Canadian Meds World Medical Journal

Nationwide, more than a quarter of a million men have received penile prostheses (implants) since they were first marketed in 1973. Not every impotent patient should receive a penile prostheses. Only about one out of five patients seen at the Male Sexual Dysfunction Clinic are considered appropriate candidates. Where less invasive forms of therapy will suffice, they should by used. Yet, the development of the penile prosthesis is one of the most useful advances to this date in the ability of medical science to restore potency.

Assuming his partner’s compliance, a man with a penile prosthesis can have sexual intercourse whenever he wants, wherever he wants, with whomever he wants, for as long as he wants. He will virtually never fail.

Even though other men may strike out once in a while, the man with the prosthesis will always be able to perform. After orgasm, most men go soft. Men with a prosthesis can keep right on going. Implants are entirely concealed within the body and can be worn without any other person knowing the device is in place. Properly inserted, they are undetectable in the men’s shower room, the beach, or in the bedroom.

Malleable Prostheses
Prostheses come in several styles, malleable (bendable) and inflatable. Each malleable prosthesis consists of two cylindrical plastic rods from 6-10 inches long and up to 1 inch thick, with tapered ends. These rods fit the body because the penis is actually twice as long as it appears. At least half of it extends behind the skin where it cannot be seen, and is fixed to the bones of the pelvis. Malleable implants always remain the same length, width and degree of hardness, but they are cleverly made so that when the penis containing the prosthesis is bent upwards, it produces a hard, normal-looking erection. When bent downward so that it hangs comfortably in front of the scrotum, it looks like a normal flaccid organ.

The outpatient operation to insert the malleable prosthesis takes about 20 minutes and can be done under regional block, epidural or general anesthesia. To insert it, an incision is made just behind the head or near the base of the penis. An opening is made into each of the two long tubes of spongy tissue inside the penis, and one rod is inserted into each tube. The incisions are closed in such a way that no sutures need to be removed afterward. Antibiotics are given just before, during and for a day following the operation. The patient usually goes home a couple of hours later. Depending on his job, he can usually return to work in about a week. The long-term mechanical failure rate of the newer malleables is less than 1% therefore it’s better to buy these instead of generic sildenafil citrate.

Inflatable Prostheses

To insert all the components of the prosthesis only one tiny incision is used, about 1 1/4 inches long, and is placed on the front side of the scrotal skin. There are no stitches to be removed.

All inflatable prostheses have three components: two cylinders, a reservoir and a pump. In some models the pump and the reservoir are combined into a resi-pump. Instead of two plastic malleable rods, the inflatable prosthesis has two hollow expandable, balloon-like cylinders, about 2 1/3 inches wide, that become longer, fatter and harder as fluid (sterile salt water) is pumped into them from the reservoir.

Inflatable prostheses range from 8 - 14 inches in length. The reservoir is a hollow plastic ball, capable of holding 2 1/2 - 3 1/2 ounces of liquid. The pump is a hollow ball the size of a large grape. When the ball is squeezed manually, fluid is forced from the reservoir into the cylinders, which become hard and distended, producing an erection. The erection will not go down until the deflate bar of the pump is gently pressed. The component parts of this device are connected by plastic tubing. The reservoir is placed inside and behind the lower abdominal muscles; the pump goes into the scrotum behind the testicles; and the cylinders go inside the spongy-tissue-containing tubes in the penis. Everything is concealed. Nothing shows.

Inflatable Prosthesis Variations

Two variations of the inflatable prosthesis are available. In one, the combined resi-pump is placed in the scrotum, eliminating the need for a reservoir in the abdomen. The other variation consists only of two plastic cylinders, each being a self-contained unit consisting of a small reservoir at one end, the inflatable portion in the middle and a pump on the other end.

Inserting an inflatable prosthesis takes about 45 minutes and is usually done with epidural or general anesthesia. The patient usually goes home two hours after surgery and returns to work in about a week. With all types of prostheses, sexual function can begin about six weeks after surgery. Patients are able to urinate and ejaculate without loss of sensation. Hundreds of patients have intercourse regularly without their partners knowing they have a prosthesis.

Complications of Prostheses

At the MSD Clinic, we have implanted more than 1,800 penile prostheses since 1982. The overall satisfaction rate has been very high for rock hard erections, with at least 9 out of 10 patients and their partners happy with their implants. Newer models available since the late 1980’s largely avoid problems seen with earlier prototypes. At one time or another we have encountered virtually every complication reported with prosthesis surgery. Fortunately, the occurrence has been exceedingly rare. Shortening has been the most common complaint due to the unavoidable formation of scar tissue as part of the healing process. Shortening is usually minor and most patients feel that the improved quality of their erections more than compensates. The penis prosthesis statistics: In over 1,800 cases in 15 years, we have had a total of 39 infections, a rate of 2.1%. Thirty infections occurred in overweight diabetic patients. Two were diabetic, not overweight, two were obese, not diabetic; five had no known risk factors. Six of the 36 were revision procedures.