If medical treatment fails, a penile prosthesis can be implanted to fully restore rigidity, while not interfering with natural shape and form of the penis, natural feeling, natural pleasure, natural ejaculation, fertility and urination, all of which are preserved. It only addresses rigidity that is completely restored.
When one desires erection, he induces rigidity in the penis by manipulating it in a special way that varies according to the type of prosthesis implanted. When the penis is made rigid, it stays that way for any length of time required, until one undoes rigidity by another manipulation. Intercourse can thus be possible for any number of sessions, every day, and for any desired length of time
The prosthesis is a device that is inserted through a small incision that is concealed and does not usually appear. The implant is totally hidden inside the body
This usually takes an average of 60 minutes of surgery, and does not usually require any length of hospital stay.
Penile Prosthesis Surgery Through the Penoscrotal Incision
Penile Prosthesis Surgery Through the Subcoronal Incision
Types of Penile Implants
Two types of prosthesis exist, depending on the mechanism of rigidity: the inflatable, and malleable/semirigid.
The Inflatable Penile Prosthesis
The inflatable prosthesis is made of two soft, long cylinders that are connected to a small fluid-filled pump. The two cylinders are placed inside the two corpora cavernosa. The pump is placed inside the scrotum next to the testis. When the pump is pressed, fluid leaves the pump and fills the cylinders expanding them and rendering them rigid. The cylinders occupy the whole length of the corpora cavernosa, thus result in rigid erection of the penis when filled.
When one desires to undo erection in case an inflatable prosthesis is implanted, he presses the top of the pump or the penis itself (according to the model of the inflatable prosthesis). Fluid flows out of the cylinders making them soft again, and the penis shrinks back to normal.
The Malleable Penile Prosthesis
The semirigid /
malleable is different. It is composed of a long silver wire that can be bent
and straightened. The silver wire is surrounded by a firm cylinder of silicon
that has the feeling of a rigid penis. The cylinder can be bent or straightened
as desired. When straightened, it stays straight and rigid.
Two cylinders are
inserted, one in each corpus cavernosum, in the same way an inflatable
prosthesis is implanted (see before). When one has a semirigid / malleable
prosthesis implanted and he desires erection, he straightens the penis with his
hand, and it stays erect as long as he needs. When he is done, he bends the
penis downwards so that it does not show underneath his pants, but it stays
rigid (though bent).
Possible complications of this surgery include wound infection, which can be prevented by strict sterilization, antibiotics and perfect surgical technique. Other very unlikely complications are over-sizing and under-sizing of the prosthesis, both of which result from poor surgical technique. Over sizing can result in perforation and extrusion of the prosthesis especially in diabetics.
If impotence is caused by venous leak, the leaking veins can be individually occluded (ligated) to repair the faulty mechanism of erection.
This requires accurate studying of the veins prior to surgery, in terms of site and number, accomplished by cavernosography.
The best results with venoligation surgery are obtained in cases where leakage is through a one or two veins at most, rather than many veins, patients less than 45 years age, non-smokers, with impotence dating since puberty.
The incision is 1-3 cm long on the upper surface of the base of the penis. Surgery takes 30-45 minutes, and patients are discharged from the hospital on the same day.
The incision for venoligation, showing the vein (blue) right in the middle, surrounded on either side by an artery and a vein.
Success rate is within 60%. Some of the cases that fail surgery respond better to medical treatment contrary to the lack of response before surgery. Other failed cases require implantation of a penile prosthesis.
