Penile prosthetics (penile prosthetics)

Penile prosthesis is the final treatment option for erectile dysfunction (third line of therapy). The operation involves implantation of a penile prosthesis (rods) into the cavernous bodies. This is one of the most effective ways to treat this pathology. Complete restoration of copulatory function is achieved in 90% of cases.

Treatment of erectile dysfunction at the Federal Scientific and Clinical Center FMBA is carried out at the modern level, using high-tech techniques that are effective at any stage of the disease. The risk of complications is minimal.

Treatment of erectile dysfunction using penile prosthesis

The third line of therapy includes penile prosthetics by implanting special synthetic structures into the organ. The goal of this stage of treatment is to ensure the elasticity of the penis sufficient for full sexual intercourse.

The advantages of the method include:

• high efficiency of achieving an erection;
• fewer complications;
• the ability to eliminate organ defects during surgery - curvature, insufficient size;
• rapid return of mental comfort;
• high satisfaction of the sexual partner.

Unlike conservative methods, penile prosthesis improves a man’s physical and mental status much faster, increases self-esteem and self-confidence.

With modern prostheses, sexual intercourse becomes as physiological as possible, the penis looks natural and in a relaxed state. The implanted implant does not have a negative effect on sexual sensations, ejaculation, or urination. The man himself determines the appropriate time for an erection to occur and its duration.

How a three-component penile prosthesis works using the example of the AMS 700 system implant

The three-component AMS-700 system consists of a pair of cylinders implanted in the penis, a pump that is placed in the scrotum, and a saline reservoir that is located in the lower abdomen. To activate the erection state, it is necessary to squeeze and release the pump in the scrotum, the fluid from the reservoir will move into the cylinders, making them hard. In order for the penis to become soft, you need to press the button on the pump block for 10-15 seconds: the penis will return to its soft natural state.

Some features of three-component implants:

• Less rigid pump makes inflation easier than a two-piece device, but requires more dexterity to pump
• Since the prosthesis creates minimal pressure on the tissue of the penis, when it is not in use, excessive pressure of the cylinders on the tunica of the cavernous bodies on the head of the penis is less likely
• The three-component system ensures the best softness of the penile cylinders when the prosthesis is not in use, which is most comfortable for the patient

Figure: Using the AMS three-piece penile prosthesis

Activating an erection in the case of a two-component and three-component prosthesis takes on average from 30 to 60 seconds, and the reverse process takes about the same amount. Many men living with this type of implant note that the penis in a calm state looks as natural as possible and does not interfere with their normal lifestyle.

Penile prosthetic methods

In modern medical practice, several types of prostheses are used, introduced into the cavernous bodies of the penis and differing in their operating principle:

• elastic non-hydraulic - reliable and simple silicone paired rods, with the help of which the genital organ is constantly in a state of erection;
• plastic non-hydraulic - double metal spiral or polyethylene rods, with good ability to plastic deformation;
• hydraulic - fluid flows into the implanted cylinders through tubes under the action of a pump from the reservoir, stretching the organ to the desired size.

The latter are 2-component (the pump and reservoir are combined and placed under the skin of the scrotum) and 3-component (the pump is located in the scrotum, the reservoir is behind the womb). The cost of hydraulic prostheses is higher, but they have a more natural appearance. The incision is made in the area of ​​the folds, the stitches are almost invisible after healing.

The question of which penile prosthesis to choose is decided together with the patient. The technique of the operation is determined by the doctor taking into account clinical indications. In some cases, plastic reconstruction is performed. For significant defects and curvature of the penis, flap corporoplasty and Nesbit surgery are performed.

How a two-component penile prosthesis works using the example of the AMS Ambicor system implant

The two-piece implant consists of a pair of cylinders that are implanted in the penis and a saline pump that is placed in the scrotum. To achieve an erection, you need to squeeze and unclench the pump. The fluid will move from the reservoirs in the inner part of the cylinders located in the legs of the cavernous bodies to the outside, and the penis will become hard. In order for the penis to go into a resting state, it is necessary to bend it at the base at an angle of 55-65 degrees and hold it for 6-12 seconds. This way the liquid will return to the reservoirs and the penis will become soft.

Some features of two-component implants:

• Two-piece penile implants are not as rigid compared to three-piece implants
• Two-piece penile implants are not as soft at rest compared to three-piece implants
• Two-component penile prostheses are technically less reliable compared to three-component implants
• To inflate the pump of a two-component penile prosthesis, more effort is required compared to a three-component implant system.

Indications for penile prosthesis

The implant is installed in patients for various reasons that have caused a pronounced degree of erectile dysfunction. The most common diseases for which penile replacement is indicated include:

• Peyronie's disease;
• underdevelopment of the genital organ;
• cavernous fibrosis;
• severe endocrine and vascular pathologies;
• post-traumatic complications;
• spinal cord injury;
• failure of conservative therapy;
• neurological diseases;
• radical prostatectomy without nerve-sparing surgery;
• psychogenic erectile dysfunction that is not amenable to other treatment methods.

The choice of treatment tactics and scope of interventions is determined by the doctor after diagnostic studies, taking into account all indications and contraindications.

We install penile prostheses from the world's leading manufacturers with a lifetime guarantee

At the Urology Clinic of the First Moscow State Medical University, implantation is performed by doctors with surgical practice of at least 10 years.

The operation is possible from two surgical approaches: through a small incision in the scrotum or pubic area. The advantages of the latter are that the risk of complications is lower and combined andrological operations are possible. For example, one-step lengthening of the penis.

The patient stays in the clinic for two days, sexual activity is possible one and a half to two months after the operation.

Contraindications

There are no absolute contraindications for penile prosthetics. However, in some cases the operation may be postponed to a later date:

• somatic diseases in the stage of decompensation;
• foci of infection;
• voluntary painful erections (priapism);
• inflammatory processes in the surgical field area.

Senile age is not a contraindication, but requires a more thorough examination before surgery with the involvement of related specialists.

Testicular prosthesis:

Urologists-andrologists at our clinic have extensive experience in prosthetic testing of modern testicular implants made of silicone gel , which do not cause immunological rejection in the body. The surface of such a prosthesis is flat and smooth or textured, and in consistency it is completely identical to a real testicle, is durable, resistant to injury and damage. The male testicular endoprosthesis is selected according to several parameters (diameter, height, weight); if necessary, the endoprosthesis can be selected using ultrasound.

Penile prosthetics at the Federal Scientific Center FMBA in Moscow

The preparatory stage before penile prosthesis involves diagnosing and identifying the causes of erectile dysfunction, consultation with an andrologist, and laboratory tests before hospitalization. If necessary, the patient undergoes examination by related specialists.

The operation is performed under general anesthesia and is painless. The duration depends on the technical complexity of the implementation and the volume of the intervention, on average it is about 2 hours.

High efficiency of treatment in the Federal Scientific Center of FMBA is achieved due to the following conditions:

• accuracy of diagnosis of the causes of the disease;
• high level of training and experience of medical personnel;
• instruments, implants only from trusted manufacturers;
• versatility of the center - the ability to attract any specialists for consultation and laboratory research;
• quality service, attentive staff and comfortable rooms;
• low rate of complications after surgery.

Unlike foreign clinics, prices for penile prosthetics in Moscow are much lower. At the same time, the quality of medical services meets international standards.

How satisfied are patients with the results of penile prosthesis?

When the implant is activated, the penis becomes as hard as a natural erection. In this case, the erection lasts as long as necessary. As a rule, orgasm, ejaculation and tactile sensations are similar to those the man had before implantation. It is worth noting that issues of satisfaction with implantation are considered in a number of scientific papers, and the results of these studies are published in medical journals.

In particular, the authors of the work “Long-term survival and patient satisfaction with inflatable penile prosthesis for the treatment of erectile dysfunction” find that the overall level of patient satisfaction in their study was 86.8%. Satisfaction with the rigidity of the device received the highest score (90.6%). The men's mean age and follow-up period were 57.0 ± 12.2 years and 105.5 ± 64.0 months, respectively.

Another study is “Why Are Men Satisfied or Dissatisfied with Penile Implants?” A Mixed Method Study on Satisfaction with Penile Prosthesis Implantation" also showed a high level of satisfaction among men who underwent penile implantation. The study participants were 47 men with erectile dysfunction who underwent surgery between 2003 and 2012. A structured telephone interview was conducted with all patients. Most men (79%) reported being satisfied with the results of their surgery.

Article information

List of references and sources

1. Yoon Seob Ji, Young Hwii Ko, Phil Hyun Song, and Ki Hak Mooncorresponding author.Long-term survival and patient satisfaction with inflatable penile prosthesis for the treatment of erectile dysfunction. Korean J Urol. 2015 Jun; 56(6): 461–465. Published online 2015 Jun 2. doi: 10.4111/kju.2015.56.6.461
2. Why Are Men Satisfied or Dissatisfied with Penile Implants? A Mixed Method Study on Satisfaction with Penile Prosthesis Implantation Carvalheira, Ana et al. The Journal of Sexual Medicine, Volume 12, Issue 12, 2474 – 2480
3. www.bostonscientific.com

Procedure for performing the intervention

At the Clinic of Operating Urology named after. Sechenov, implantation of a penile prosthesis is carried out in a minimally invasive way. Therefore, the operation is usually performed under spinal anesthesia. In some cases, general anesthesia is used. The surgeon makes a 2-3 cm long incision through which he creates a tunnel and a bed for implantation. The specialist then places the prosthesis inside. The implant is installed with minimal tissue trauma. This significantly reduces the risk of bleeding and speeds up recovery. The duration of the operation is 1-2 hours.

Types of penile prostheses

There are several types of penile prostheses: ● Rigid. Cheap models, which are silicone rods that give the phallus the necessary elasticity. Since the penis is in an erect state all the time, this creates discomfort for the man. ● Plastic. In appearance they are no different from the first models, they allow the penis to maintain a more natural appearance and any position. ● Inflatable. The most popular implants that allow you to maintain the natural state of the sexual organ at rest and during erection.

Benefits of penile prosthetics

The main advantages of penile prosthetics are:

• restoration of a man’s sexual capabilities, regardless of the causes of impotence,
• imitation of an erection without failures when necessary.

It is important to understand that penile implantation is a serious surgical procedure that has contraindications. This procedure should be resorted to only in cases where potency cannot be restored by other methods.

To get a consultation with a urologist-andrologist on penile prosthetics, make an appointment at our clinic. Details by phone.

The effectiveness of modern methods of surgical treatment

The main reason for the lack of complete blood supply to the cavernous bodies of the penis is excessive venous outflow. That is, the artery fills the organ, but the veins do not hold it. Treatment of vascular erectile dysfunction may require changes in the vascular beds. In this case, doctors surgically stop the discharge of blood by ligating (tying off) the deep dorsal vein.

Practice shows that even such a radical intervention in the long term has a weakening of erectile function.

The human body compensates for a blocked vascular channel by forming new venous channels. After just 2 years, the result will decrease by 30%.

As for trauma to nerve endings, the reconstruction of nerve fibers cannot, in principle, be reproduced. For this reason, what to do about erectile dysfunction? A man will have to rely on independent restoration of innervation, but the process for nerve cells is much slower - the body does not always have enough resources.

If it is not possible to normalize blood flow and blood flow from the penis, then the only way to guarantee a long-term result is penile prosthesis.