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Penile prosthesis

Penile prosthesis
A penile prosthesis, or penile implant, is one of the oldest effective treatments for the condition
of erectile dysfunction. [1]  The medical device which is surgically implanted within the corpora
cavernosa of the penis during a surgical procedure, provides the highest levels of patient and
partner satisfaction of all available treatment options. [2]  The device is indicated for use in men with
organic or treatment-resistant impotence or erectile dysfunction that is the result of various physical
conditions such as cardiovascular disease, diabetes, pelvic trauma, Peyronie's disease, or as the
result of prostate cancer treatments. [3]  Less commonly, a penile prosthesis may also be used in the
final stage of plastic surgery phalloplasty to complete female to male gender reassignment
surgery as well as during total phalloplasty for adult and child patients that need male genital
modification.
Reasons for use[edit]
A penile implant is one treatment option available to individuals who are unable to achieve or
maintain an erection adequate for successful sexual intercourse or penetration. Its primary use is for
men with erectile dysfunction from vascular conditions (cardiovascular disease, high blood pressure,
diabetes), congenital anomalies, iatrogenic, accidental penile or pelvic trauma, Peyronie's disease,
or as a result of prostate cancer treatments. This implant is normally considered when less invasive
medical treatments such as oral medications (PDE5 inhibitors: Viagra, Levitra, Cialis), penile
injections, or vacuum erection devices are unsuccessful, provide an unsatisfactory result, or are
contraindicated. [4] For example, many drugs used to treat erectile dysfunction are unsuitable for
patients with heart problems and may interfere with other medications.
Sometimes a penile prosthesis is implanted during surgery to alter, construct or reconstruct the
penis in phalloplasty. The British Journal of Urology International reports [5]  that
unlike metoidioplasty for female to male sexual reassignment patients, which may result in
a penis that is long but narrow, current total phalloplasty neophallus creation using a
musculocutaneous latissimus dorsi flap could result in a long, large volume penis which enables safe
insertion of any type of penile prosthesis.
This same technique enables male victims of minor to serious iatrogenic, accidental or intentional
penile trauma injuries (or even total emasculation) caused by accidents, child abuse or self-
mutilation to have penises suitable for penile prosthesis implantation enabling successful sexual
intercourse.
In some cases of genital reconstructive surgery, implantation of a semirigid prosthesis is
recommended for three months after total phalloplasty to prevent phallic retraction. It can be
replaced later with an inflatable one.
Types of devices[edit]
There are two primary types of penile prosthesis: noninflatable, semirigid devices and inflatable
devices. [6]  Noninflatable, semirigid devices consist of rods implanted into the erection chambers of
the penis and can be bent into position as needed for sexual penetration. With this type of implant
the penis is always semi-rigid and therefore may be difficult to conceal.
Hydraulic, inflatable prosthesis also exist and were first described in 1973 by Brantley Scott et
al. [7]  These saline-filled devices consist of inflatable cylinders placed in the erection chambers of the
penis, a pump placed in the scrotum for patient-activated inflation/deflation, and a reservoir placed in
the abdomen which stores the fluid. The device is inflated by squeezing the pump several times to
transfer fluid from the reservoir to the chambers in the penis. After successful sexual relations, the
pump can be deactivated to return the penis to a flaccid condition. Almost all implanted penile

prosthesis devices perform satisfactorily for a decade or more before needing replacement. [8]  Some
surgeons recommend these due to the opinion that they are more easily concealed and provide the
highest levels of patient/partner satisfaction.

3 Piece Inflatable Penile prosthesis
Advantages[edit]
 Mechanical failure rates are low: most often inability to deflate the penis because of pump
failure; less often inability to inflate the prosthesis; and sometimes disconnection or failure of the
reservoir.
 IPP (Inflatable Penile Prostheses) are easily concealable under clothing
including swimsuits or jeans.
 The erection can be maintained as long as necessary, or as long as desired without any of the
potentially serious complications of organic priapism.
 Psychological and emotional well-being is enhanced in a proportion of men who undergo implant
surgery. Some studies indicate a high level of patient satisfaction, attributable in part to
improved technology in the prosthesis itself, improved surgical techniques making the procedure
less painful, and more reasonable patient expectations.
 Inflation of the device can be accomplished discreetly.
Disadvantages[edit]
 The glans does not enlarge and sexual penetration may be awkward. The penis also may not be
as firm as a natural erection.
 Some models do not deflate easily; some degree of manual dexterity is required to operate any
of the inflatable models, making them inappropriate for men with other neurological
disorders such as stroke or Parkinson's disease.
 The penis may not be completely flaccid, depending upon the model of prosthesis (most usually
seen in semi-rigid or malleable implants).
 Many men lose between 1–2 cm (.25 to .75 in) in length.

 Following surgery, patients experience one to two weeks of moderate or occasionally severe
pain, usually controlled with analgesics. This is most often due to scrotal swelling, which can be
quite profound at times. Normal sexual intercourse can be resumed six to eight weeks post-
operatively, pending clearance from the surgeon.
 Not all men report complete satisfaction with the prosthesis.
 Some studies indicate a partner satisfaction rate of 70% or less, due, some studies suggest, to
heightened or unreasonable expectations. Many surgeons are now recommending that both
partners be counseled pre-operatively regarding outcome and expectations.
 The inflation of the devices is not instantaneous.
 It can be difficult to conceal a prosthesis because the scrotal components are hard and
irregularly shaped. A partner feeling the scrotum will notice this.
 Manual stimulation can be painful.
 There is a 2-10% complication rate, mainly as a result of infection or device failure.
Complications include: uncontrolled bleeding after the surgery possibly leading to re-operation,
scar tissue formation, erosion (tissue around the implant may break down) requiring removal or
mechanical failure leading to re-operation and removal.