Although it is a safe and well-established treatment, there are risks of penile prosthesis surgery, such as infection, extrusion, improper positioning, and others. Learn what can be done to minimize them.
There are many precautions, advancements in surgical techniques, and in the design of prostheses that help reduce the likelihood of problems during or after surgery. Learn more about them below!
What Is Penile Prosthesis Surgery and What Is Its Purpose?
Penile prosthesis surgery is a procedure that provides additional vertical firmness and restores the erectile capacity of patients with erectile dysfunction by placing an implant.
This procedure is indicated for men who have tried other treatments, such as medications and injections, without achieving a satisfactory erection. In other words, it is for severe cases of erectile dysfunction, which are often associated with diabetes, cardiovascular diseases, penile curvature, or surgical interventions in the pelvic region.
Placing the implant provides the rigidity required for sexual intercourse, but the experience may vary according to the patient’s clinical factors.
How Is Penile Prosthesis Surgery Performed?
In penile implant surgery, the surgeon places the cylinders that make up the prosthesis inside the penis.
For this, a subcoronal incision is usually performed. This access route offers good exposure of the penile structures while minimizing contact with the external environment and preventing infections. It also avoids contact with nerves, which could cause a loss of local sensitivity.
The prosthesis is inserted into the penile corpora cavernosa. Preserving this spongy tissue, which fills with blood during an erection, is very important so that the man still has residual filling during arousal.
If the patient has penile fibrosis, small incisions are made before placing the prosthesis to expand the tissue and reconstruct the penis, addressing as much as possible the curvature, thinning, and loss of length.
Types of Prostheses: Malleable and Inflatable
There are two main types of penile prostheses. They adapt to each patient’s needs and have pros and cons, so it’s necessary to analyze them thoroughly with the help of a surgeon before making a choice.
Malleable Prostheses
The malleable prosthesis model consists of flexible rods covered with silicone, which can be manually adjusted. In this way, the man can position them as he prefers.
A malleable prosthesis keeps the penis extended without flaccidity. Therefore, to keep it less noticeable under clothing, it’s recommended to wear slightly tighter underwear.
Inflatable Prostheses
The inflatable prosthesis includes a reservoir and a small pump, located under the abdomen and in the scrotum, respectively, allowing control of the erection.
This model must always be activated during intercourse. When pressurized, the device inflates, creating penile rigidity. When deactivated, the penis becomes flaccid.
Because it is a hydraulic mechanism, it carries some fragility, with a risk of failures and leaks. Although it provides a more natural result, this prosthesis may require maintenance more often.
Who Is a Candidate for a Penile Prosthesis?
The prosthesis is indicated for patients who need axial rigidity, which is necessary for penetration and to prevent bending or slippage during movement.
Men who have difficulty or are unable to achieve penetration and who have already tried treatments like Sildenafil, Tadalafil, and even penile injections without success may be candidates for a penile implant, as this indicates a significant compromise in erectile function.
What Are the Risks of Penile Prosthesis Surgery?
Learn about the risks of penile prosthesis surgery, the details, and what can be done to avoid them.
1) Infection
Penile prosthesis infection is rare when all precautions are taken before, during, and after the procedure, such as diabetes control, hair removal, antifungal and antibiotic medications, washing of the area, and the use of an antibiotic solution on the prosthesis.
Additionally, the surgery is performed using the no-touch technique, which aims to reduce the need for touching the skin, avoiding the transfer of harmful microorganisms to the surgical site.
2) Deflated Glans or Glans Drop
The prosthesis may not adequately support the glans, resulting in an unfavorable appearance.
To prevent this, the size of the prosthesis must be properly measured. It should have the correct diameter to fit the glans, and it must extend from the base of the penis to the end of the corpora cavernosa.
Patients with narrowing at the tip of the penis, for example, may need reconstruction in that area to create enough space.
3) Bleeding or Hematomas
Common postoperative complications, bleeding can be avoided by evaluating preoperative tests and using minimally invasive surgical techniques.
Another strategy involves proper dressing to prevent bleeding and later hematomas.
4) Prosthesis Extrusion
Extrusion is when the prosthesis cylinder passes through the tunica albuginea (the layer surrounding the corpora cavernosa) and moves toward the glans, often noticeable by the patient himself.
To prevent this perforation, it is crucial to assess the condition of the tunica albuginea. If it is too thin, reinforcement sutures can be applied to the cylinder on the penis structure (a technique called anchoring), preventing displacement.
5) Improper Prosthesis Positioning
An incorrectly adjusted implant can cause discomfort and difficulties during sexual intercourse. This commonly happens when the man has a penile curvature that was not corrected before implant placement. Therefore, penile reconstruction must be performed up to the nerve limits, straightening the penis and restoring length and thickness.
Only after penile reconstruction can the surgeon measure the prosthesis. By fitting the implant to the already reconstructed penis, it’s possible to place the implant with the largest feasible size and diameter.
6) Prosthesis Rejection
Prostheses are made of silicone, a material approved for medical use by regulatory agencies and biocompatible, which offers greater safety. Therefore, the body’s rejection of this material is very rare.
7) Need for Surgical Revision
Some patients may need a new surgery for adjustments or prosthesis replacement.
To minimize this risk associated with a malleable penile prosthesis, devices without silver rods (which are more fragile) are recommended, opting for nitinol rods. Other, even more resilient materials are being developed and will soon be available to patients.
The malleable implant is more vulnerable. You should watch out for leaks in the saline reservoir, the condition of the tubing, pump locks, and aneurysms in the cylinder. Sometimes the problem can be solved at the office, but it might require another surgery to replace the device. Studies indicate that around 10% of patients may require a revision within 10 to 15 years, due to the durability of the penile prosthesis.
8) Inadequate Rigidity
To provide adequate rigidity, the penis must be evaluated before surgery.
If there are thinning areas, it’s necessary to reconstruct the penis. This way, the surgeon can insert a larger prosthesis, offering more firmness to that penis.
For malleable implants, it’s important to consider the material of the rod. Since silver rods are more vulnerable, they can break over time, causing the penis to lose firmness. Ideally, more resistant alloys, such as nitinol, should be used.
Inflatable models should also be tested during surgery. The prosthesis is inserted deflated into the penis and must fully inflate. If there is any restriction, it will not fully inflate, and consequently, it will not provide good rigidity.
Additionally, it is necessary to avoid using extenders, which are more fragile than the prosthesis itself and do not favor rigidity. Instead of using them, the prosthesis must be properly sized, making various lengths and diameters available at the time of surgery so that the best option can be chosen for each patient.
9) Excessive Scarring
Penile implant healing depends on proper tissue closure during surgery and, subsequently, on penile physiotherapy sessions, mainly for men who have received an inflatable penile prosthesis.
In the first few days, the inflatable model should remain partially inflated so that there is no excessive tissue regeneration, which could cause retraction.
Remember that the stitches are absorbable and no grafts are used, which supports healing and provides a satisfactory aesthetic result.
10) Anesthetic Risks
Only sedation is used — it is not general anesthesia. The base of the penis also receives local anesthesia so that the patient does not feel pain.
As with any surgical intervention, there is a possibility of adverse reactions to anesthesia, such as allergic responses, which can be identified through a detailed preoperative evaluation.
After All, Is Penile Prosthesis Surgery Safe?
Penile prosthesis surgery using the Egydio Technique has been used for over 25 years to treat erectile dysfunction and Peyronie’s disease. Penile prosthesis surgery is widely performed and can be a safe option for many patients, provided it is properly indicated and includes appropriate medical follow-up.
Personalizing the approach for each patient, combined with the surgeon’s experience and technological advancements, can contribute to a more favorable recovery. In about 60 days, it is usually possible to resume all activities, including sexual intercourse.
It is important to bear in mind that selecting the type of prosthesis suitable for the patient’s profile and following postoperative care guidelines are essential for satisfaction with the procedure.
Dr. Paulo Egydio: A Reference in Penile Prosthesis Surgery
Dr. Paulo Egydio brings together 25 years of experience and research in Brazil and abroad in the placement of prostheses. More than 6,000 patients have already undergone surgery with this urologist, achieving a high satisfaction rate, as these men were able to resume their sexual lives.
His individualized approach aims for careful planning to achieve the best possible results within medical indications and to closely monitor recovery so that the patient maintains healthy sexual function.
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- 10 Tips for Penis Care to Maintain Health and Prevent Infections and Diseases
- See What Causes Erectile Dysfunction and Available Treatments
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