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Penile Prosthetics

 

A penile prosthetic is an excellent option to cure erectile dysfunction.  This is a device that is completely placed under the skin during a procedure that takes between 30-60 minutes.  The prosthesis allows men to get a full erection and still have normal sensation of the skin.  The erection occurs when men activate or pump up the device by pressing a pump in the scrotum.  This is generally placed between the testicles and a testicle is not removed during surgery.  The pump fills the cylinders and provides good rigidity or hardness to the penis.  This will even stay inflated after men reach orgasm, and yes men can still reach orgasm with this device.  The device does not change urination and still allows men to ejaculate.  

Technique for inflating the penile prosthesis. It is often helpful to use the non-dominant hand to hold the prosthesis tubing above the pump as this will keep the pump from moving around. The pump is then activated with the patient's dominant hand.

 

Important aspects of a penile prosthesis:

  • Men have normal sensation of the penis- it continues to feel good for men to have sexual activity
  • From outside the body, it is not able to be seen that a man has a penile prosthesis
  • Patients have noted that if they do not tell their partner, the partners are not typically able to tell they have a prosthesis
  • The erection stays until men push a button to deflate the prosthesis
  • This is an excellent option for men who have failed other treatments
  • The penile prosthesis provides men confidence and reassurance that the erection will occur when they want one
  • There is no needles involved and it is always with a man
  • It allows for sexual activity as often as patients desire
  • These devices are very reliable- they can break down like any product but at 10 years around 92% are still functioning well
    • If it does stop working, it can often be replaced 
  • IT IS IMPORTANT TO SELECT AN EXPERIENCED SURGEON WHEN CONSIDERING A PENILE IMPLANT
    • Research shows that physicians that perform over 31 prosthetics per year have better outcomes and fewer revision surgeries
      • In Columbus, there are very few physicians at or near this number- in the last 5 years I have placed the largest number of penile prosthetics in the Columbus Ohio region. 

 

Things to know about penile prosthesis surgery:

  • There are several types of penile prosthesis to consider.  See below for more information.
  • Once this is completed, it is very difficult to go back to any other treatment options
    • This is why I do not rush patients to surgery and we consider all options prior to committing to surgical corrections.
    • I want to ensure my patients are confident and informed in their desire to move to penile prosthesis placement.
  • There is a risk of infection, around 1-3% for men undergoing a first time implant
    • Men with diabetes need to control blood sugar as much as possible leading up to surgery and following implant of the prosthesis
    • I use a no-touch implant process to minimize risk of infection
    • Shorter surgical times have shown to lower infection risk as well- experience matters in this regard.
  • The devices can fail or break- this is thankfully rare due to the high quality of these devices
    • These are so strong that you cannot over-inflate the device, therefore pump it up as much as possible.
    • The devices typically last over 10 years for patients.
  • The head of the penis (glans) does not inflate with this device.
    • Some patients will feel that the head is more flexible following penile prosthesis surgery- we can repair this if noted at the time of surgery and this typically does not cause a problem for patients or their partners.  Plus, the sensitivity and pleasure is still present!
  • Following penile prosthesis surgery, there is typically pain and swelling as the body heals.  This can be minimized with medication and keeping the scrotum elevated.
    • We will work to keep patients as comfortable as possible following surgery
    • Healing typically will take around 2-8 weeks, with most patients being able to start working with the device around 3-4 weeks after surgery.
  • Penile prosthetics do not make the penis longer without extra procedures being performed
    • To estimate the length of the penis following surgery, place the penis on full stretch out from the body when not erect
    • If you have concern over this, be sure to discuss with Dr. Lowe during the consultation

 

What type of prosthesis is available?  Which is right for me?

  • There are two primary manufacturers for penile prosthetics.  Both companies make excellent products with good reliability.  Each can have slight differences and Dr. Lowe is happy to discuss both companies and potential benefits with you.
    • I have been fortunate to be a consultant and provide education to other physicians for both companies.  
    • I do not have a financial relationship with either company except being compensated to provide education to other physicians (teaching how to place the devices) or for work consulting on product improvement.
    • There are 3 types of prosthetics available to consider:
 
  • A malleable prosthesis
    • This type of device is a simple flexible rod- two rods are placed (one in each corpora/side).
      • This device bends up when a patient wants an erection and bends down when not desiring an erection.  
      • There is no mechanical parts and therefore these rarely break.
   
(L) The Genesis malleable prosthesis is beneficial for men with dexterity issues or bad arthritis.
(R) The Spectra Malleable Prosthesis bends into position for sexual activity and down at other times.
 
 
  • A two-piece prosthesis
    • This device has only two cylinders that are placed in the penis and a pump in the scrotum.
      • This device does pump up and inflate, increasing the rigidity of the device.
      • To deflate this device, the penis is bent allowing the fluid to be removed.
      • This device is useful in cases when there is extra risk or danger in trying to place a reservoir.
​​​​​
Ambicor two-piece prosthesis lack of a fluid reservoir simplifies surgery, but may decrease how rigid the prosthesis feels when inflated.
 
  • A three-piece prosthesis
    • This device has two cylinders, a pump and a fluid reservoir.
    • This is the most commonly used device.
      • The fluid reservoir contains the majority of the fluid, so when the pump is pumped the fluid will move into the cylinders.  
      • By moving more fluid through the pump, the prosthesis is able to reach increased girth (width enlargement) and become very rigid.
      • When the device is deflated, having a reservoir allows more fluid to be removed so the penis will hang more normally.
  • There are many factors that can influence the decision for different types of penile prosthetics.  It is important to discuss this with your surgeon.


 (L) AMS 700 LGX- a three-piece penile prosthesis that expands in length and girth (thickness).
 (C) Titan penile prosthesis as it is placed in the penis and location of the components.
(R) Titan penile prosthesis- a three-piece prosthesis which provides full rigid erections to cure erectile dysfunction. This device has a coating that allows it to hold antibiotics and slowly release the antibiotic after placement in the body. This decreases infection rates.
 

How is a prosthesis implanted?

  • A surgical procedure that takes around 30-60 minutes
  • Can be done as an outpatient procedure with patients going home the same day
  • Patients are typically asleep during the surgery
  • A nerve block is attempted to minimize pain for several hours following surgery
  • Everything is under the skin following the surgery
    • There are no tubes exposed outside the body
  • The surgical incision is approximately 1-1.5 inches in length
  • There are several locations for the incision, please see the options below
  • Patient receive antibiotics at the time of surgery to minimize risk of infection
  • All portions of the prosthesis can typically be inserted through the same incision
  • After the device is placed, it is tested to ensure the device is working well and the glans is well supported

Where is the incision for a penile prosthesis?

  • There are three typical locations for a penile prosthesis.  Each has a benefit and potential down side, therefore a discussion with the patient is important to pick the correct approach.  With all approaches, a second incision is typically not needed.
  • Infrapubic implant:
    • This incision is made just above the penis and typically the quickest way to place the prosthesis.  
      • The incision is typically well hidden.
      • This procedure makes placement of the fluid reservoir easier to place.
      • The potential down side with this incision is a risk the prosthesis pump may not be placed as down in the scrotum as typically desired.
    • Puboscrotal implant:
      • This implant is made at the junction between the penis and the scrotum.
        • Again the incision is typically well hidden when healed. 
        • During this procedure, a penoscrotal web can be removed and for some patients this will provide the appearance of a longer penis.
        • The pump is easy to place in the scrotum.
        • This incision provides easy access to the corpora if prior scarring is present.
          • This is typically seen with prior fibrosis after priapism or previously removed penile prosthesis.
        • The potential down side with a penoscrotal approach is increased difficulty with placement of the fluid reservoir. 
    • Subcoronal implant:
      • This incision is made around a prior circumcision line, therefore there is not a new scar created for most patients.
        • In a few small studies, this procedure has shown to increase the potential length following a penile prosthesis by releasing the skin- these studies suggest between 0-3 cm gained.
        • This incision provides excellent access in cases of Peyronie’s disease, or penile curvature.
        • The down side with this incision is an increased risk of vascular injury to the penis, particularly in men with prior vascular disease or cardiac disease.  This potential risk should be discussed with your surgeon 

 

Who is a good candidate for a penile prosthesis:

  • Any patient with erectile dysfunction can consider a penile prosthesis.
  • Some patients will consider a penile prosthesis earlier because it is a better fit for they and their partner’s lifestyle.
    • We are able to provide personalized medical care to meet patient needs.
  • Patients how have tried intracavernosal injections, trimix injections and pills without success will often do better with a penile prosthesis.
  • Post-prostatectomy patients often do very well with a penile prosthesis, particularly if they develop venous leak.
  • Patients with heart disease, diabetes or vascular disease often do well with a penile prosthesis.  
    • Many of these patients have poor flow of blood into the penis, and that limited blood will not improve with medications.
  • Patients with Peyronie’s disease will often do well with a penile prosthesis.  
    • The penile prosthesis will often overcome the curvature.  At times, we need to perform addition maneuvers during the placement to ensure the curvature is corrected.  

Where can I find more information on a penile prosthesis?

  • Contact and schedule an appointment with Dr. Lowe
    • Partners are welcome to come to the visit as well!
    • 614-788-2870
  • Keep an eye out for flyers to attend a seminar held by Dr. Lowe
    • Partners are very welcome at these seminars.
    • These are done routinely to provide an informal setting for patients to hear more about their options
  • There are websites to provide more information:


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OhioHealth Urology Physicians
OhioHealth Riverside Methodist Hospital
Bing Cancer Center
500 Thomas Lane, Suite 3G
Columbus, Ohio 43214

Phone: (614) 788-2870
Fax: (614) 533-0177
 
 

OhioHealth Urology Physicians
OhioHealth Riverside Methodist Hospital
Bing Cancer Center

500 Thomas Lane, Suite 3G
Columbus, Ohio 43214

Phone: (614) 788-2870
Fax: (614) 533-0177