Penile prosthesis

A penile prosthesis is a medical device implanted in the penis requiring a surgical procedure. The device is often used for men with organic or treatment-resistant psychogenic impotence who suffer from erectile dysfunction. A penile prosthesis is also used in the final stage of plastic surgery phalloplasty to complete female to male gender reassignment surgery as well as during total phalloplasty for adult and child patients that need male genital modification.

Reasons for use

A penile implant is used when there is a medical need and when the problem is unlikely to resolve or improve naturally. These problems can include erectile dysfunction, congenital anomalies, iatrogenic, accidental penile trauma, micropenis or Peyronie's disease. This implant is normally only considered when less invasive medical treatments have been exhausted or deemed unsuitable. For example, many drugs used to treat erectile dysfunction are unsuitable for patients with heart problems and may interefere with other medications.

Sometimes a penile prosthesis is implanted during surgery to alter, construct or reconstruct the penis in phalloplasty. The British Journal of Urology International reports that unlike metoidioplasty for female to male sexual reassignment patients, which may result in a penis that is long but narrow, current total phalloplasty neophallus creation using a musculocutaneous latissimus dorsi flap could result in a long, large volume penis which enables safe insertion of any type of penile prosthesis.

This same technique enables male victims of minor to serious iatrogenic, accidental or intentional penile trauma injuries (or even total emasculation) caused by accidents, child abuse or self-mutilation to have penises suitable for penile prosthesis implantation enabling successful sexual intercourse.

In some cases of genital reconstructive surgery, implantation of a semirigid prosthesis is recommended for three months after total phalloplasty to prevent phallic retraction. It can be replaced later with an inflatable one.

Types of Device

Semirigid devices range from permanently erect ones that cannot be altered to malleable ones that can be bent into position where appropriate. The simplest type of prosthesis consists of a pair of malleable rods surgically implanted within the erection chambers of the penis. With this type of implant the penis is always semi-rigid and merely needs to be lifted or adjusted into the desired position.

Hydraulic, inflatable prosthesis also exist. These use fluid and are inflated or deflated on demand. Almost all current devices perform satisfactorily for a decade before needing replacement. Some surgeons recommend these due to the opinion that they are more easily concealed.

3 Piece Inflatable Penile prosthesis

Advantages

1. Mechanical failure rates are low: most often inability to deflate the penis because of pump failure; less often inability to inflate the prosthesis; and sometimes disconnection or failure of the reservoir.
2. IPP (Inflatable Penile Prostheses) are easily concealable under clothing including swimsuits or jeans.
3. The erection can be maintained as long as necessary, or as long as desired without any of the potentially serious complications of organic priapism.
4. Psychological and emotional well-being is enhanced in a proportion of men who undergo implant surgery. Some studies indicate a high level of patient satisfaction, attributable in part to improved technology in the prosthesis itself, improved surgical techniques making the procedure less painful, and more reasonable patient expectations.
5. Inflation of the device can be accomplished discretely.

Disadvantages

1. The glans does not enlarge and penetration may be awkward. The penis also may not be as firm as a natural erection.
2. Some models do not deflate easily; some degree of manual dexterity is required to operate any of the inflatable models, making them inappropriate for men with other neurological disorders such as stroke or Parkinson's disease.
3. The penis may not be completely flaccid, depending upon the model of prosthesis (most usually seen in semi-rigid or malleable implants).
4. Many men lose between 1–2 cm (.25 to .75 in) in length.
5. Following surgery, patients experience one to two weeks of moderate or occasionally severe pain, usually controlled with analgesics. This is most often due to scrotal swelling, which can be quite profound at times. Normal sexual intercourse can be resumed six to eight weeks post-operatively, pending clearance from the surgeon.
6. Not all men report complete satisfaction with the prosthesis.
7. Some studies indicate a partner satisfaction rate of 70% or less, due, some studies suggest, to heightened or unreasonable expectations. Many surgeons are now recommending that both partners be counseled pre-operatively regarding outcome and expectations.
8. The inflation of the devices is not instantaneous.
9. It can be difficult to conceal a prosthesis because the scrotal components are hard and irregularly shaped. A partner feeling the scrotum will notice this.
10. Manual stimulation can be painful.
11. There is a 2-10% complication rate, mainly as a result of infection or device failure. Complications include: uncontrolled bleeding after the surgery possibly leading to re-operation, scar tissue formation, erosion (tissue around the implant may break down) requiring removal or mechanical failure leading to re-operation and removal.

External links

• http://www.emedicine.com/med/topic3047.htm
• http://cat.inist.fr/?aModele=afficheN&cpsidt=862126