Penile prosthetics

Endophalloprosthetics, or phalloprosthetics, is a surgical intervention to correct erectile dysfunction. During the operation, the cavernous bodies of the penis are replaced with implants. This treatment helps eliminate severe forms of impotence: at the same time, the physiological functions of urination and ejaculation, as well as the aesthetics and sensitivity of the penis, are not affected. [ 1 ]

Penile prosthetics is performed by qualified urologists-andrologists in a hospital setting. The patient's recovery is relatively quick - within 2-4 months, after which he can lead a completely normal and active sexual life. [ 2 ]

Penile prosthetics according to quota

The penile prosthesis operation is quite expensive. However, few people know that this type of treatment can be financed by the state. The legislation provides for the issuance of so-called quotas, which patients can use free of charge.

A quota for treatment or surgical intervention is issued within the framework of high-tech medical care for the population. The list of diagnoses for which you can receive a subsidy is quite wide: in particular, they include organ transplantation and prosthetics.

The amount of coverage of the quota for penile prosthetics is determined based on the actual cost of treatment, as well as the limit set by the state for the elimination of a specific pathological problem. In most cases, the quota can be obtained for the purchase and installation of one-component (semi-rigid) implants.

Indications for the procedure

Penile prosthesis is one of the radical ways to eliminate erectile problems in men. According to statistics, about 40% of patients with erectile dysfunction have vasculogenic diseases, about 30% have diabetes. In 15% of patients, the problem is associated with taking certain medications, in 6% with traumatic injuries to the groin and pelvic area, in 5% with neurological disorders, in 3% with endocrine disorders. In 1% of cases, the origin of erectile dysfunction cannot be determined.

Erectile dysfunction has always been a serious problem for men who have a full and active sex life. The study of possible disorders and the search for their causes began in the 8th century AD: since then, specialists have been diligently developing and developing new methods of treating erectile dysfunction, including penile prosthetics.

During an erection, the cavernous bodies of the penis are filled with blood. If the blood flow is not intense enough, or if it leaks quickly, a normal erection is disrupted. Many patients can solve the problem by using certain medications, psychotherapy and physical therapy. In difficult cases, when these methods are ineffective, phalloprosthetics are prescribed. The operation is effective, but irreversible, since after the intervention, restoration of the cavernous bodies becomes impossible.

Most often, penile prosthetics are practiced for the following pathologies:

• Peyronie's syndrome (replacement of functional tissue with connective tissue structures), cavernous fibrosis;
• vasculogenic erectile dysfunction (vascular pathology that cannot be corrected with microsurgery);
• anatomical features of the genital organ (both congenital and acquired);
• endocrine disorders (hereditary hormonal diseases, diabetes mellitus);
• errors in previously performed operations on the pelvic organs, prostate gland (damage to nerve fibers or vascular network); [ 3 ]
• psychogenic disorders that do not respond to medication and psychotherapeutic correction.

At what age do they do penile prosthesis?

Phalloprosthetics can be performed at almost any age, if there are medical indications for it, and the patient does not have standard restrictions on surgical interventions. The state of health is important in how the anesthesia will work, how comfortable and fast the rehabilitation period will be.

In order to assess the patient's condition and his readiness for surgical intervention of phalloprosthetics, the doctor prescribes a comprehensive examination in advance, including laboratory tests, instrumental diagnostics, consultation of narrow specialists. If any chronic pathologies are detected, the doctor prescribes the appropriate treatment to achieve stable remission of these diseases.

Phalloprosthetics can be performed in a stable state of health. On the day of surgery, the patient should not have any signs of acute respiratory viral infection.

Young people up to 40-45 years old can seek medical advice on penile prosthetics after various traumatic injuries, accidents, vascular anomalies of the genital organ and other pathologies that have led to problems with erection. Less often, the operation is performed as part of the treatment of congenital erectile dysfunction.

Older patients (45-75 years and older) most often choose penile prosthetics as a way to eliminate erectile problems caused by prolonged sexual abstinence, chronic pathologies or age-related changes.

Preparation

The first preparatory stage includes a consultation with medical specialists (surgeon, urologist, andrologist, therapist) to determine the indications for penile prosthetics. It may be necessary to additionally conduct a number of diagnostic studies to ensure the need for surgical intervention. Thus, the patient may be prescribed the following procedures:

• cavernosography – X-ray contrast study of the causes of venogenic erectile dysfunction;
• cavernosometry – study of the state of the cavernous bodies of the genital organ (measuring the pressure inside the cavernous bodies during its infusion);
• papaverine test – intracavernous test with a vasoactive drug;
• Ultrasound Doppler examination of the penis blood vessels.

The penile prosthesis surgery is most often performed using epidural anesthesia, so preparation should also include a consultation with an anesthesiologist, a general blood and urine test, and an electrocardiogram. Additional tests include:

• study of clotting time and bleeding duration, coagulogram;
• blood glucose determination;
• biochemical blood test (ALT, AST, total bilirubin, total protein, creatinine, urea);
• determination of blood type and Rh factor.

The evening before the penile prosthesis surgery, the patient should shave the hair from the groin area and lower abdomen. The last meal should be no later than 8-9 hours before the surgery.

You should not drink alcohol 3 days before the procedure. It is advisable to refrain from smoking on the day of the operation.

Technique phalloprosthetics

The surgical intervention of penile prosthesis can last from 1 to 2 hours. Most often, epidural anesthesia is used, but in some cases there are indications for endotracheal anesthesia.

The technique of the operation depends on the type of implant that will be used: for example, phalloprosthetics is performed using a scrotal or subpubic approach. [ 4 ]

The scrotal approach involves making a longitudinal incision of approximately 4.5 cm in length in the area between the penis and the scrotum. If the subpubic approach is used, the incision is made above the penis.

The first operational phase consists of removing the cavernous bodies. For this, bougienage is performed. Then the bodies are replaced with plastic implants or chambers of multi-component phalloprostheses.

When installing a three-component prosthesis, an additional incision is made in the scrotal area with subsequent internal placement of a pump that pumps fluid into the chambers. The reservoir is placed near the bladder. All devices are inserted in a "deflated" state.

At the end of the phalloprosthesis procedure, stitches are applied to achieve the most aesthetic appearance.

Types of implants in penile prosthetics

Modern surgical urology has a wide range of penile implants. Prosthesis models are constantly being improved, becoming more physiological and functional. They also differ in cost. [ 5 ]

Just a few years ago, the only choice for patients was an uncomfortable and unaesthetic rigid dildo implant. It consisted of silicone rods sewn into the cavernous bodies: as a result of the operation, the penis became tense not only during an erection, but also in a relaxed state. However, such phalloprosthetics were relatively inexpensive and easy to perform, and the risk of damage to the implant was minimal. [ 6 ]

The next generation of penile prostheses are semi-rigid models that can be oriented in the desired direction and even bent up or down. [ 7 ]

Somewhat later, “inflatable” implants were developed, which gain volume during an erection and collapse when relaxed. The “pumping” of the balloons occurs after pressing and starting a pump located in the scrotum area. Such penile prostheses can be two- or three-component. Two-component models consist of cylinders and a silicone pump connected to them, which is also a liquid reservoir. A three-component prosthesis is equipped with a separate reservoir, inserted under the muscular corset in the lower abdominal cavity, near the bladder. [ 8 ]

Filling of the cylinders occurs by three or four presses on the pump inserted into the scrotum area. To return the penis to a state of rest, it is enough to simply point the penis downwards and hold it for 15 seconds until all the liquid flows into the reservoir. [ 9 ]

Three-component penile prosthesis is considered the highest quality option among existing ones, but it also has a drawback: during an erection, there is no significant increase in the organ's thickness, and there is no complete relaxation at rest. In addition, a three-component penile prosthesis is relatively expensive, and its complex structure increases the chances of damage to the device.

Contraindications to the procedure

Phalloprosthetics are not performed:

• for arterial priapism (uncontrolled prolonged and painful erection);
• during active inflammatory processes (including exacerbation of chronic prostatitis);
• during periods of colds and viral diseases (it is necessary to wait until recovery).

It is not recommended to perform penile prosthetics on people with severe concomitant pathologies in the decompensation stage and with mental disorders.

Consequences after the procedure

In most cases, penile prosthesis surgery does not cause adverse effects. Problems may occur in only 3-4% of patients. Among the possible violations, the following sometimes occur:

• infectious and inflammatory processes; [ 10 ]
• displacement of the penile prosthesis; [ 11 ]
• hypersensitivity, the appearance of an allergic reaction to the implant;
• hemorrhages in tissue, transient swelling of the genital organ;
• tissue necrosis caused by an incorrectly selected implant;
• damage to blood vessels and the urethra.

Sometimes, deterioration of tissue trophism and associated necrosis occur if the patient has not deactivated the three-component penile prosthesis and has been wearing it for a long time, although such cases are extremely rare. [ 12 ]

Experts note that after penile prosthetics, the length of the penis may decrease slightly - by about 1.5 cm, which is due to the stretching of the penis tissue in width.

Complications after the procedure

One of the most unfavorable complications of penile prosthetics is the development of prosthetic infection and inflammation of the organ tissues surrounding the implant. In approximately 65% of cases of such complications, the "culprits" are gram-positive microorganisms, and only in 30% of cases are we talking about gram-negative bacteria. Much less frequently, up to 5% of infections are associated with the activity of fungal pathogens, anaerobic bacteria and methicillin-resistant Staphylococcus aureus.

Today, penile prosthetics is a fairly common surgical procedure worldwide. Surgeons and urologists have a wide and varied selection of different penile prosthetic models and techniques for their implementation. To reduce the incidence of complications, modern implants with antibacterial coating are available, which virtually eliminate the occurrence of postoperative inflammatory reactions and prosthetic infections. In addition, preventive methods of therapy are actively used in penile prosthetics - in particular, preoperative and postoperative antibiotic therapy.

Care after the procedure

After the surgical phalloprosthesis, the patient spends approximately 3-4 days in the hospital. During this time, minor pain may bother you, which is easily eliminated by taking painkillers.

The stitches are removed on the 8th-10th day. Physical activity is prohibited for approximately 2 weeks from the moment of the intervention.

The patient will be able to return to sexual activity no earlier than 1.5-2 months after the penile prosthesis. The exact period of sexual abstinence is discussed with the attending physician and depends on the variation of the installed prosthesis, on the quality of healing of the postoperative suture.

About a month after the operation, swelling subsides and sensitivity of the penis is restored.

Experts note that penile prosthetics does not affect ejaculation, orgasm quality, or other physiological sensations during sexual intercourse. To monitor the quality of the operation, the patient is recommended to visit an andrologist regularly and annually.

Patient Reviews

Patients who have undergone penile prosthetics respond mostly positively to the operation. Minor pain and swelling gradually disappear approximately 2 weeks after the procedure. Sexual activity can be resumed after 1.5-2 months: the patient must first visit a doctor who will confirm that the penile tissue has fully healed. If you ignore the recommendations and start having sex before the due date, there is a risk of complications, such as displacement of the penile prosthesis, development of purulent-inflammatory processes and hemorrhages, and rejection of the implant.

After the recommended rehabilitation period, the man can lead a normal life, including intimate relations. The sensitivity of the organ does not suffer, since the nerve fibers are not damaged during the operation. Sometimes the sensitivity of the head of the penis changes slightly, but in most cases this change is temporary.

Penile prosthesis does not affect the reproductive function of men in any way. Sperm production continues as before, provided there is no damage to the prostate gland.