Placing a penile prosthesis for diabetic patients is an important topic in urology. These patients are more likely to experience erectile dysfunction and surgical complications, so they need specific care before, during, and after the procedure. Check it out!
Sexual health in diabetic patients is directly related to blood glucose control, since high glucose levels affect the blood vessels and nerves of the penis, compromising the mechanisms required for an erection.
It’s no surprise that a study published in the scientific journal Diabetic Medicine in 2017 found that half of men with diabetes also experience erectile dysfunction. Type 2 diabetic patients are the most affected by difficulties achieving and/or maintaining an erection.
In this scenario, erectile dysfunction is a significant concern for men with diabetes and also for the doctors who treat these patients. That’s why, in today’s blog, we’ll explore the best practices for such cases. Keep reading!
Erectile Dysfunction in Diabetic Patients
Diabetes is a metabolic syndrome. In it, the body does not produce or properly absorb insulin. Consequently, it cannot use glucose, which remains in excess.
When blood glucose levels stay high for a long period, it can damage organs, blood vessels, and nerves. That’s where diabetes intersects with erectile dysfunction in diabetic patients.
To achieve a firm and long-lasting erection, healthy blood vessels and nerves in the penis are essential. With diabetes, vessels can become blocked and nerves less sensitive, which tends to hinder erection.
Treatment for Erectile Dysfunction in Diabetic Patients
The first step in treating male impotence in diabetic patients is controlling blood glucose levels.
It is recommended to seek an endocrinologist for guidance. Along with medication, adjusting one’s diet, exercising, and avoiding excess weight all help manage diabetes.
If the first lines of erectile dysfunction treatment (oral medications and penile injections) are not effective, a urologist may recommend a penile prosthesis for diabetic patients. In this situation, keeping diabetes under control is crucial not only for overall health but also to lower infection risks and facilitate recovery.
However, before undergoing implant surgery, a medical evaluation by a urologist is essential. The professional will conduct some exams to assess your erection, detect any fibrosis, and understand the anatomy of your penis. These aspects are crucial to determine whether the patient is indicated for an implant or if there are still alternatives to the penile prosthesis.
Who Can Receive a Penile Prosthesis?
Penile implant surgery is indicated for men with severe erectile dysfunction. Generally, these are men with vascular compromise or fibrosis inside the penis. These patients do not respond well to medications such as Sildenafil or Tadalafil, nor to penile injections with Alprostadil.
In these cases, to restore penile rigidity, this patient profile may require a penile prosthesis.
Moreover, it is important for the man to be in good health and receive treatment for the causes of erectile dysfunction, such as diabetes and Peyronie’s disease, among others.
What Types of Penile Prosthesis Are Available?
The penile prostheses most often recommended by urologists today are malleable and inflatable models.
A malleable penile prosthesis is a device implanted in the corpora cavernosa of the penis, composed of flexible silicone cylinders with a metal core. This allows the patient to manually position the penis for erection or rest.
An inflatable penile implant, on the other hand, not only has cylinders but also a fluid reservoir in the abdomen and a pump implanted in the scrotum. To activate the erection, the patient presses the pump, transferring the fluid into the cylinders and expanding them. After use, a release mechanism drains the fluid back into the reservoir, leaving the penis flaccid.
How Long Does a Penile Prosthesis Last?
The durability of a penile prosthesis may vary depending on several factors, including:
- Quality of the material used in manufacturing;
- Surgeon’s experience in performing the implant;
- Postoperative care to avoid complications;
- Usage, avoiding excessive strain or improper movements;
- Natural wear over time, depending on the model and the patient’s body;
A penile prosthesis can be replaced if necessary. Generally, inflatable models are more prone to failures and leaks than malleable ones.
How Is Penile Prosthesis Surgery for Diabetic Patients Performed?
In summary, the procedure to restore the penis and insert the prosthesis is the same for men with or without diabetes.
First, the surgeon makes relaxation incisions in the tunica albuginea to expand the tissue and restore alignment, length, and width of the penis up to the nerve limits.
Once that stage is complete, it’s time to insert the best prosthesis for the penis, taking into account the member’s anatomy.
Now, in the case of diabetic patients, the doctor must consider a few factors for the surgery to be successful for the patient. Understand:
Hygiene
Many diabetic patients take medications to control blood glucose. These medications can make the skin covering the glans more prone to retaining urine droplets and glucose, which facilitates recurring infections in the glans area.
Therefore, in the preoperative period, the patient must be meticulous with local hygiene as instructed by the doctor and may need to use an antifungal.
Access Routes
The safest surgical access route for the patient is subcoronal.
In it, the surgeon lowers the penile skin, which is later raised and used to close the incision once procedures inside the member are completed.
Compared to other access routes, such as scrotal or suprapubic, the advantage lies in minimal skin contact and staying away from the scrotum, which naturally harbors bacteria. As a result, infection risks can be minimized.
Avoid Using Grafts
A graft is nonvascularized tissue and thus carries a higher risk of bacterial colonization leading to infection—diabetic patients are more susceptible to this complication.
Ideally, graft use should be avoided, and this is possible thanks to penile reconstruction, which addresses contractures, thinning, and curvatures with multiple small incisions that the body regenerates on its own, without the need for other tissues.
Prosthesis with Antibiotic Impregnation
A penile prosthesis for diabetic patients should preferably include antibiotic impregnation. That means it has an antibiotic coating on its surface and/or structure.
More porous prostheses, which allow antibiotic solution impregnation, are also a highly recommended option for these patients.
Postoperative Follow-up
Care for a penile prosthesis for diabetic patients does not end at the time of surgery.
After the operation, several measures are still required, such as correct use of antibiotics, a vasodilator in the penis, and filling the corpora cavernosa with antibiotics. Collectively, this can reduce the infection rate to nearly 0.5%.
What Are the Risks of Surgery for Diabetic Patients?
Men with diabetes are more susceptible to certain risks. However, strict diabetes control can help prevent complications. Learn about these risks:
Penile prosthesis implantation surgery in diabetic patients involves certain specific risks due to conditions associated with diabetes, such as slower healing and increased vulnerability to infections. The main risks include:
- Greater susceptibility to infections
- Slower healing
- Nerve damage associated with diabetes, raising the chances of sensory changes in the area
- Thrombosis or vascular complications
- Hyperglycemia
Recovery After Surgery: What to Expect?
Recovery after penile prosthesis surgery for diabetic patients can be somewhat slower, requiring close medical monitoring to avoid infection and ensure the prosthesis functions properly.
In the first few days, it’s common to experience pain, swelling, and bruising in the area, which can be managed with painkillers and cold compresses. The patient should rest adequately, take antibiotics, and monitor glucose levels to prevent complications.
Most patients can resume normal activities in about 45 to 60 days, depending on how healing progresses, including sexual activity.
Expectations for a Penile Prosthesis for Diabetic Patients
It is important for the doctor and patient to have an open discussion about expectations for a penile prosthesis for diabetic patients regarding the outcome of the implant.
We must remember that functionality is the primary goal of the surgery. Choosing the implant aims to provide vertical firmness for penetrative resistance, according to medical indication.
Preserving the corpora cavernosa and addressing fibrosis also help achieve better functionality of the member.
When Should You Consult a Urologist to Assess Prosthesis Needs?
A diabetic man should see a urologist to assess the need for a penile prosthesis in the following cases: when erection is not satisfactory. In other words, if the penis does not remain rigid enough for penetration or throughout intercourse most of the time.
He may also be referred to a urologist by an endocrinologist if there is nerve and blood vessel damage that can affect erectile function.
Additionally, deformities such as curvatures, loss of length, or thinning of the penis, associated with Peyronie’s disease, may worsen the condition and require treatment.
What Is the Best Penile Prosthesis for Diabetic Patients?
The best penile prosthesis for diabetic patients is the one that best fits the particular anatomy of that penis, respecting the reconstructed penis’s dimensions and girth.
For a malleable implant, preference is generally given to thicker options. For an inflatable device, it’s essential that the cylinders have enough room to fully expand.
Moreover, simply selecting a good prosthesis is not enough: it’s crucial to treat the tissues and minimize damage to the corpora cavernosa. Finally, erotic stimulation is still important at the moment of sexual activity.
A penile prosthesis for diabetic patients can help men who have erectile dysfunction. Combining erectile dysfunction treatment with glucose control is the first step toward surgery. With proper pre-, intra-, and postoperative care, many patients report an improvement in sexual quality of life.
If you identify with this situation, contact Dr. Paulo Egydio to have your case evaluated and find out whether you can still be treated with medication or injections, or if it’s time for a penile prosthesis for diabetic patients.
Learn more:
- Sexual Health: Egydio Medical Center EMC
- How Not to Fail at the Right Moment? Tips to Avoid Impotence
- When Is a Penile Prosthesis Necessary in Curvature Surgery?
- What Causes Hormonal Disorders in Men? Find Out!
- Penile Prosthesis: Detailed Advantages and Disadvantages
- Penile Prosthesis Rejection: Risks and Cases
- Does prostate removal affect ejaculation? What changes in sexual life
- Penile Prosthesis Maintenance: Do I Need Frequent Replacements?
