The choice between a malleable or inflatable penile prosthesis depends on factors such as the degree of erectile dysfunction, penile anatomy, manual dexterity, and the patient’s expectations.
The penile prosthesis is mainly indicated when other treatments for erectile dysfunction do not provide satisfactory results. It may also be considered in cases of anatomical changes, such as marked curvature, thinning, or penile shortening.
Below, learn the differences between the models and which factors help determine the most suitable penile prosthesis for each case.
How does the malleable penile prosthesis work?
Unlike an inflatable penile prosthesis, the malleable penile prosthesis maintains constant rigidity even when not in use.
Structure
The implant consists of flexible metal rods covered with silicone. This structure provides support and allows the patient to adjust the position of the penis according to his preference.
Operation
Operation is simple: the man manually positions the penis upward during sexual activity and, after use, directs the prosthesis downward.
When is it indicated?
It may be indicated for men who have difficulty operating an inflatable penile prosthesis, such as patients with limited strength or manual dexterity.
It may also be considered in specific situations where a less mechanically complex implant and lower risk of mechanism-related failures are desired.
How does the inflatable penile prosthesis work?
The inflatable penile prosthesis may be considered in selected situations, according to clinical evaluation, the ability to operate the device, and the patient’s expectations. Because it involves a more complex mechanism, it may require revision or replacement over time, depending on the implant characteristics and clinical course.
There are two models:
1) Two-piece inflatable penile prosthesis
The saline reservoir is integrated into the pump system.
2) Three-piece inflatable penile prosthesis
The reservoir is separate and implanted in the abdominal area, providing greater flaccidity when the prosthesis is deactivated.
How does it work?
- Two cylinders are implanted in the corpora cavernosa.
- A pump is positioned in the scrotum to control the device.
- To obtain an erection, simply activate the pump, which transfers saline to the cylinders.
- After sexual intercourse, a new activation causes the fluid to return to the reservoir, leaving the penis flaccid again.
This system allows the device to be activated by a pump and can provide characteristics different from those of the malleable prosthesis, both during erection and at rest. The suitability of the model should be discussed individually with the urologist, considering the benefits, risks, and applicable limitations.
Malleable or Inflatable Penile Prosthesis: Which Is Indicated for Each Patient?
The choice between a malleable or inflatable penile prosthesis depends on the urologist’s evaluation, considering factors such as clinical history, health conditions, penile anatomy, the ability to operate the device, and the patient’s expectations.
See the main indications in different situations:
1) Diabetes
Men with diabetes can use a malleable or inflatable penile prosthesis. The choice depends on disease control, surgical risk, anatomical characteristics, and individual preference.
2) Peyronie’s disease
In some cases of Peyronie’s disease associated with erectile dysfunction, the penile prosthesis can be considered as part of the treatment after evaluation of the deformity, erectile function, functional goals, and risks. The choice between different models depends on the clinical and anatomical characteristics of each patient.
3) Severe erectile dysfunction
A penile prosthesis is indicated for men with erectile dysfunction who have not achieved a satisfactory response with other treatments, such as oral medications or intracavernosal injections.
4) Spinal cord injury
Both models can be used. The malleable penile prosthesis may be an alternative for patients with motor limitations, while the inflatable penile prosthesis may be considered for men who can manipulate the pump and who seek greater discretion.
5) Older adults and younger patients
The malleable penile prosthesis may be indicated for men with limitations in strength or manual dexterity, such as tremors or neurological sequelae.
In some cases, it may also be considered by patients seeking an implant with lower mechanical complexity.
For younger men, the choice depends on individual evaluation, considering lifestyle, anatomy, and expectations.
Malleable or Inflatable Penile Prosthesis: Recovery After Surgery
Recovery after penile prosthesis surgery varies according to the type of implant, surgical technique, and each patient’s health conditions.
Following the urologist’s instructions is essential to promote healing and reduce risks.
What care is needed after surgery?
In the postoperative period, it is important to:
- Take the prescribed medications;
- Keep the dressing clean and dry;
- Avoid physical exertion during the recommended period;
- Wear comfortable underwear;
- Attend follow-up appointments to assess healing and prosthesis function.
When can activities be resumed?
Return to activities depends on each patient’s recovery.
- Office work can be resumed after 1 to 2 weeks.
- Intense physical exercise is usually allowed after 4 to 6 weeks, depending on medical evaluation.
When can sexual intercourse be resumed?
Return to sexual activity generally occurs between 4 to 6 weeks after surgery, provided healing is adequate.
In cases of inflatable penile prosthesis, the patient receives instructions on how to activate and deactivate the device.
Malleable or Inflatable Penile Prosthesis: What Do Scientific Studies Say?
Scientific studies primarily assess three aspects of penile prostheses: patient satisfaction rates, implant durability, and procedural safety.
See what the evidence shows about malleable and inflatable penile prostheses:
What is the satisfaction rate with the penile prosthesis?
Review studies that compared malleable and inflatable penile prostheses report variable levels of satisfaction. Interpretation of these data depends on the population studied, implant type, assessment method, and follow-up period.
The percentages of satisfaction published in the literature vary between studies and clinical contexts. When presented, they should be accompanied by the source, the population evaluated, measurement criteria, and limitations, and should not be interpreted as an individual expectation or guarantee of outcome.
How long does a penile prosthesis last?
The durability of a penile prosthesis depends on factors such as implant model, surgical technique, and individual patient characteristics.
The available studies describe differences in function and mechanical complexity between penile prosthesis models. Interpretation of the results should consider the implant type, follow-up duration, the population studied, and each patient’s individual characteristics.
Is the penile prosthesis safe?
Research that evaluated the safety of the different types of penile prostheses analyzed patients who underwent implantation between 2010 and 2019, comparing two groups:
- 93 patients with a malleable penile prosthesis;
- 38 patients with an inflatable penile prosthesis.
The results indicated that some of the observed failures were related to mechanical problems of inflatable prostheses, due to the greater number of device components.
In general, the safety and performance of the penile prosthesis depend on correct indication, selection of the appropriate implant, and the operating surgeon’s experience.
Information and medical assessment about the penile prosthesis
Dr. Paulo Egydio practices in the evaluation and treatment of erectile dysfunction and conditions related to male sexual function, according to his registered professional qualifications and scope of practice.
For information about medical consultation and evaluation, the service contact channels are available. Guidance about the penile prosthesis is provided after individual evaluation.
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