Living With A Penile Prosthesis

Penile Prosthesis (also known as penile implants) are specialized devices that are surgically implanted to address a number of sexual and non-sexual ailments. Discovered in 1973, penile prosthesis was once considered the gold-standard treatment strategy for the management of erectile dysfunction in men; however, with the widespread popularity of pharmacological agents like Viagra and Sialis, more people are now diverting away from the penile implants for the management of ED alone (1).

There are two primary types of penile prosthesis:

• Semirigid, or malleable implants (or rods): These implants are made up of silicon and two stainless steel wires that are always in erect position (ready to use). The person can bent it down or up (depending upon the sexual needs).
• Inflatable implants: These implants are made up of inflatable cylinder/s along with an abdominal reservoir to contain the fluids, until the valve is released. These implants are not ready to use and require inflation manually via pumps.

What Are The Indications Of Penile Prosthesis?

Erectile dysfunction: Despite a number of wonderful pharmacological options that are currently available to address erectile dysfunction, sometimes penile prosthesis is the only fair choice to manage ED in men – a sexual dysfunction that affects more than 30 million Americans. This is mainly because, the response rate of Viagra and other phosphodiesterase inhibitors is significantly low in males who undergo procedures like radical prostatectomy. Other indications of penile prosthesis include:

• Peyronie's Disease: Based on latest estimates, approximately 20-30% men with PD experience significant erectile dysfunction that is refractory/ non-responsive to traditional ED treatments (1).
• Psychological infertility: For example, if a person is unable to achieve erection due to relationship conflicts or other related issues, he can be a good candidate for penile implants; however, psychotherapy and relationship counselling are always considered a superior choice.

What Are Some Benefits Of Penile Prosthesis?

According to a latest research, healthcare providers suggested that over the course of past 10 years, the prevalence of erectile dysfunction has increased by 165% (2). One of the biggest advantage of penile prosthesis is, ability to achieve erection whenever you want. Also, you can keep the erection as long as you want without exposing yourself to drugs or other devices (highly effective for individuals with poor response to other methods such as vacuum devices, penile bands and injections). In addition:

• Penile prosthesis doesn’t impact your sensations.
• You can ejaculate normally with prosthesis.

If you are considering a penile implant; it is very important to discuss with your healthcare provider about your primary indications for opting this treatment modality. The doctors suggest the implants after carefully analyzing patient history, age, comorbid medical conditions, size of the penis and other related ailments.

Living With Penile Prosthesis

According to a new study reported in the Journal of Sexual Medicine (3), investigators analyzed the results of penile implant surgery in men who underwent surgery between 2010 and 2013 at a tertiary care center. The results of the retrospective study suggested that patients with Peyronie's Disease and refractory erectile dysfunction responds very well to penile prosthesis. However, it has been observed that there has been a recent decrease in the use of penile prosthesis; especially for the management of erectile dysfunction. For example, the use of penile implants has been decreased from 4.6% in 2002 to 2.3% in 2010.

Here are a few tips that can help in improving the quality of life with penile prosthesis:

• Follow post-procedure instructions: Make sure to practice abstinence for a period of 4 to 6 weeks (or as advised by your doctor). Avoid strenuous physical activity until your wound has healed completely. Complete the course of antibiotics to minimize the risk of infection.
• Set realistic expectations: A lot of people believe that penile implants can improve sexual desires or libido, which is not true. Also, the implant itself doesn’t improve or increase the size of your penis. In fact, sometimes a mild reduction in the size of penis is reported. It is very important to take your decision regarding the procedure after careful deliberation and consultation with your primary care provider.
• Keep communication open with your partner: As expected, healthy communication is the key to maintain a healthy sex life regardless of prosthesis.
• Maintain a healthy lifestyle: The quality of your sex life can be improved significantly, by maintaining a healthy lifestyle. For example, smoking, obesity and excessive alcohol consumption adversely affects the libido.
• See your healthcare provider at intervals: Keep up with your follow-up check-ups. This is important because, in some rare cases the implant may break under the skin or adhere to the surrounding tissues; thereby aggravating the risk of infection and other complications.
• Learn how you can prevent infections: After your procedure, learn how to prevent infections and other complications. This is mainly because, all such issues are addressed by removing the implant that can lead to scarring, loss of sensation, shrinkage in the size of penis etc.

References

1. Carvalheira, A., Santana, R., & Pereira, N. M. (2015). Why Are Men Satisfied or Dissatisfied with Penile Implants? A Mixed Method Study on Satisfaction with Penile Prosthesis Implantation. The journal of sexual medicine, 12(12), 2474-2480.

2. Osterberg, E. C., Maganty, A., Ramasamy, R., & Eid, J. F. (2014). Pharmacologically induced erect penile length and stretched penile lengh are both good predictors of post-inflatable prosthesis penile length. International journal of impotence research, 26(4), 128-131.

3. Chung, P. H., Scott, J. F., & Morey, A. F. (2014). High patient satisfaction of inflatable penile prosthesis insertion with synchronous penile plication for erectile dysfunction and Peyronie's disease. The journal of sexual medicine, 11(6), 1593-1598.