Penile Prosthesis: What It Is, How It Works, Why It Is Done
Introduction
In which cases is penile prosthesis or penile prosthesis surgery indicated? What exactly does it consist of and how can it control erection?
Football news has made the question of what a penile prosthesis or penis prosthesis is and how it works very popular in recent hours, after Juan Bernabé, now former falconer of Lazio, made public, with a wealth of details and photographic documentation, the fact that he underwent this type of surgery. Let’s try to understand better what medical device we are discussing and what it is for.
When Is Penile Prosthesis Indicated?
A penile prosthesis or penile prosthesis is considered the last line of treatment for erectile dysfunction, which is the inability to achieve or maintain a satisfactory erection during sexual intercourse. This common ageing condition is usually related to abnormalities in the blood vessels or nerves of the penis, which are promoted by factors such as atherosclerosis (hardening of the arteries), diabetes, obesity, complications of prostate surgery, but also hormonal disorders, drug intake, or conditions such as anxiety or depression. If first-line treatments, based on drugs such as Viagra or Cialis, are not effective, you can discuss the possibility of resorting to a penile prosthesis with your urologist.
How Is Penile Prosthesis Made?
A penile prosthesis is a medical device that is surgically implanted into the corpora cavernosa, an internal region of the penis made of spongy tissue that is supplied with blood during an erection. The procedure usually takes 30 to 40 minutes to two hours and is done under general or spinal anaesthesia. “One way to think about it is to imagine placing a tube inside a deflated tyre,” said Bahaa Malaeb, a urologist at Michigan Medicine.
There are two macro-types of penile prosthesis, semi-rigid non-inflatable and inflatable. The first is made up of two cylinders that, explains the SIU (Italian Urological Society), “are implanted in the corpora cavernosa (the erection chamber of the penis) and can be bent during sexual activity. With this type of implant, the penis always remains in a semi-rigid position, a condition that is difficult to hide”. This type of implant has the disadvantage of giving the penis a constant state of partial rigidity, which can cause discomfort in the patient, but it is easier to use and rarely fails (given the smaller number of components).
Inflatable penile prostheses are hydraulic devices, which means they are filled and emptied with a liquid. They can be made up of two or three pieces, and are made up of hollow cylinders connected by tubes to a tank containing sterile water and to a pump, positioned inside the scrotum, the wrinkled sac that encloses the testicles.
The inflatable penile prosthesis is used most often because it allows for more natural erections. The components are completely inserted into the genitals, including the pump, which is placed in the scrotum through an incision no longer than 4 cm. In the case of the three-piece penile prosthesis, the fluid reservoir is placed under the abdominal wall. In the two-piece version, the fluid reservoir is part of the pump implanted in the scrotum. After the operation, the patient is discharged, returning for a check-up of the wound after a couple of weeks and again after six to learn how to operate the prosthesis.
How Does Penile Prosthesis Work?
When the patient wants to have an erection, he presses the button on the pump in the scrotum and activates the mechanism. Water flows from the reservoir to the cylinders through the tubes, bringing the penis to a rigid state. After intercourse, the penis can return to rest by activating the pump again, to send the water back to the reservoir.
The penile prosthesis does not alter the sensitivity of the penis or the pleasure experienced during sexual intercourse (because it does not involve the nerve pathways of the organ), does not hinder ejaculation or urinary capacity, and is normally not visible during erection – except in the case of semi-rigid, non-inflatable prostheses.
How Long Does Penile Prosthesis Last, And What Are The Risks?
“The mechanical life of these types of implants is on average about 10-12 years. Sometimes they last longer, sometimes less. It’s very similar to a car,” Malaeb explains. Their use carries a certain risk of infection, especially during surgery, as well as malfunction of the device, which may require another operation to fix. In rare cases, there may be problems with internal erosion or adhesion of part of the implant to the internal skin of the penis. But generally, penile prostheses are well tolerated and guarantee almost total effectiveness against erectile dysfunction.
