Introduction
Penile prosthesis implantation is a definitive surgical solution for men with erectile dysfunction (ED) when pharmacological therapies and less invasive treatments fail. This approach offers long-term satisfaction by restoring the ability to achieve and maintain an erection suitable for intercourse. Before electing this procedure, patients must understand preoperative evaluation, device options, surgical technique, and expected outcomes.
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Types of Penile Prostheses
There are two primary categories of implants:
– Semi-rigid (malleable) rods
– Comprised of bendable silicone-metal rods that maintain constant firmness and can be manually positioned for intercourse or concealment.
– Inflatable cylinders
– Two fluid-filled cylinders implanted in the penile shaft connect to a scrotal pump and an abdominal reservoir, allowing on-demand inflation and deflation for a natural flaccid and erect state.
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Surgical Technique and Procedure
The typical operative workflow includes:
1. Anesthesia
– General, spinal, or epidural anesthesia is administered, with some centers offering local block plus sedation.
2. Incision and device placement
– A small incision is made in the infrapubic area or at the penoscrotal junction.
– Inflatable device components are positioned: cylinders in the corpora cavernosa, a saline reservoir in the lower abdomen, and the pump in the scrotal sac.
3. Closure and dressing
– Incisions are closed with absorbable sutures, and a light compression dressing is applied.
Patients usually go home the same day or after an overnight stay. Full healing requires 4–6 weeks before device activation and sexual activity initiation.
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Patient Selection and Indications
Ideal candidates include:
– Men with organic ED refractory to oral medications, injections, or vacuum devices
– Patients with Peyronie’s disease causing penile curvature and coexisting ED
– Individuals who prioritize a permanent, reliable solution over repeated conservative therapies
Preoperative assessment often involves duplex ultrasonography to evaluate penile blood flow and cardiovascular clearance to minimize perioperative risks.
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Risks and Complications
While success rates exceed 90%, potential complications merit discussion:
– Infection, which may necessitate device removal
– Mechanical device failure leading to replacement surgery
– Perioperative bleeding and hematoma formation
– Scar tissue development potentially affecting penile length or girth
Antibi
