Penile Prosthesis

What is Erectile Dysfunction?

Erectile dysfunction in men is defined as the inability to achieve or maintain an erection sufficient for a satisfactory sexual intercourse and is one of the most common sexual dysfunctions with premature ejaculation. Almost one in three men face this problem in their lifetime. On the other hand, the incidence of the problem increases with age, with the addition of chronic diseases such as hypertension, diabetes, and heart disease. Although it is such a common problem, most men in our country unfortunately do not see this as a health problem and avoid going to the doctor with this complaint. However, erectile dysfunction alone may be the first sign of serious health problems that may develop in later periods.

What is the Treatment Protocol of Erectile Dysfunction?

As with any health problem, an accurate diagnosis is very important before making a treatment plan. First of all, a detailed medical and sexual history taken by an expert doctor, followed by a complete physical examination forms the basis of the work. Some scales to be filled in with the physician during the examination also provide very valuable data. Afterwards, tests such as blood pressure measurement, penis-testicle-prostate examination, cholesterol and blood sugar measurements and determination of male hormone level may be required. In addition, it is very important that the patient is evaluated by other specialists such as cardiology, psychiatry and endocrinology, as well as urology, from the first moment.

Today, almost all urology guidelines recommend a stepwise treatment algorithm for the treatment of erectile dysfunction. In the first step, there are lifestyle changes that the patient will implement. Can be counted as getting rid of excess weight if possible, limiting alcohol intake, staying away from smoking, a balanced diet such as the Mediterranean diet, living away from stress and anxiety, and correct communication with the sexual partner.

In the first steps of medical treatment, there are some drugs (PDE5 inhibitors), ESWT (shock wave therapy) and some injections that the patient self-injects before intercourse. Most patients benefit from these treatments. However, despite all these, there are also resistant cases where the erection problem persists.

Penile Prosthesis Application To Whom?

Patients who do not benefit from other treatment options in the first place are considered as a candidate group for penile prosthesis. However, sometimes a penile prosthesis can be recommended as the first choice for patients who are not suitable for other treatments in terms of safety-efficacy-cost. On the other hand, prosthetic surgery may be the first choice in special cases such as trauma (penile fracture), Peyronie's disease, and prolonged priapism.

What is the Success Rate in Penile Prosthesis Application?

With the appropriate patient and prosthesis selection and a successful surgical process, the satisfaction of the patients with the prosthesis application is over 95% and this situation continues for life if no complications develop.

How Does the Surgery Process Work?

Depending on the type of prosthesis, the average operation time varies between 1-2 hours. The prosthesis is placed inside the body with a 3-4 cm incision to be made in the genital area and it is absolutely invisible from the outside. This procedure is performed under general anesthesia or spinal anesthesia (anesthetized from the waist down). In the absence of additional complications, a one-day hospital stay is required. The patient who is discharged the next day is recommended to abstain from sexual intercourse for at least 6-8 weeks. Infection, bleeding, some complications related to anesthesia are among the possible risks here, as in any surgery. However, these complications can be minimized with the prostheses used today, increasing surgical experience and the selection of the appropriate center.

Are There Types of Penile Prosthesis? Which Prosthesis Is Preferred For Which Patient?

Today, single-two- and three-piece penile prostheses are available. However, the most frequently used types all over the world are pliable and inflatable types. The type of prosthesis to be chosen is decided by evaluating the patient's profile, expectation, anatomy and additional diseases. In other words, the most suitable model for the patient should be preferred, not a suitable model for every patient.

• Pliable type: It consists of two main parts, it is partially easier to place. Its cost is more affordable than others. The risk of complications and mechanical failure is less. Although it can be bent, it can be said as a disadvantage that it remains in a constant erection.
• Inflatable type: It is the most preferred type of penile prosthesis all over the world. It consists of 3 main parts: the inflatable prosthesis part, the reservoir and the pump mechanism. The prosthesis, which is normally in a lowered position, swells with maneuvers to the pump during use and is restored to its original state after intercourse. The similarity to a normal erection is the biggest advantage of this prosthesis. The fact that its use requires training and its cost is partially higher than the others can also be counted as disadvantages. However, it should not be forgotten that it is a long-term effective treatment. It should also be emphasized that the prosthesis used has a lifetime renewal guarantee.

Also Some Curious Topics:

• With the penile prosthesis application, the person's ejaculation and orgasm are not affected. The pleasure he receives during intercourse does not change.
• If the partner does not perform a detailed examination as much as the doctor, he cannot realize that the person has a penile prosthesis and does not feel discomfort during intercourse.
• Prosthesis application does not change the voiding functions of the person. 
• It does not increase the risk of prostate, bladder or penile cancer.
• It is not a problem in places entered by X-ray search, such as airports, shopping malls. It does not interfere with MRI or tomography.