Penile Prosthesis: A Small Surgically Implanted Device Inside the Penis That Allows Men to Achieve an Erection Again, Providing an Effective Treatment for Erectile Dysfunction. Learn More About It!
How Does a Penile Prosthesis Work?
Thanks to the mechanical components of the penile prosthesis, once implanted, it can produce an erection when activated by the man.
This way, he can have satisfying sexual relations, with a rigid penis long enough for orgasm and ejaculation.
Types of Prosthesis
There are three types of penile prostheses, each with distinct features tailored to the needs of individual patients. Learn more:
Maleable Penile Prosthesis
The malleable prosthesis, also known as semi-rigid, has two silicone-coated rods that allow the man to position it downward, to the sides, or upward, in an erect position. It is available in various sizes and calibers to match the penile anatomy of patients.
Inflatable Penile Prosthesis
The inflatable prosthesis or hydraulic type is an implant that includes a mechanism allowing it to be pressurized to produce an erection, and deflated, returning the penis to a flaccid state. This is made possible by a saline solution reservoir and a pump that fills the cylinders.
Articulable Penile Prosthesis
The articulable penile implant resembles the malleable version but includes joints inside that provide greater flexibility for the penis.
How to Choose the Right Type of Penile Prosthesis?
Choosing the most suitable penile prosthesis for a patient depends on individual case details, penile anatomy, and personal preferences.
It is crucial for the man to be properly guided by the doctor at this time about the pros and cons of each model.
Malleable prostheses are simple to operate, well-accepted among patients, and available through public health services. However, since they are sized with the penis in an erect state, the member does not return to its retracted state, requiring the use of tighter underwear to conceal the volume.
The inflatable prostheses, on the other hand, allow the penis to be adjusted to flaccid and erect states. However, this model requires more manipulation and is subject to failures and leaks – necessitating another surgery for replacement. Additionally, it is not provided by public health services.
Articulated prostheses, while offering greater flexibility and mobility, are not as popular among surgeons. Their complex design tends to increase the risk of failures, while not providing as much firmness for penetration compared to the other two models.
Who Needs a Penile Prosthesis?
Only men who have severe erectile dysfunction and have already tried treating it with medications and/or injections are candidates for a penile prosthesis implant.
The device aims to provide the penis with sufficient firmness to perform penetration without difficulty, recovering penile functionality.
Moreover, elective patients for the prosthesis must be in good health and treat all pre-existing diseases and conditions that interfere with the placement and satisfaction of the implant, such as fibrosis, penile curvature, venous occlusions, and diabetes.
How is the Surgery for Implanting the Prosthesis Performed?
The surgical procedure can vary according to penile anatomy and the severity of each patient’s case.
Before placing the prosthesis, it is necessary to perform the so-called adjuvant maneuvers, which reconstruct the penis affected by fibrosis and Peyronie’s Disease that may lead to erectile dysfunction.
For this reason, in the first stage of the surgery, the doctor will make multiple precise incisions, based on geometric principles, on the tunica albuginea. These cuts produce tissue expansion, which allows for the alignment and reconstruction of the length and circumference of the penis up to the nerve limits.
In the next stage, with the penis at its maximum dimensions, the cylinder is inserted within the cavernous bodies. These spongy structures are preserved as much as possible, as they aid in supporting the erection and enhance the sensitivity and temperature of the member.
Post-Implantation Recovery
Recovery from surgery generally takes 60 days, but everything depends on the progress of each patient.
In the first five days, the newly operated man should be closely monitored by the surgeon. He will need to rest. It is also necessary to change the dressing according to the received instructions, and it is possible to shower normally. The stitches are naturally absorbed by the body.
Up to the first month after the operation, if the recovery progresses positively, the patient is released to perform daily activities, such as working and exercising. Between 45 and 60 days, the man may return to sexual activity.
Total healing of the surgery may take longer to occur. In most cases, it is discreet and does not cause discomfort.
Advantages and Disadvantages of the Prosthesis for Men
The placement of a penile prosthesis has more advantages than disadvantages for men who present severe cases of erectile dysfunction, with serious impacts on their sexual life. Check out more details:
Advantages
- Recovers penile functionality, allowing rigid and lasting erections
- It is an effective, safe treatment, and endorsed by international medical guidelines
- Improves the sexual life of the man and his partner
- Increases the man’s confidence and self-esteem, helping to alleviate symptoms of anxiety and depression
- Promotes care for the man’s sexual and general health
Dr. Paulo Egydio also reports that the penile prosthesis offers prevention against the formation of new fibrosis in the penis, as a result of Peyronie’s Disease.
Disadvantages
- Need to undergo a surgical intervention, which implies risks
- High cost of the surgery and the prosthesis, if not covered by public health services or health insurance
- Risk of extrusion or failure of the prosthesis
Are There Risks Associated with Implanting the Prosthesis?
Yes, there are risks associated with the surgery, the use of the prosthesis, and the choice of model.
Like any surgery, there are risks. In this case, the main concern is with infections. To minimize the chance of problems, various procedures of asepsis are performed both on the member and the prosthesis. Careful recovery also avoids this risk.
The prosthesis runs the risk of going through the process of extrusion, i.e., it is expelled from the penis through the skin, slowly and progressively. Therefore, the device needs to be properly sized, avoiding this possibility.
Malleable prosthesis models can break. This occurs when the implant is manipulated incorrectly or when there is a very strong collision in the penile region. However, this problem is not so common to occur.
Inflatable prostheses have more chances of failures compared to malleable ones. They may leak or their hydraulic mechanism may suddenly stop working.
Read more: Find out if patients are satisfied with the penile prosthesis
How Long Does a Prosthesis Last?
Depending on the patient’s age, if the penile prosthesis does not show failures, it can last until the end of life. However, it is not possible to determine a shelf life for the implant.
Failure rates for the inflatable prosthesis had a study published in the journal Urology. It pointed out that:
- 7% of implants fail by the first year
- 9% of implants fail within three years
- 13% of implants fail within five years
- 23% of implants fail within ten years
- 36% of implants fail within 15 years
- 48% of implants fail within 20 years
It can be stated that, compared to the inflatable option, the malleable penile prosthesis has less risk of malfunctioning and therefore, less need for a surgery for reoperation.
Does the Prosthesis Affect Sensitivity?
When the penile prosthesis surgery is properly performed, it does not cause the loss of penile sensitivity when the man is aroused.
Dr. Paulo Egydio reminds us that “Arousal is the brain activity for sexual excitement. When the brain processes the stimulus, the response is the relaxation of the vessels so that an erection occurs.”
The procedure should preserve the nerves of the penis so that sensitivity is not affected. Also, by avoiding the removal of the cavernous bodies at the time of inserting the cylinders, the surgeon also contributes to preserving sensations.
Is It Possible to Feel Pleasure with a Penile Prosthesis?
Yes, it is possible to feel pleasure, have an orgasm, and ejaculate after placing a penile prosthesis if the man is aroused.
The sensation of pleasure and climax will continue to occur. What may change is that men who took longer to have an orgasm may take even longer if they are not aroused. Additionally, as the erection can be maintained even after orgasm, it is possible to continue the relationship and have more pleasure.
Regarding ejaculation, there will be no changes in the volume or quality of the semen. However, patients who had premature ejaculation may notice a delay. Men who did not ejaculate for some medical reason will continue to have dry orgasms.
Does the Penile Prosthesis Allow for a Natural Erection?
Yes, by positioning the malleable prosthesis or activating the mechanism of the inflatable prosthesis, you will provoke an erection without the aid of medications and injections, with the appearance and sensation of a natural erection.
As the prostheses are implanted inside the penis, they are not visible externally. Therefore, in many cases, the partner may not even know you have an implant.
On a daily basis, the prostheses can be very discreet. In the case of the malleable one, just wearing tight underwear will keep the penis close to the groin. In the case of the inflatable one, when it is deflated, the penis will be flaccid.
Can the Prosthesis Be Removed After Surgery?
It is possible to remove the penile prosthesis, but if it is not replaced, the man will return to presenting erectile dysfunction.
The removal of the penile prosthesis is performed in some situations:
- When the man has not adapted to the model and considers, together with the surgeon, making a change
- When the implant presents some failure – which is more frequent in the case of the inflatable prosthesis, which may have mechanical defects and leaks
- When the prosthesis breaks – generally, this occurs with the malleable implant
Both for the removal and for the placement of a new prosthesis, the patient needs to undergo the surgical procedure again.
Is the Prosthesis Covered by Insurance or Health Plan?
Most insurance or health plans cover the penile prosthesis.
Generally, this coverage includes medical consultations with the health professional who will perform the surgery, the affiliated hospital where the operation will take place, the medical team present on the day, the equipment and materials needed, and the prosthesis itself.
Attention: the model of penile prosthesis included in the role of the National Health Agency (ANS) and provided by insurers is the malleable one. They are not obligated to cover the inflatable model.
If the inflatable implant is the only option for the patient, it is possible to present a medical report to the insurer for them to analyze the situation. In some cases, there is authorization for the surgery to be done with the model at no cost to the insured.
Alternatives to the Penile Prosthesis
When a patient needs to resort to a penile prosthesis, it is precisely because there was not a good erectile response to other treatments for erectile dysfunction.
This means he has already tried oral medications, such as Sildenafil and Tadalafil, penile injections based on Alprostadil and other compounds, and in some cases, treatments with therapists or sexologists.
The good news is that penile implant surgery is an effective and satisfactory treatment for cases of erectile dysfunction.
A study published in The Journal of Urology, from the American Urological Association, showed that the surgery caused a significant improvement in erectile function. It also indicated that satisfaction increased in the first year after the implant.
Another publication, this time in the journal Urology, revealed that 89% of patients with a penile prosthesis reported an improvement in sexual satisfaction, 76% improved their self-image after the surgery, and 87% are satisfied with the appearance of the member. In addition, 76% of the sexual partners of these patients approved the device.
Having access to reliable information about the penile prosthesis is essential for men dealing with erectile dysfunction to have optimistic and realistic expectations regarding the functioning of the device and postoperative satisfaction.
All questions about this subject can be clarified by Dr. Paulo Egydio and his team. Contact us, send your question, and receive appropriate guidance for your case.
