ANDROLOGICAL SURGERY
Penile prosthesis implant
for erectile dysfunction
Penile prosthesis implant for erectile dysfunction
The penile prosthesis is a medical device that is surgically implanted in subjects suffering from severe erectile dysfunction. This operation, in fact, is considered the last solution in patients who do not respond satisfactorily to drugs taken orally (iPDE5) or injected intracavernous or who have an absolute contraindication to taking these drugs or do not want to resort to medical-physical therapies (even of the vacuum device type).
The different types of prostheses:
– Three-component hydraulics – Two-component hydraulics – One-component malleable or semi-rigid – Fluffy – Differentiated stiffness (spectra)
The choice of the device is agreed by the implanter doctor with the patient taking into account:
a) Patient expectations b) Age c) Patient compliance (patient acceptance and ability to activate the device) and partner involvement d) Severity of erectile dysfunction e) Possible associated penile malformations f) General conditions (associated diseases such as diabetes, hypertension, neoplasia and heart disease)
HYDRAULIC PROSTHESIS
The most frequently performed prosthetic intervention involves the implantation of three-component prostheses.
This device consists of two cylinders of silicone or other biocompatible material which are inserted into the corpora cavernosa, a reservoir which contains the liquid necessary to fill the cylinders present in the corpora cavernosa and an activation pump positioned in the scrotum, for transferring the inflation liquid from the reservoir to the cylinders in the corpora cavernosa themselves. The cylinders, the pump and the tank are connected to each other by thin connecting pipes.
The two-component hydraulic prosthesis, unlike the three-component one, is made up of cylinders connected with connecting pipes to the pump which also acts as a tank. The prosthesis is therefore characterized by a greater volumetric bulk of the pump, by a lower capacity for filling and distension of the corpora cavernosa, and by a lower rigidity.
Anesthesia is general and/or peripheral. A bladder catheter is placed. Access is only penoscrotal or infrapubic, just above the root of the shaft. First of all, the cavernous bodies are incised and dilated with the help of progressive dilators, all in order to position two expandable cylinders at the level of the cavernous bodies of the penis. The scrotal space is then prepared for pump insertion. The reservoir is inserted into the space beside the extraperitoneal bladder. If it is impossible to position the reservoir in this space, it is placed in a different location, directly in the peritoneum with an incision in the
lower part of the abdominal wall or in the retroperitoneal site with a higher and lateral incision.
The intervention usually lasts up to 3 hours. A bladder catheter is placed for 24-48 hours and drainage of the dartoic tunics is performed, but this is not always necessary.
The operation is not free from complications, more or less rare, including:
– Penoscrotal hematoma/ecchymotic suffusion.
– Lesion and/or rupture of the urethra with the need to resort to epicystostomy placement and repair of the same urethra at different surgical times.
– Perforation of the corpora cavernosa.
– Rejection of the prosthesis with fibrosclerosis and cicatricial fibromatosis of the cavernous bodies due to infection or subjective intolerance, glans necrosis.
– Possible penile deformities or bowing of the glans (concord effect).
– Painful symptomatology even such as not to allow intercourse.
– Poor sensitivity of the glans in a significant percentage.
– Scrotal pain even in case of correct positioning of the device (scrotal pump).
– Malfunction of the prosthetic system (possible extrusion of the scrotal pump).
PROTESI NON IDRAULICA
RECONSTRUCTIVE SURGERY
One-piece penile prosthesis in abdominal phalloplasty
For further information:
Impotence diagnosis and treatment
UPSalute Channel Erectile Dysfunction
Which penile prosthesis to choose?
Post surgery after penile prosthesis for erectile dysfunction.
How to use (activate and deactivate) the penile prosthesis?