Posts Tagged ‘penile prosthesis’

Penile Implant: The “Total Knee Replacement” of Urology

November 21, 2020

Andrew Siegel MD     11/21/2020

A penile implant effectively restores erectile function for men who have a poor response to or are unsatisfied with conservative measures.  Penile implants for men with severe erectile dysfunction share much in common with total joint replacement for those suffering with crippling arthritis.  In both cases, these procedures are quality-of-life restoring considerations after conservative measures (pills, injection therapy, physical methods, etc.) have been tried and deemed ineffective.  Penile implants and total joint replacements are sophisticated prosthetic devices implanted by orthopedic surgeons and urologists, respectively, and both require some healing time before put into use.  Whereas a total joint replacement can convert an arthritic “cripple” into a person who can not only ambulate without pain and participate in sports, a penile implant can convert an erectile “cripple” into a functional male with restored erections and resolution of the psychological and emotional anguish resulting from the loss of virility and vitality.  

The penile implant has undergone numerous refinements, modifications and innovations since its initial availability over forty years ago.  Today’s models are sophisticated and highly-engineered devices composed of medical-grade synthetic materials. Surgically implanted under anesthesia– usually on an outpatient basis–these devices are totally internal and function to provide the penile rigidity to permit penetrative sexual intercourse and restore sexual confidence.  For the right man under the appropriate circumstances, the penile prosthesis can be a life changer.

Penile sensitivity, sex drive and ability to ejaculate are essentially unchanged following implantation of a penile prosthesis.  Unlike a normal erection, a penile prosthesis does not result in swelling of the head of the penis nor the erectile tissue surrounding the urethra. Nonetheless, it results in a penetrable and durable erection that can restore sexual function in a man who is incapable of achieving an erection.

There are two types of penile prostheses: semi-rigid and inflatable. I liken the difference between these two implants to the distinction between a Volkswagen and Mercedes, both effective and functional, but the latter with many more “bells and whistles.”  In either case, the dimensions of one’s erectile chambers are precisely measured in order to size the implant properly, similar to measuring the length and width of your feet in order to ensure a good shoe fit.

A semi-rigid penile prosthesis (a.k.a. malleable implant) is a “static” implant that always remains rigid, not unlike the penile bone present in many primates, except that it can be hinged. It is bent upwards for sexual use and downwards for concealment. It consists of two malleable cylinders that are implanted within the paired penile erectile chambers through a small incision. Its advantage is its simplicity, its utility for men with dexterity issues, and its price. Its disadvantage is that it cannot go from an inflated state to a deflated state as does the inflatable penile implant, potentially causing concealment issues. Furthermore, by virtue of the constant pressure of the implant on the soft tissues of the penis, it can be more uncomfortable than the inflatable variety and has the potential for thinning the penile flesh.

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Semi-Rigid Penile Prosthesis (Boston Scientific American Medical Systems)

The inflatable penile prosthesis is a “dynamic” hydraulic implant designed to mimic a normal erection.  It can be inflated and deflated at will by virtue of a self-contained hydraulic system. Cylinders (inner tubes) are implanted within the paired erectile chambers. The control pump is implanted in an accessible area of the scrotum. The third element is the reservoir that contains the fluid necessary for inflation, which is typically implanted behind the pubic bone or the abdominal wall. Tubing connects the control pump to the cylinders and to the reservoir.

When an erection is desired, the scrotal control pump is repeatedly squeezed, transferring saline from the reservoir into the penile cylinders. As the cylinders fill, an erection develops and with each consecutive squeeze, more fluid fills the cylinders, creating a more rigid erection of wider girth. The erection will remain until the release bar located at the upper aspect of the control pump is activated.  After the completion of sexual intercourse, by pressing this release bar, the fluid in the cylinders returns to the reservoir where it is again stored, returning the penis to its flaccid state. Of note, some inflatable implants are designed to increase in girth only, whereas others increase in length and girth.

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Inflatable Penile Prosthesis (Boston Scientific American Medical Systems)

Advantages of the inflatable implant are its ability to inflate and deflate, mimicking normal erectile function and creating no concealment issues. The penis can be kept rigid for as long as desired and will not deflate after ejaculation, unlike the flaccidity that occurs after ejaculation under normal circumstances. Disadvantages include its additional expense (although it is usually covered by insurance), the fact that it requires some degree of manual dexterity to operate, and the fact that it is more susceptible to mechanical malfunction than the semi-rigid variety because of its complexity.

Wishing you the best of health,

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.  Today’s entry is excerpted from his latest book, Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families. 

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Video trailer for Prostate Cancer 20/20

Preview of Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families is now on sale at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours). 

Dr. Siegel’s other books:

FINDING YOUR OWN FOUNTAIN OF YOUTH: The Essential Guide to Maximizing Health, Wellness, Fitness and Longevity

PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health

Video on THE KEGEL FIX