Penile Implants

Overview:

Penile implants are also called the penile prosthesis. These are implantable devices that are placed surgically in men. These are indicated in individuals with erectile dysfunction (ED) whose penis does not erect. This helps an individual get an erection. These are indicated when other types of treatments fail. 

About Penile Implants:

A penile implant helps to get an erection in conditions of ED in men. Penile implants are of two types. They are inflatable and non-inflatable implants:

• Inflatable implants: These are the most common type of implants placed inside a man’s body. These are 3-piece structures having a fluid-filled reservoir, pump and valve, and inflatable cylinders. These can be inflated to create an erection and deflated at other times. The pump and the valve are placed inside the scrotum while the cylinders are placed inside the penis and the fluid -felled reservoir is in the abdomen. 

The pump is filled with fluids like saltwater. Erection is achieved by pumping the fluids from the reservoir into the cylinders. Then the valve is released to drain the fluid back into the reservoir. Two-piece structures also work similarly, but the fluid reservoir is pump's part implanted in the scrotum and, has the advantage of providing partial flaccidity when deflated. 

The three-piece implants have the advantage of creating the most natural rigid erection and are even available with antibiotic coatings or frictionless coatings that can increase the life of the implant.  

• Semi-rigid non-inflatable implants: These implants are firm and non-inflatable. They contain bendable silicone rods that are placed in the erection chambers of the penis. They can be bent away from the body for sexual activity and towards for concealing. 

A positionable penile implant is a type of semirigid implant that can maintain the position better than other semirigid implants. It contains a series of segments held with the help of springs on each end. They have the advantage of a low chance of malfunctioning due to a lesser number of structural components. They can be used easily even by those with limited mental or manual dexterity. 

Indications

Penile implants are indicated in ED. They are particularly used: 

• Failure of medications and intracavernous injections 
• When one cannot use medications for erection
• When one needs a permanent solution 
• This is also indicated when penis pumps do not work. 
• This can be used when sufficient erection is not obtained by other methods 
• They can also be used in a condition called Peyronie’s disease which causes scarring in the penis.

Contraindications 

Penile implants are not for every individual. They cannot be used in case of infections like pulmonary or urinary tract infections. They are also not indicated in metabolic diseases like uncontrolled diabetes. They cannot be used to increase the size of the penis. They do not increase sexual desire. 

Advantages

There are many advantages to the procedure: 

• Penile implants are safe and are not visible outside.
• It increases the self-esteem.
• Penile implants are durable and give satisfactory results.

Before the Procedure

Before undergoing penile implants, an individual should understand the importance and necessity of the procedure by discussing it with the healthcare provider (HCP). All the medications taken by the individual should be informed to the HCP along with the history of previous diseases, infections, surgeries, and allergies. Based on the medications taken, some medicines are advised to stop depending on the health condition and risk vs. benefits. These include over-the-counter medications, blood thinners, and opioid painkillers. Medicines will be prescribed before undergoing the surgery.

Certain routine blood and urine investigations are carried out to rule out any infections or other conditions not known to the individual. Assessment based on a physical examination is done to understand the ED. Based on the type of ED and understanding the failure of the other methods, penile surgery is planned. It is necessary to understand the importance of the surgery and the expectations before the surgery. Penile surgery is done on an empty stomach. Hence it is advisable to stop eating or drinking 8 hours before the procedure. 

During the Procedure 

Penile implant surgery is done in a hospital under general or spinal anesthesia. The surgical portion will be cleaned with an antiseptic solution and shaved before to reduce the risk of infections. A fine tube called the catheter is inserted in the penis for urine passage. A small cut is made on the head or base of the penis or in the abdomen. The spongy tissue in the penis is stretched as it is the tissue responsible for erection. Based on the size of the penis, the implants are chosen and placed in the penis for an erection. Occasionally, a second may be needed to place the fluid reservoir in the abdomen. Later the sutures are closed. The entire procedure lasts about 1-2 hours. 

After the Procedure

An individual will be monitored till the vitals are stabilized. Medications are given to ward off pain and infections. Mild pain may exist for a few weeks. Instructions will be given on physical and sexual activities. One can resume strenuous physical and sexual activities after 4-6 weeks of surgery. About 3-6 weeks after the surgery, instructions on using the device, inflating, and deflating will be given. 

Effectiveness of Penile Implants

They have the highest acceptance and satisfaction among the various treatments done for ED. Inflatable implants can last as long as 10-15 years. 

Risks and Complications 

Certain risks and complications linked with the procedure include bleeding, risk of infections, and pain. The other complications are the issues with the implants like the malfunctioning of the implants, and broken implants which might need a second surgery to replace them. Sometimes adhesions and scarring develop between implant components and penile tissues and rarely implant may protrude from the skin. 

Conclusion

Penile implants are devices placed in the penis of a man to treat erectile dysfunction. They are safe, and long-lasting which restores the erection ability. They increase self-esteem, bring back pleasure in the sexual life, and also improve the quality of life.