A penile prosthesis is offered to patients as a last-resort option when treatments for erectile dysfunction have not worked.
The ideal candidates for a penile prosthesis are sexually active men with long-standing organic or physiological erectile dysfunction (impotence) who have not benefited, or are not expected to benefit, from medical treatment.
Penile prostheses are surgically placed in the corpora cavernosa, the spaces inside the penis that fill with blood during an erection.
By function, penile prostheses fall into two groups: semi-rigid penile prostheses (fixed and bendable, made of steel wires covered with a silicone cylinder, consisting of 2 parts) and inflatable penile prostheses (2- or 3-piece devices that can be inflated and expanded. These include a pump, a reservoir and 2 cylinders. In 3-piece prostheses there is also a reservoir that stores the fluid circulating in the cylinders. The reservoir is placed in the lower abdomen near the groin, the pump in the scrotum, and the cylinders in the corpora cavernosa inside the penis.)
Choosing the right prosthesis for each patient is an important decision. Besides being able to implant the chosen type through a comfortable, uncomplicated operation, the advantages and disadvantages for the patient in everyday use must be carefully weighed. Although inflatable (3-piece) prostheses are cosmetically and physiologically the most ideal, they should not be chosen for patients with whom communication is difficult or who have a functional impairment in using their hands. In such cases, bendable 2-piece silicone prostheses should be preferred.
Before surgery, the patient should be told that the prosthesis will provide an erection sufficient for intercourse at any time, and it should be explained that desire, ejaculation and satisfaction will not be adversely affected.
Penile prosthesis surgery takes 1.5–2 hours and requires a 1-day hospital stay.
It is recommended to avoid sexual intercourse for about 1 month after penile prosthesis surgery. The surgical approach may vary with the type of prosthesis; the incision is made as far away from the penis as possible.
The most important problem in penile prosthesis surgery is infection. Infection-related checks and treatments must be strictly applied during and after the operation.
In conclusion, for men with erectile dysfunction who cannot benefit from other treatments, a penile prosthesis is the only alternative. When choosing a penile prosthesis, the patient’s general health should be carefully assessed, it should be confirmed that no other option remains, and the patient should be informed about all possible outcomes.