything else 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 bladder catheter may also be inserted to facilitate urination before and after surgery.

There are several surgical techniques to insert the prosthesis inside 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. by its ventral face.


Results of penile prosthesis implantation

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 just that, naturalness and confidence, without having to think about previous conventional treatments: pills, intracavernous injections, psychological treatment or use of vacuum pumps for the penis.

The simple fact that more than 92% of men with penile prostheses say they have an average of almost 2 intercourses per week five years after surgery shows a significant (and by no means 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 sees his sexual life affected, but as a consequence of this, alterations arise in almost all facets of his life, both affective and self-esteem and work performance. Many men see their relationships lost because they cannot sexually please their partners.

Through them, the surgeon can insert the cylinders inside the cavernous bodies 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 being inserted into the scrotal or pubic cavity.

Post-surgery care

The next day, the patient must undergo removal of the bladder catheter so that he can urinate on his own again. In addition, the doctor will empty the cylinders filled with the prosthesis (because that is how they were inserted inside 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 treatment with analgesics and anti-inflammatories (there may be some pain in the scrotal area).

Recovery time

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


Frequent questions

Is it painful to have the implant in place?
They do not generate (under normal conditions) compression of nervous structures and therefore should not be a cause of chronic pain in the penis. Many men with hydraulic prostheses even say they «forget» that they are wearing them. However, it is likely that some men will experience some discomfort or pain during the first few weeks after penile implant implantation surgery. This can often be controlled with pain relievers and non-steroidal anti-inflammatory drugs (NSAIDs).
How soon can I have sex again?

After medical discharge, it is likely that many men who have undergone this type of surgery want to start seeing immediate results such as having sex again with the «new device» but the reality is that it is necessary to wait about 4 or 6 weeks (time may vary) before trying the system for the first time before sexual intercourse.

Are those erections very different from the natural ones? Is there a difference between the two?

The reality is that they are very similar. However, artificially induced erections with penile prostheses can make the member a bit colder. This is partly because the blood supply is not the same as in a natural erection. In any case, the degree of satisfaction is quite high since many men go from «suffering» sexual relations to enjoying them without worries.

Are there risks associated with penile prostheses?

Among the most reported complications from penile prosthesis implantation surgeries are infections and pain, but fortunately they are rare. According to statistics, 6% of patients develop some type of mild or moderate infection and 2% pain due to prosthesis breakage.

If I am a person who does a lot of cycling, is the penile prosthesis recommended?

Yes, there is no problem with penile prostheses and almost no sports, including cycling. If it is recommended to avoid sports with a high risk of contact such as karate, which may receive some kicks or severe trauma that could cause the breakage of some component of the prosthesis.

Realmente el apoyo del sillín de bicicleta es recomendable que sea lo más ancho posible y que no haya un apoyo en ninguno de los componentes, pero la prótesis normalmente va alejada de los sitios de apoyo del asiento de la bicicleta.

How long does a penile implant or a hydraulic prosthesis last in your experience?

Penile prosthesis implants are guaranteed for life. We have experience with patients over 25 or 30 years old without any problem in the components of the prosthesis.

How big is the penis with the prosthesis?

The size of the penis will not be affected by the prosthesis. In any case, it is possible to gain some size if it is the patient’s wish. Current prostheses expand and are capable of completely filling the corpus cavernosum and we always try, at andomedic, to maximize the size and improve the size with which you finish with respect to which you start the intervention. The size of the penis will remain the same as it was or better.

Why is it that there are so many testimonials on the internet that comment that with the implantation of the penile prosthesis they have been left with a smaller size?

There are several factors that can condition a decrease or the sensation of loss of size.

One of the factors is that the patient remembers when he had erections and his member was larger and then after a while without suffering erections he suffered atrophy and that is difficult to recover.

A good measure is to measure the penis stretched to the maximum, at the top stretched, before placing an implant. That maximum stretch size is going to be roughly the size you are going to be after the prosthesis.

How can you avoid the cold glans problem when implanting or penile prosthesis?

The cold glans penis is mainly produced by a lack of arousal, the erection of the glans penis occurs especially when there is a good sexual arousal.

Sometimes, although it is rare for it to occur, it can still manifest itself even despite having a good arousal. In these cases, some treatment with inhibitors, or some treatment with alprostadil cream at the glans or urethra level, can benefit the appearance, that is, they can prevent the cold glans from appearing, but it is not during the intervention, nor before.


Dr. Ignacio Moncada

Professional Trajectory (Current positions)

2014 – Present. Associate Professor of Urology, Faculty of Medicine, Francisco de Vitoria University

2008 – Present. Head of Urology Service, Hospital de La Zarzuela, Madrid

2011- Current. Director of the Institute of Robotic Surgery of Madrid

2001- Present. Member of the Staff of the Urology Service of Hospital Ruber Internacional, responsible for the Andrology Unit

2003 – Present. President of the Spanish Association for Sexual Health (AESS)

2010 – Present. Member of the Guidelines Committee of the European Association of Urology (EAU)

2004 – Present. Member of the Faculty of the European School of Urology (ESU)

Evaluación de la DE ~5 min.


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