Penile Implants

A look back

There are many rumors about erectile dysfunction, its cure and harm that may result from penile prosthetics implant

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Penile Implants are not a new invention

In the 16^th century, the first attempt to make a synthetic shaft was made by the French scientist Ambroise Pare when he made a wooden shaft to aid a patient in urination.The first implant inside a penile tissue was achieved by Russian surgeon Nikolaj Bogoraz in 1936 when he used a cartilage from the rib cage to increase the rigidity and strength of erections.This was not a perfect technique and alternatives to cartilages were sought Dr. Scardino achieved such an alternative in 1950 when he inserted the first synthetic implant.In 1952, doctors Goodwin and Scott published the results of using acrylic inserted in buck’s fascia (the internal penile fatty tissue) Research and breakthroughs continued and in 1960 doctors Loeffler and Sayegh published a paper about the use of acrylic inserted into the cavernous tissue not outside it In 1966, Dr. Beheri, an Egyptian plastic surgeon was famously credited for using Polyethylene rods inserted under the tunica albuginea of the cavernous tissue after dilating it using Hegar dilator.Dr. Beheri confirmed that 700 surgeries were operated using this technique resulting in more rigid erections The first inflatable implant was invented in 1973 by Dr. Scott and colleagues. It consisted of three parts operating by pumping fluid form a reservoir into two cylinders inserted in the cavernous tissue to achieve erections. After intercourse, the fluid returns into the reservoir by applying pressure.As a result, we now have two implants. An inflatable prosthesis which is rapidly advancing and is a favorite in the American market. And malleable prosthesis which is cheaper and widely used in Egypt and the middle east.

But most importantly do all cases of erectile dysfunctions need an implant?

The answer is no, it is used in cases resistant to medical treatments Those cases are usually a result of a chronic illness like peripheral neuropathy and vasculopathies in diabetes and atherosclerosis They were prescribed recently in psychological cases unresponsive to medical treatments.

What is a Penile Prosthetic Implant?

It is not despair that awaits a person afflicted by erectile dysfunction.

Many men around the world suffer from erectile dysfunction and most use medical treatment instead of a definitive solution to the problem.

What is the definitive solution?

Penile prosthetic implants are this definitive solution. But first, what are penile implants?

Penile prosthetic implant surgeries are simple surgeries that require no hospital admission. It has been widely used for almost 4 decades.

Worldwide statistics of satisfaction and recovery of penile implant surgeries are very positive.

The implants don’t change any of the penile structures wither shape, sensations or pleasure as they don’t replace but support the normal tissues by adding rigidity when needed.

Simply put, they are two cylinders that guarantee extreme rigidity by being implanted into the cavernous tissues. They cannot be noticed after insertion as the cavernous tissue is covered by skin.

What are the types of Penile Prosthesis?

1- Hydraulic implants

It is widely used implant in the western world and preferred by many in the middle east.

It has the distinct advantage of being totally flaccid when not in use.

Before intercourse, a pump inside the scrotum is pressed initiating erection which is maintained as long as required. By pressing the pump again the erection subsides completely.

The hydraulic prosthesis has two types:

The two-part hydraulic prosthesis

It consists of two empty silicon cylinders connected to a saline filled pump.

The three-piece hydraulic prosthesis

It differs in that it has a separate tank for saline in addition to the cylinders and the pump.

2- Malleable prosthesis

It consists of two malleable metal cylinders covered in biomedical silicon that guarantees extreme rigidity of the metallic cylinders. It is malleable to prevent bulging unless required during intercourse.

During intercourse, the man uses has hands for two seconds to control the malleable prosthesis to achieve erection which is maintained for as long as required. This is done without affecting any physiological function like ejaculation and sensations provided that there are no underlining medical problems.

After intercourse the malleable prosthesis is bent upward or downward to prevent visible bulges in outerwe.

How is the prosthesis implanted?

It is done under general anesthesia for the comfort of the patient Spinal anesthesia may be used in case of medical conditions that prevent general anesthesia like heart and kidney diseases for example.

A small incision is done under the penile head through which two cylinders are inserted in the cavernous tissue without damaging the vasculature or the surrounding tissues.

In hydraulic prosthesis, a small incision is made in the scrotum or the abdomen to insert the fluid reservoir needed for the pump.

The operation takes from one to two hours and the patient is discharged in the same day.

Click here to watch an unedited footage of a prosthesis implant surgery

What follows the surgery? Any advice about the implant?

It is normal to have fears and reservations about the possible adverse effects to the surgeries even with the current high success rate.Some side effects and irritating symptoms may occur.

Below are the adverse effects and that may occur after the surgery and tips and advice as to how to decrease them and to achieve total remission.

There are some medical care tips required after the implant surgery:

Personal hygiene is of most importance after the surgery to prevent any infections or inflammations that may cause pain or discomfort during remission

It’s important to avoid hard labor, lifting big weights or playing violent sports during the first two weeks after the surgery. Simple manual tasks may begin after two days from the operation.

Continuous follow up with the physician is of most importance and their advice must be followed to the letter to avoid adverse effects and discomfort.

There are some general adverse effects related to surgeries that may occur. But there are some adverse effects specific to penile implant surgeries. They are mild and usually persist for 10 days to a month at most. For example:Slight pain or discomfort during urination which result mainly from irritation caused by the insertion of urinary catheters.It may result from mild inflammation in the tissues surrounding the urethra. This can be prevented prescribing some medications before the surgery.The most common complaint after the surgery is delayed ejaculations. Though it seems therapeutic to patients who suffered from premature ejaculation. It is not a therapeutic use but it is one of the effects of the implant.

Under skilled surgeons, no adverse effects may occur. But it some cases, usually as a result of inexperienced surgeons, the surgery may need to be performed again.

Penile implant surgeries are very easily repeated and all surgical errors are easily reversible. Unlike most other surgeries.

Failure of the operation may result from:

Surgical infection : that results in fibrosis of the cavernous tissue. It needs experienced surgeons and a longer time to reverse

Fracture of the prosthesis : This may occur due to surgical errors like accidental needle insertion in the prosthesis compromising its integrity.

Severe pain : May happen due to implanting a prosthesis of bigger size than suitable leading in some cases to the protrusion of the implant through the skin or urethra

It may not be corrected for up to two months after the protrusion.

It’s normal to feel mild pain, heaviness or discomfort at the site of the operation.Some analgesics may be prescribed to help alleviate those symptoms as they gradually subside during remission.

Please seek immediate medical should there be any redness, inflammation in or around the site of the surgery, increase in body temperature or problems during urination. These may be the symptoms of wound infection.

The average period before resuming intercourse after the surgery is 6 weeks. It may vary between patients according to the physician’s estimation. Some patient may need only 3 weeks.

Sexual intercourse experience with the penile implant?

There is no difference whatsoever in sensation before and after the surgery The incision used for the surgery is very small and absorbable sutures are used for closing it, making it practically unnoticeable.
Penile implants use is not easily recognizable specially hydraulic implants Penile implants use is not easily recognizable specially hydraulic implants Sexual pleasure and reproductive abilities are not affected by the surgery Yet implants are useful cases where reproductive abilities are reduced due to problems of erections preventing sufficient amount of semen reaching the uterus

Penile implant prices:

Prices range according to the degree of dysfunction and type of the implant. Please contact Dar Elzokora for related inquiries.

Concerns regarding the surgery

Due to misinformation, some patients may have concerns about the surgeries, even though great strides have been taken in this field. These concerns may be about safety, result and effects of the surgery.

Some of those concerns will be discussed below:

All surgeries have a degree of risk but risk associated with penile Implant surgeries is rare and simple compared to other surgeries

It can be done under local or spinal anesthesia for some patients like those who suffer from cardiovascular diseases.

Pain occurrence is within 48 hours after the surgery and is managed by appropriate analgesics.

The procedure itself is not complicated but the technical aspects require great precision and experience to address issues ranging from deciding the suitable implant size to handling any verse events or complications during or after the surgery.

The window for choosing the suitable size is narrow as it is decided during the surgery hence the need for an experienced surgeon. Any miscalculation of the implant size may lead fracture of the implant inside the penis, penile curvature, insufficient blood flow to the penile head and protrusion of the implant through the urethra.

Penile implant surgeries are relatively fast, they take about 20 minutes to one hour at most.

The patient may be discharged on the same day or the following day after suitable observation.

All investigation results done during the examination period and for the operation must be provided to the hospital before the surgey.

Blood sugar and blood pressure must be controlled before the surgery.

Fasting for 8 hours by withholding water and food intake before the operation. Bladder voiding is a done before the surgery.

Shaving the pubic area is done before the surgery using electric shaver, traditional lade shaving may cause micro abrasions that act as an incubator for bacteria.

Using antiseptic body wash for at least 2 to 3 days after shaving and before the operation.

Thorough disinfection of the patient before entering the OR.

There are no visible effects from the surgery. The incision used for the surgery is very small and absorbable sutures and cosmetic techniques are used for closing it, making it practically unnoticeable.

It has no effect on physical sensations. It completely aids in erections and may delay ejaculation but it has no effect on sexual desire or penis size.

The surgery has a very high success rate if done by an expert. Some of the factors affecting success are:

Appropriate disinfection to prevent infections, choosing a suitable implant size and adherence to all surgical and medical precautions.

Successful experiences in Dar Elzokora Centers:

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