Penile Prosthesis

Penile implants are mechanical devices that can be implanted in the penis to help men suffering from erectile dysfunction achieve an erection. These are generally prescribed only if other treatments have been unsuccessful. Their two forms are: Semirigid and Inflatable. Each carries certain advantages and disadvantages for the patient. Surgery will be necessary for implant placement.  Educating oneself about the procedure, the possible risks, complications, and post-operative management is necessary before making this decision.

Symptoms:

Penile prosthesis are not related to particular symptoms. Nevertheless, they are aimed at managing erectile dysfunction (ED) symptoms, such as the incapacity to get or sustain an erection strong enough for engaging in sexual activity.

Causes:

A number of physical and psychological issues, such as anxiety, depression, and stress, as well as neurological illnesses, cardiovascular diseases, diabetes, hormone imbalances, and hormonal imbalances, might be the true cause of erectile dysfunction. When alternative treatments for ED, including medication or vacuum devices, are not working, penile prosthesis are advised.

Treatments:

If other methods of treating erectile dysfunction (ED) fail, penile prosthesis may be used as a treatment. For those with severe ED, they offer a dependable and efficient means of obtaining and sustaining erections appropriate for engaging in sexual activity, thus improving their quality of living.

Ideal Candidate for penile implantation

A good candidate for a penile implant is usually someone who has:

1. Chronic Erectile Dysfunction (ED): Men who have tried other treatments like medications, injections, or therapy without success may consider a Penile Prosthesis as a long-term solution.

2. Physical Causes of ED: Men with physical conditions such as diabetes, prostate surgery, or injury that affect blood flow or nerves in the penis may benefit from an implant.

3. Stable Health: Candidates should be in generally good health and able to undergo Penile implant surgery. Conditions like heart disease or uncontrolled diabetes may increase surgery risks.

4. Emotional Readiness: Men who are mentally prepared for Penile Prosthesis surgery and have realistic expectations about the outcomes are ideal candidates. The procedure restores the ability to have erections but doesn’t affect libido or sensation.

What is the size of a penile implant?

The size of a penile implant is customized based on the individual’s anatomy. During surgery, the doctor selects an implant that matches the length and girth of the penis. Implants do not increase size - they aim to provide a natural, functional erection based on the patient's original size.

Types of Penile Prosthesis

Penile prostheses are also called penile implants. Penile prostheses are used for the surgical insertion of erectile implants in the penis to cure erectile dysfunction (ED). In these two main types:

1. Inflatable Penile Implants:

Inflatable penile implants contain all components used during erection, but are compressed through a suprapubic reservoir outside the body. Pump squeezing causes fluid administration to the inflatable cylinders implanted in the penis. Natural look and feel can be adopted, with two and three-piece designs adopting dual inflatable cylinders. Three piece implants are considered superior for a natural appearance and actual functionality. Two-piece implants combine a pump and reservoir in the scrotum. 

2. Malleable (or Semirigid) Penile Implants:

Flexible rods inserted into the penis to provide an erect but bendable position for varying degrees of activity. These comparatively simpler prostheses have fewer parts attached to them, thus lowering the possibility of mechanical surgery failure, and they are also easier to use for those men who might not have all the dexterity. 

Benefits of a penile implant

1. Restores Sexual Function: A penile implant allows men with erectile dysfunction (ED) to achieve and maintain an erection suitable for sexual activity. This can significantly improve a man's confidence and relationship with their partner.

2. Long-Term Solution: Unlike other treatments for ED, such as medications or injections, a penile implant offers a permanent solution. Once implanted, the device works for many years without the need for ongoing treatment.

3. Natural Feel: Inflatable implants, in particular, can provide an erection that feels natural. When deflated, the penis looks and feels flaccid, and when inflated, it becomes firm enough for intercourse.

4. No Need for Medications: Men who cannot take ED medications due to health conditions, or who experience side effects from them, benefit from an implant as it doesn't rely on drugs or chemicals to work.

Risks of a penile implant

1. Infection: As with any surgery, there’s a risk of infection. The risk is higher in men with certain conditions, like diabetes. If an infection occurs, the implant may need to be removed.

2. Mechanical Problems: Though rare, implants can develop mechanical issues. Inflatable implants might leak or malfunction, requiring additional surgery to fix or replace the device.

3. Scar Tissue Formation: Over time, scar tissue may form around the implant, which can affect its function or lead to discomfort. In some cases, the implant might not work as well as expected.

4. Implant Erosion or Injury: In rare cases, the implant can erode into the surrounding tissues or cause injury, leading to complications that may require further treatment or removal.

Complication

Penile prosthesis implantation is considered a safe and effective procedure in terms of generally carrying some possible complications, as other operations do. A list of these complications is as follows: 

• The risk of Infection due to the Implant ranges from mild to severe. Some of the cases may require removal of the implant for treatment 
• Bleeding during and post-surgery leads to hematoma formation.
• Common device faults include leaks and problems with the pump (common to inflatable).
• Potential erosions-strictures-urethral injuries-scarring-penile complications.
• Postoperative pain and/or shortening of the penis or ischaemia of the glans. 
• Other complications might involve problems with urination, unhappiness with the outcome, and the possibility of having to undergo revision surgery.

Recovery After Penile Prosthesis

Postoperative guidance must be followed closely for recovery following penile prosthesis implantation. This is a broad overview of what you can expect:

• The length of hospital stay varies. Some patients may be sent home the same day.
• For pain and swelling, pain management consists of ice bags and medicine.
• Get instructions for wound care, antibiotics to avoid infection.
• For a brief period, a urinary catheter could be used.
• Pay attention to resting. Avoid strenuous activity and follow the surgeon's instructions.
• Avoid intense workouts for four to six weeks.
• Watch incisions for signs of infection and obey wound care advice.
• Bruising and swelling are normal and go away in a short period.
• Surgeon's guidance on penile prosthesis use given. Many times, someone is counseled to start engaging in sexual activity in four to six weeks.
• Regular follow-up visits help to track recovery and guarantee correct implant performance.

The penile implant surgery involves a few key steps to help men with erectile dysfunction (ED) regain the ability to have an erection. Here’s a detailed breakdown of the process:

Before Surgery:

1. Consultation: The doctor will assess the patient’s medical history, perform physical exams, and review other ED treatments tried. Tests may be conducted to ensure the patient is fit for surgery.

2. Preparation: The patient will be advised to avoid certain medications (such as blood thinners) and fast for a few hours before surgery.

During Surgery:

1. Anesthesia: The patient will be given general anesthesia, so they will be asleep and pain-free during the procedure. In some cases, regional anesthesia may be used to numb the lower half of the body.

2. Incision: The surgeon will make a small incision either at the base of the penis or lower abdomen, depending on the type of implant being used.

3. Placement of the Implant: The selected Penile Prosthesis(inflatable or semi-rigid) will be inserted. For inflatable implants, a pump is placed in the scrotum, while the cylinders are inserted into the penis. In semi-rigid implants, bendable rods are placed inside the penis.

4. Closure: After placing the implant, the surgeon closes the incision with stitches or sutures. The surgery typically takes about 1 to 2 hours.

After Surgery:

1. Recovery: Patients are monitored in the hospital for a few hours or overnight. Pain medications are provided to manage discomfort.

2. Postoperative Care: After leaving the hospital, patients are advised to rest and avoid strenuous activities for several weeks. They will receive instructions on how to care for the surgical site to prevent infection.

3. Follow-Up: A follow-up appointment will be scheduled to check on healing and ensure the implant is working correctly. Inflatable implants will require some training on how to operate the pump.

Full Recovery:

Most patients can return to normal activities, including sexual activity, within 4 to 6 weeks after surgery.