Penile Prosthesis

With Dr. Scardino first penile implantation in 1950, penile prosthesis came into limelight though it dates back to earlier times. Dr. Scardino implanted synthetic material into the penis. This work improved with more research and investigations over time. And nowadays, penile prosthesis has attained a very high level in the treatment of Erectile Dysfunction. Penile prosthesis is advocated when Erectile Dysfunction is associated with some medical cause like vascular diseases, prostate cancer, diabetes, neurological diseases and peyronie’s disease where medication for ED and mentioned diseases may tend to have interaction, thus worsen the situation. Still, there may arise some contraindications for penile implants, like in case of poorly controlled diabetes, and extreme bladder outlet obstruction.

What is penile prosthesis?
It is the inflation of penis by using some malleable or inflatable devices. This process makes the penis remain always in a semi-rigid state. Penis just needs to be lifted or adjusted into the erection to start with the sexual activity. At present, there are more natural implants where a hydraulic, inflatable prosthesis is done that allow a man to have an erection whenever he wants. Moreover, this implantation is much easier to conceal.

Mechanism of Penile Prosthesis
The process involves surgical placement of two cylinders -- a reservoir and a pump - into the body. Placed into the penis, these cylinders are connected by tubing to a separate fluid reservoir, which is implanted under the groin muscles. This whole system is connected to a pump that is fitted under the loose skin of the scrotal sac, between the testicles. However, the he type of surgery for the penile prosthesis is generally decided by device chosen and surgeon’s experience. The most common surgeries include;

• a perineal surgery which is under the scrotum
• a penoscrotal surgery which is at the base of the penis on top of the scrotum
• the protheses may be placed in the penile shaft
• An incision above penis called an infrapubic incision

To have the complete erection, you have to press on the pump that transfers fluid from the reservoir to the cylinders in the penis. This fluid inflates the cylinders placed in the penis and results into an erection. To bring the penis back to flaccid state, you press on a deflation valve present at the base of the pump that will return the fluid to the reservoir, thus deflates the penis.

Penile prosthesis has been found very effective with a satisfaction rate of 80-90% in men. Neither sensation on the skin of penis is affected nor man’s power to reach the orgasm, or ejaculation. However, natural erection reflex may be lost after penile prosthesis. Shortness of penis is also reported in some cases.

Safety

• There is no surgery that is not associated with 1% probability of complications. Same is true with penile prosthesis. The complications may include;
• Formation of scar tissue
• Uncontrolled bleeding after the surgery in some cases that may lead to re-operation
• Infection
• Tissue Erosion
• Failure of system, like Fluid leak and tubing kink leading to re-operation

Unfortunately, if infection appears then cost to treat infection may exceed the implant.