The use of the semiflexible and flexible hydraulic penis prosthesis is a big advance in the treatment of erectile dysfunction. The industrial advances in polymer and biochemical fields and hydraulics led to the development of the new prosthesis that is inert and hydraulically inflatable and deflatable and is also a those semiflexible prosthesis. They can be safely implanted so that they connot be noticed and in such a way as to function very similarly to the normal physiological state of the body.The operation has been developed and advanced to the point of the well known hydraulic penile prosthesis that has been safely implanted in thousands of patients.
The penis consists of three separate cylinders: the corpus spongiosum where the urethra runs, and two dorsal corpora cavernosae which include a specialised spongy tissue. They are able to expand according to the amount of blood included within. These structures are responsible for the erection of the penis. When they are engorged with blood they are rigid and erect and when blood escapes back into the body through the veins they become flaccid. This function is influenced by the psychological state and the health of the arteries, the veins and the nerves. The failure of the latter to be treated pharmacologically indicates the need for implanting a penile prosthesis. -- -- --
Anatomy of the urogenital tract
Incision
Who is qualified for the operation?
Patients who do not respond to the pharmacological or physical treatment of impotence or those who refuse it. Psychological causes of impotence are to be excluded in every case.
How does the operation work?
The patient lies on his back. A long incision is done in the middle between the penis and scrotum to reach the spongy caverneous tissue of the penis (erectile bodies). This structure is evacuated of tissues and blood. The maximal length of the space is determined. Adequate cylinders for the prosthesis with similar length are chosen and implanted in the space. The tissues of the septum of the scrotum are prepared to create a gap for the pump to be invisibly inserted between the two testicles. The pump is fixed in place by two sutures.
An incision is done at the very lower side part of the abdomen to reach the peritoneum which is then opened. A tunnel is created between the penoscrotal incision and that of the abdomen. The tubes between the cylinders and the fluid reservoir are pulled through this tunnel and connected to the fluid filled reservoir. The reservoir is inserted in the cavity of the abdomen, that is to say the peritoneum or inside the pelvis behind the pubic bone. The incisions are closed. The penis is erected by filling the penile cylinders to compress the tissues to prevent bleeding.
I do use the modern method of tissue ingeneering to surround the shaft of the penis with a special material inclosing self cells of the patient (fibroblasts) to thicken the penis, give a normal consistency and let the prosthesis not to be felt.
Healing:
The wounds heal within ten days. The penis is made flaccid on the second day after the operation. The cylinders are filled every day for ten minutes to keep the space open until healing is completed. The patient leaves the hospital after 2 hours to one day and is looked after as an out patient until complete healing is achieved.
Complications are normally limited to the complications experienced with any surgery: infection (most deleterious), wound oozing, bleeding and wound dehiscence. These complications occur very rarely and can be treated effectively in the case of their occur. Infection is prevented by the administration of a broad spectrum antibiotic. A very small percentage of patients experienced temporary urinary retention and pain in the penis, which were treated rapidly and effectively.
How to prepare for the operation?
See chapter on preparation of the patient
X-ray of the penis no backflow into the vein penile
X-ray of the penis with a strong return flow through the vein of the penis as an indication for the implantation of a penile prosthesis
Frequently Asked Questions (FAQ): --
Is the prosthesis noticeable after its implantation? -- No --
Is there any change of sensation? -- No, there is some discomfort at the start which disappears after 4-6 weeks. --
Does it feel normal to have sex using the prosthesis? -- The prosthesis gives a sense of firmness to the erected penis. The consistency is harder, but the partner gets used to it because it is nearly normal. --
When can I begin having sex after the operation? -- You can begin 6 weeks after the operation. --
Is there an effect of enlargement of the penis after the operation? -- Yes, the hydraulic inflatable prosthesis gives some elongation and thickening to the erected penis when inflated. --
Is there any limitation to sex after the operation? -- No, you can perform sex as long and as much as you wish. --
Are there complications? -- The most important complications are infection (2-8%) and the deformity that may take place if one of the implanted prosthesis is a different size as normally fits the individual penis, revision of the implant or its extraction in very rare cases. --
What are the costs of the operation? -- This depends on the type of prosthesis, whether it is semi-rigid or inflatable. The surgery costs between 5 - 7.500 €.
The semi-flexible penile prosthesis in erregierten condition. a = cylinders of the penile prosthesis hidden in the cavernous
Hydraulic penis prosthesis in the sleeping state a = cylinders of the prosthesis hidden in the cavernous b = liquid container hidden in the belly c = pump between the testicles hidden
Hydraulic penis prosthesis in the sleeping state a = cylinders of the prosthesis hidden in the cavernous b = liquid container hidden in the belly c = pump between the testicles hidden
