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The Penile Prosthesis provides a natural appearing erection

January 16, 2018 | 8:26PM ET


By Dr. Angelo D. Gousse



When medications (pills) such as Cialis, Viagra, Levitra etc. no longer work, it might be time to try penile injections. If you are unable to tolerate penile injections or they do not work for you, consider a penile external vacuum erection device (VED) . When all these 3 choices fail, the only remaining solution is the penile implant. Of note, there are 3 major types of penile implants. There is a one piece malleable ( easy to insert, less complications , no pump to inflate, difficult to conceal, not good rigidity and poor penile girth. There is a 2 piece (Inflatable). The features of the 2 piece include inflatable, easier to insert, poor penile girth and less natural appearance compared to the 3 piece.

How Does the 3 Piece Penile Prosthesis Work?

The answer is very user friendly. The inflatable 3 piece penile prosthesis consists of two attached cylinders -- a reservoir and a pump -- which are placed surgically in the body. The two cylinders are inserted in the penis and connected by tubing to a separate reservoir of saline. The reservoir is implanted under the rectus muscles in the lower abdomen. A pump is also connected to the system and sits under the loose skin of the scrotal sac, between the testicles.This penile prosthesis is referred to as a 3-piece inflatable penile prosthesis, due to the three different components.

To inflate the prosthesis, the man presses on the pump. The pump transfers saline from the reservoir to the cylinders in the penis, inflating them and causing an erection. Pressing on a deflation valve at the base of the pump returns the fluid to the reservoir, deflating the penis and returning it to the normal flaccid state.. Today most men choose a hydraulic, inflatable prosthesis, which allows them to have an erection when they choose, and it's easier to conceal. It is also more natural.

A penile implant is usually used when there is a clear medical cause for Erectile Dysfunction ED and when the problem is unlikely to resolve or improve naturally or with other medical treatments. Sometimes a penile prosthesis is implanted during surgery to reconstruct the penis when scarring has caused erections to curve (Peyronie's disease).

Penile implant surgeries take about an hour and are typically done in an outpatient center. A man can resume sexual intercourse by 6 weeks after surgery. The surgery is covered by most insurance companies.

Is the Prosthesis Noticeable?

The answer is No. While men who have had the prosthesis surgery can see the small surgical scar where the bottom of the penis meets the scrotal sac, or in the lower abdomen just above the penis, other people probably will be unable to tell that a man has an inflatable penile prosthesis. Most men would not be embarrassed in a locker room or public restroom, for example.

What Is Sex Like With the Prosthesis?

The answer is excellent. When the penis is inflated, the prosthesis makes the penis stiff and thick, similar to a natural erection. Most men rate the erection as shorter than their normal erection; however, newer models have cylinders that may increase the length, thickness, and stiffness of the penis.

A penile prosthesis does not change sensation on the skin of the penis or a man's ability to reach orgasm. Ejaculation is not affected. Some men are still able to father children with the penile implant in place. The penile implant does not adversely affect the prostate gland or urination.

The penile implant will help with penile rigidity but not with sexual desire. If you have sexual desire issues the penile implant will not help your libido. Many patients with erectile dysfunction also take testosterone replacement therapy for low libido symptoms.

How Effective Are the Implants?

The answer is excellent. About 90%-95% of inflatable prosthesis implants produce erections suitable for intercourse. Satisfaction rates with the prosthesis are very high, and typically 80%-90% of men are satisfied with the results and say they would choose the surgery again.

Is the Implant Safe?

The answer is very safe. No surgery is totally free of possible complications. Complications associated with penile implants include:

o Uncontrolled bleeding after the surgery possibly leading to re-operation o Infection o Auto inflation of the device o Scar tissue formation o Erosion (tissue around the implant may break down) requiring removal o Mechanical failure leading to re-operation and removal


Angelo E. Gousse, MD
Clinical Professor of Urology - Herbert Wertheim College of Medicine - FIU
Voluntary Professor of Urology - University of Miami , Miller School of Medicine
Director of Fellowship:Female Urology,Voiding Dysfunction, Reconstruction

Memorial Hospital Miramar, South Broward Hospital District
1951 SW 172 Avenue, Suite 305, Miramar, FL, 33029

Tel: 954-362-2720 Fax: 954-362-2761 www.bladder-health.net





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