Penile prosthesis

Endophalloprosthetics, or penile prosthetics, is a surgical intervention for the correction of erectile dysfunction. During the operation, the cavernous bodies of the penis are replaced with implants. Such treatment helps to 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, do not suffer. [1]

Phalloprosthesis is performed by qualified urologists-andrologists in a hospital setting. The recovery of the patient takes place relatively quickly - in 2-4 months, after which he can lead a completely normal and active sex life. [2]

Phalloprosthesis by quota

The operation of penile prosthesis is quite expensive. However, few people know that this type of treatment can be funded 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 surgery is issued as part 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 quota coverage for penile prosthetics is determined on the basis of 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, a quota can be obtained for the purchase and installation of one-piece (semi-rigid) implants. 

Indications for the procedure

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

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

During an erection, the cavernous bodies of the penis fill with blood. With insufficiently intense rush of blood, or with its rapid leakage, a violation of a normal erection occurs. In many patients, the problem can be solved by using certain medications, psychotherapy and physiotherapy. In difficult cases, when these methods are powerless, phalloprosthesis is prescribed. The operation is effective, but irreversible, since after the intervention, the restoration of the corpora cavernosa becomes impossible.

Most often, penile prosthetics is practiced with such pathologies:

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

At what age is a penile prosthesis done?

Phalloprosthetics can be performed at almost any age, if there are medical indications for this, and the patient does not have standard restrictions on surgical interventions. The state of health matters 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 penile prosthesis, the doctor prescribes a comprehensive examination, including laboratory tests, instrumental diagnostics, and consultation of narrow specialists. If any chronic pathologies are found, the doctor prescribes the appropriate treatment to achieve a stable remission of these diseases.

Penile prosthesis is possible against the background of a stable state of health. On the day of surgery, the patient should not have signs of an acute respiratory viral infection.

Young people up to 40-45 years old can consult doctors about penile prosthetics after various traumatic injuries, accidents, vascular anomalies of the penis and other pathologies that have led to problems with erection. Less often, surgery is performed as part of the treatment of congenital erectile dysfunction.

Older patients (45-75 years and more) most often choose penile prosthesis 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 phaloprosthetics. It may be necessary to additionally conduct a series of diagnostic studies to make sure that surgical intervention is necessary. So, the following procedures can be prescribed to the patient:

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

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

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

On the evening before the surgery for penile prosthetics, the patient should shave off the hairline from the groin and lower abdomen. The last meal should take place no later than 8-9 hours before the operation.

Alcoholic beverages should not be drunk 3 days before the intervention. It is advisable to refrain from smoking on the day of the operation.

Technique of the penile prosthesis

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 which implant will be used: for example, phalloprosthesis is performed using scrotal or subpubic access. [4]

Scrotal access involves making a longitudinal incision about 4.5 cm long in the area between the penis and the scrotum. If a subpubic approach is used, then the incision is made over the penis.

The first operational phase is to remove the cavernous bodies. To do this, perform bougienage. Further, the bodies are replaced with plastic implants or chambers of multicomponent phalloprostheses.

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

At the end of the penile prosthesis intervention, sutures are applied, achieving the most aesthetic appearance.

Types of implants for penile prosthetics

Modern surgical urology has an extensive selection of penile implants. Models of prostheses are constantly being improved, becoming more and more physiological and functional. They also differ in cost. [5]

Until a few years ago, the only choice of patients was an uncomfortable and unaesthetic hard penis implant. It consisted of silicone rods sewn into the cavernous bodies: as a result of the operation, the sexual organ acquired tension not only during an erection, but also in a calm state. However, this penile prosthesis was relatively inexpensive and easy to perform, and the risk of implant damage was minimal. [6]

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

Somewhat later, "inflatable" implants were developed, which acquire volume during an erection and fall down in a calm state. "Pumping" of the cylinders occurs after pressing and starting the pump located in the scrotum. Such penile prostheses are two or three-component. Two-component models consist of cylinders and a silicone pump connected to them, which is also a liquid reservoir. The three-component prosthesis is equipped with a separate reservoir, embedded under the muscular corset in the lower parts of the abdominal cavity, near the bladder. [8]

The filling of the balloons occurs by three or four clicks on the pump, which is embedded in the scrotum. To return the penis to a state of rest, simply point the penis down and hold for 15 seconds to completely drain the liquid into the reservoir. [9]

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

Contraindications to the procedure

Phalloprosthesis is not carried out:

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

It is not recommended to perform penile prosthetics for persons with severe comorbidities in the stage of decompensation and with mental disorders.

Consequences after the procedure

In most cases, the operation of penile prosthesis does not cause adverse effects. Only 3-4% of patients are allowed to have problems. Possible violations sometimes include:

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

Sometimes deterioration of tissue trophism and associated necrosis appear if the patient has not deactivated the three-component phalloprosthesis and walked with 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, 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 a prosthetic infection and inflammation of the tissues of the organ surrounding the implant. In about 65% of cases of the development of such a complication, gram-positive microorganisms become the “culprits”, and only in 30% of cases we are talking about gram-negative bacteria. Much less often, up to 5% of infections are associated with the activity of fungal pathogens, anaerobic bacteria and methicillin-resistant Staphylococcus aureus.

Today, penile prosthesis is one of the most common surgical interventions around the world. Surgery and urology specialists have a wide and varied selection of different models of penile prostheses and techniques for their implementation. To reduce the incidence of complications, modern implants with an antibacterial coating are presented, which practically exclude the occurrence of postoperative inflammatory reactions and prosthetic infections. In addition, preventive methods of therapy for penile prosthetics are actively used, in particular, preoperative and postoperative antibiotic therapy.

Care after the procedure

After surgical penile prosthesis, the patient spends about 3-4 days in the hospital. During this time, minor pains may be disturbing, which are easily eliminated by taking painkillers.

Removal of stitches occurs on the 8-10th day. Physical activity is prohibited for approximately 2 weeks after the intervention.

The patient will be able to return to sexual activity not earlier than 1.5-2 months after penile prosthesis. The exact term of sexual abstinence is discussed with the attending physician and depends on the variation of the installed prosthesis, on the quality of the healing of the postoperative suture.

Approximately within a month after the operation, the swelling subsides, the sensitivity of the penis is restored.

Experts note that penile prosthetics do not affect ejaculation, the quality of orgasm and other physiological sensations during sexual intercourse. To control the quality of the operation performed in the future, the patient is recommended to visit the andrologist regularly and annually.

Patient reviews

Patients who have undergone a penile prosthesis respond mostly positively to the operation. Slight soreness and swelling gradually disappear about 2 weeks after the intervention. It is allowed to resume sexual activity after 1.5-2 months: the patient must first visit a doctor who will confirm the full healing of the tissues of the penis. If you ignore the recommendations and start having sex before the due date, then there is a risk of developing complications, such as displacement of falloprostheses, the development of purulent-inflammatory processes and hemorrhages, implant rejection.

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

Phalloprosthetics does not affect the reproductive function of men. Sperm production occurs as before, provided there is no damage to the prostate gland.