A penile prosthesis is a device that is implanted inside the penis to give it the ability to achieve erection. It is a solution for erectile dysfunction.
A penile prosthesis is a mechanical device that is implanted inside the penis in order to give it the ability to achieve erection and maintain rigidity to maintain sexual intercourse with penetration.
This device is composed of two cylinders that are placed inside the corpora cavernosa and perform the function of these to achieve the state of erection. A surgical intervention is necessary for its implantation.
Among all the existing treatments for erectile dysfunction, penile prosthesis is the one with the best satisfaction rates. However, because once implanted it is not possible to resume other treatments, it is the last of the therapeutic options.
Penile implants are usually used when other more conservative treatments such as medication, shock waves or intracavernous injections have not worked, or when the patient wants a definitive solution.
There are two types of penile prostheses and it is important to know the pros and cons of each prosthesis prior to placement:
The erection result is excellent and the detumescence is very natural. For this reason, the satisfaction rate is very high among men and their partners, exceeding 90%. On the other hand, they are somewhat more difficult to use, as you have to learn how to activate and deactivate them, and their cost is higher.
Preoperatively, a blood test with coagulation and urine culture, a chest X-ray and an electrocardiogram are performed. During the anesthetic visit, the anesthesiologist determines, together with the patient, the best anesthesia for the surgery, which is usually spinal or deep sedation, although general anesthesia can also be performed.
There are several incision routes for prosthesis placement: subpubic (behind the pubis), subcoronal (under the glans) or penoscrotal (between the base of the penis and the scrotum). The choice depends on the surgeon and the type of prosthesis. The surgery does not usually take more than 1 hour.
A compressive bandage is applied during the operation, which is usually changed after 24 hours. The patient will go to a post-anesthesia recovery unit while it is validated that the recovery is ideal and that there are no complications.
Admission is usually short, in many cases even non-existent. The following days there should be penile blockade and an optimized analgesic regimen should be followed.
As in any intervention, there may be complications such as urinary retention, or the appearance of hematomas or edema, which will not lead to long-term problems. However, the most feared complication is prosthetic infection, which can lead to its removal. For this reason, infection prevention measures are very strict and make infection infrequent, affecting 1-8% of cases. The mechanical failure rate at 5 years is approximately 10%.
Implantation by expert centers and surgeons reduces the complications associated with the procedure. Our group is recognized by the Ministry of Health as one of the two groups accredited in Spain to perform these procedures.
Once the first month is over, the possibility of infection decreases drastically and sexual activity can be resumed.
The results of the penile prosthesis are very good and the satisfaction rates are very high. These prostheses do not interfere with sexual quality, neither sexual desire, nor orgasm, nor ejaculation are affected.
Penile prostheses are the active - not cosmetic - prosthetic material with the longest average useful life. Some studies indicate that 50% of penile prostheses are active and functioning 15 years after implantation.
It is a permanent solution for erectile dysfunction.
It allows to have an erection at the desired moment.
It allows more spontaneity to enjoy sexual activity when your mood is appropriate.
It allows maintaining the erection for the desired time.
Eliminates the need for pills and injections.
They provide a natural feel for you and your partner.
It does not interfere with daily life. You can go on with your normal life.
They do not interfere with sexual desire, the sensation of orgasm and ejaculation.
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Three-component prostheses are practically unnoticeable, even when naked. The malleable prostheses, by elongating the penis, may be more noticeable, although they are not at all conspicuous.
It is a surgery that causes few problems. The most relevant is the infection of the prosthesis, which occurs in 2% of cases. To avoid it we use antibiotics during and after surgery, together with antibiotic-impregnated prostheses to further minimize this risk. The implantation of a penile prosthesis is a surgical procedure that, although generally safe, may involve certain complications: >> Intraoperative complications: - Perforation of the corpora cavernosa: During dilatation, crural perforation of the proximal end of the corpus cavernosum may occur. This situation is relatively frequent and requires immediate attention to avoid major complications. - Urethral injury: Although uncommon, there is a possibility of damage to the urethra during prosthesis placement, which may require additional interventions. >> Postoperative complications: - Infection: One of the most significant complications is infection of the prosthesis, which may lead to the need to remove the device. However, with improvements in surgical techniques and prosthesis design, the incidence of infection has been greatly reduced to below 5%. - Mechanical failure of the prosthesis: Although modern prostheses are designed to be durable, there is the possibility of mechanical failure that may require revision or replacement of the device. - Erosion or extrusion: In rare cases, the prosthesis may erode surrounding tissues or even extrude, which may require additional surgical intervention. - Shortening of the penis: Some patients may perceive a decrease in penile length after implantation, especially if there was previous fibrosis in the corpora cavernosa. - Postoperative pain: It is common to experience pain and swelling in the operated area during the first few weeks, although this usually resolves with time and proper management. For all these reasons, it is essential to perform this surgery with a very experienced team that guarantees the success of the surgery.
It is not usual. Especially with malleable prostheses, which have less surgical material, the feel is practically normal. With inflatable prostheses there are a few more structures, although they remain discreet even during sexual intercourse.
Penile prostheses have an estimated average life of about 10 years and once this time has passed, the prosthesis can be changed with a surgery as simple as the first one.
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