Paediatrics Urology Unit
Prostate Growth And Greenlight Method
Premature Ejaculation (Early-Fast-Rapid Ejaculation)
Penile Prosthesis İmplantation
Sexually Transmitted Diseases (Venereal Diseases)
Testicle And Epididymis İnfection
• Assoc. Prof. Ömer ÖGE, MD
• Işık H. ÖZGÜ, MD
• Uğur SARAÇOĞLU, MD
PENILE PROSTHESIS IMPLANTATION
Penile prosthesis placement operation is a surgical method applied when patients developing erectile dysfunction in penis do not respond to drug treatment. This problem is observed in 52 % of men between 40-70 years of age in different modes.
Interventions or Analyses Applied Prior to Penile Prosthesis Implantation
In cases where erectile dysfunction is not remedied with drug treatments or some vascular surgeries or these drugs or surgeries are inconvenient or it is identified that it will not beneficial, penile prosthesis placement surgeries may be performed. A special ultrasound may be used for obtaining information relating to blood flow in penis as well as preoperative routine blood analyses. Measurements conducted with a device called "Colour Doppler Ultrasonography" can clearly shown blood disorder in penis. In the disease making curvature in penis in case of erection and starting with a painful process in penis and where mostly palpable hardened layers are formed inside a penis, known as Peyronie's disease, if erectile difficulty has started, a special test can be conducted with a drug injected inside a penis. The result of this test can be used as a diagnostic for the placement of prosthesis.
Penile Prosthesis Implantation Indications
Surgery is required for a healthy sexual life, a good life quality, social and spiritual state of a patient rather than only vital functions of a person. Patients can make use of penile prosthesis placement surgery only if they have seen no benefit from previous drugs or surgical applications or these applications have not been performed or these applications would not be useful for these patients. Furthermore, in case of a special case such as Peyronie's disease defined above, if disease has existed for a long time and there has been an erectile problem, penile prosthesis placement surgery can be performed.
Type, Structure and Purpose of Penile Prosthesis Application
Penile prostheses are the materials produced for inserting into penis with a surgery as a last treatment option in men with erectile dysfunction. Basically there are two groups of penile prosthesis. The first group of prostheses is comprised of a metal coated with silicone coated, constantly hard but with a feature of capability of bending and twisting. The second group prosthesis is produced from silicone and is two or three parts devices having mechanism that can be inflated and deflated.
That the prosthesis in second group can be inflated and deflated can give them more natural functional feature; however, prosthesis in this groups has disadvantages such as cost, difficulty in use and mechanical disorders.
If sense of penis, orgasm capability and ejaculation function are normal prior to surgery after operation, these functions maintain after placement of prosthesis. Prosthesis only ensures penis to become hard upwardly independent of sexual stimulus. Purpose of prosthesis surgery is to ensure this hardness and upward angle in penis. On the other hand, penis prosthesis placement does not provide an increase in penis size or diameter, or does not directly affect the person's sexual desire.
Duration of Surgery and Hospitalization Stay Time
This operation can vary between 45 minutes and 1.5 hours as to the type of prosthesis to be placed. Tissue is not removed during operation and possibility of serious loss of blood. Hospitalization stay time after operation may vary between 2-5 days as to pain and wound healing. That antibiotics are administered with injection as protective may extend this time. It is normal that bags have a little swelling and purple areas below skin in genital area and they will vanish over time.
After discharge from hospital, water should never be contacted the wound area for 1 week and wound area should be kept very clean. Besides, there should be no sexual intercourse for minimum 4-6 weeks. At the end of this period, required checks are performed by the physician performing the surgery and sexual intercourse is permitted. In case of presence of high fever, prolonged pain, wound discharge, penis swelling and redness, anuria or difficulty to urinate, the physician performing the operation should be consulted without any delay.
Risks, Complications and Results of Penile Prosthesis Implantation
Tearing in some layers inside penis may develop during penile prosthesis placement surgery. This condition is repaired and the procedure is continued. Other risk is damage to urinary canal. In such a case, urine catheter is fitted and the procedure is delayed to a later time.
The most important complication of prosthesis surgery is infection. A day before the surgery, it is attempted to be protected from infection with the help of large spectrum antibiotics provided in injection mode and application ensuring cleanliness of surgery area. Antibiotics are continued for at least five more days after the operation. However, despite all measures, prosthetic infection can be seen between 1 – 10% rates. Infection risk is more likely in patients with diabetes and spinal cord injury. In case of emergence of infection, antibiotics are started again and prosthesis is removed. A new prosthesis may be placed in the same session by cleaning structures inside penis as to the status of patient with fluids containing antibiotics or after 6 months.
This case may remove tissue surrounding perimeter of prosthesis in the rate of 1-3 % by causing erosion over time; in this case, prosthesis is removed and a new prosthesis is placed with a second operation thereafter.
Mechanical problems seen between 10-15 % are also important complications in inflatable prosthesis. Leakages leading reduction in fluid inflating prosthesis ranks as the first among these mechanical problems developed following a particular time. Whole prosthesis or some parts of it need to be replaced due to this sort of or similar mechanical problems.
A problem such as temporary urinary incontinence may be experienced among especially local anesthesia. (below the waist). In such a case, placement of urinary catheter needs to be placed for a few days. Following local anesthesia, problems such as numbness extending in legs, hypotension, headache, nausea and vomiting may be observed. Continuous hard remaining prostheses obstruct urinary tract interventions to be performed in the future in the persons having urinary incontinence such as prosthesis diseases. In such person, inflatable prosthesis allowing diagnostic or treatment purpose inputs when deflated should be preferred.
Advantages and Expected Results of Penile Prosthesis Implantation
Once this treatment is applied, there will be advantages such as patients will have sexual intercourse at any time they desire and they can maintain their sexual intercourse as sufficient as possible. This treatment option is in the first place among other treatments in terms of satisfaction of their spouses. Furthermore, it may take a while to get accustomed to using inflatable prosthesis at ease and adopting existence of this new foreign object inside the penis. When patients become a complete stranger for this prosthesis, fail to reach their expectations or are disturbed extremely in the future, these prosthesis can be removed with a surgical intervention. This is also possible when an alteration should be made in type and model of the prosthesis over a time.
Consequences Created by Disease When Penile Prosthesis Implantation Applications is Rejected
When this treatment is rejected, any result creating any vital threat or deteriorating general health condition of a person shall not be observed. However, failure to fulfill sexual function will continue creating social and psychological problems in male.
Alternative Treatment Options for Penile Prosthesis Implantation Their Advantages, Disadvantages, Risks, Complications
Since prosthesis surgery is applied in patients having seen no benefit in drugs and other surgical treatments tried before, this is a treatment method having no alternative in these patient groups. If patients directly prefer prosthesis surgery, it should be emphasized that there are various drug treatments that shall ensure erection in penis. Of these drugs, oral drugs should be primarily preferred. In case oral drugs fail to provide any benefit, drugs administered with direct injection to penis or applied into urinary tract as cream can be tried. This medication is usually not very cheap and can be inconvenient for the persons having undergone diseases such as heart attack and stroke in recent time and some retinal diseases in the individuals using drugs due to especially coronary artery disease. Besides, administering drug inside the penis with injections may lead to a kind of erection and deterioration in spongy structures in penis depending on administered drug and injection. Moreover, necessity of increasing dosage may arise for a while in all drug treatments. Some medications may completely lose their effectiveness over time.