Penile prosthesis

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A penile prosthesis, or penile implant, is a medical device that is surgically implanted within the corpora cavernosa of the penis during a surgical procedure. The device is indicated for use in men with organic or treatment-resistant impotence or erectile dysfunction that is the result of various physical conditions such as cardiovascular disease, diabetes, pelvic trauma, Peyronie's disease, or as the result of prostate cancer treatments. [1] Less commonly, a penile prosthesis may also be used in the final stage of plastic surgery phalloplasty to complete female to male gender reassignment surgery as well as during total phalloplasty for adult and child patients that need male genital modification.

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Reasons for use

A penile implant is one treatment option available to individuals who are unable to achieve or maintain an erection adequate for successful sexual intercourse or penetration. Its primary use is for men with erectile dysfunction from vascular conditions (cardiovascular disease, high blood pressure, diabetes), congenital anomalies, iatrogenic, accidental penile or pelvic trauma, Peyronie's disease, or as a result of prostate cancer treatments. This implant is normally considered when less invasive medical treatments such as oral medications (PDE5 inhibitors: Viagra, Levitra, Cialis), penile injections, or vacuum erection devices are unsuccessful, provide an unsatisfactory result, or are contraindicated. [2] For example, many drugs used to treat erectile dysfunction are unsuitable for patients with heart problems and may interfere with other medications.

Sometimes a penile prosthesis is implanted during surgery to alter, construct or reconstruct the penis in phalloplasty. The British Journal of Urology International reports [3] that unlike metoidioplasty for female to male sexual reassignment patients, which may result in a penis that is long but narrow, current total phalloplasty neophallus creation using a musculocutaneous latissimus dorsi flap could result in a long, large volume penis which enables safe insertion of any type of penile prosthesis.

This same technique enables male victims of minor to serious iatrogenic, accidental or intentional penile trauma injuries (or even total emasculation) caused by accidents, child abuse or self-mutilation to have penises suitable for penile prosthesis implantation enabling successful sexual intercourse.

In some cases of genital reconstructive surgery, implantation of a semirigid prosthesis is recommended for three months after total phalloplasty to prevent phallic retraction. It can be replaced later with an inflatable one.

Types of devices

There are two primary types of penile prosthesis: noninflatable semirigid devices, and inflatable devices. [4] Noninflatable, semirigid devices consist of rods implanted into the erection chambers of the penis and can be bent into position as needed for sexual penetration. With this type of implant the penis is always semi-rigid and therefore may be difficult to conceal. [5]

The hydraulic, inflatable prosthesis also exists and was first described in 1973 by Brantley Scott et al. [6] These saline-filled devices consist of inflatable cylinders placed in the erection chambers of the penis, a pump placed in the scrotum for patient-activated inflation/deflation, and a reservoir placed in the abdomen which stores the fluid. The device is inflated by squeezing the pump several times to transfer fluid from the reservoir to the chambers in the penis. After intercourse, a valve next to the pump is manually operated, allowing fluid to be released from the penis (not instantaneously; squeezing the penis may be necessary), causing the penis to return to a flaccid or semi-flaccid condition. Almost all implanted penile prosthesis devices perform satisfactorily for a decade or more before needing replacement. [7] Some surgeons recommend these due to the opinion that they are more easily concealed and provide the highest levels of patient/partner satisfaction.

Three pieces inflatable penile prosthesis Penile prosthesis.jpg
Three pieces inflatable penile prosthesis

Advantages

Disadvantages

Related Research Articles

Erectile dysfunction Human disease which results in trouble maintaining an erection

Erectile dysfunction (ED), also known as impotence, is a type of sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual activity. ED can have psychological consequences as it can be tied to relationship difficulties and self-image.

Priapism A medical condition were an erection lasts excessively long

Priapism is a condition in which a penis remains erect for hours in the absence of stimulation or after stimulation has ended. There are three types: ischemic (low-flow), nonischemic (high-flow), and recurrent ischemic (intermittent). Most cases are ischemic. Ischemic priapism is generally painful while nonischemic priapism is not. In ischemic priapism, most of the penis is hard; however, the glans penis is not. In nonischemic priapism, the entire penis is only somewhat hard. Very rarely, clitoral priapism occurs in women.

Peyronies disease Human disease

Peyronie's disease is a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis. Specifically, scar tissue forms in the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa, causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening.

Penis enlargement Increase size of the Human Penis

Penis enlargement, or male enhancement, is any technique aimed to increase the size of a human penis. Some methods aim to increase total length, others the shaft's girth, and yet others the glans size. Techniques include surgery, supplements, ointments, patches, and physical methods like pumping, jelqing, and traction.

A penis pump, or penis vacuum, is an external medical device developed to treat male erectile dysfunction. The device is designed for the patient to get and maintain erection by blood flow suction to the penis, via a vacuum. It is also used to recover from the effects of Peyronie's disease and penis enlargement therapy.

Sexual dysfunction is difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including physical pleasure, desire, preference, arousal or orgasm. According to the DSM-5, sexual dysfunction requires a person to feel extreme distress and interpersonal strain for a minimum of six months. Sexual dysfunctions can have a profound impact on an individual's perceived quality of sexual life. The term sexual disorder may not only refer to physical sexual dysfunction, but to paraphilias as well; this is sometimes termed disorder of sexual preference.

Penile fracture Rupture of one or both of the tunica albuginea, the fibrous coverings that envelop the peniss corpora cavernosa

Penile fracture is rupture of one or both of the tunica albuginea, the fibrous coverings that envelop the penis's corpora cavernosa. It is caused by rapid blunt force to an erect penis, usually during vaginal intercourse, or aggressive masturbation. It sometimes also involves partial or complete rupture of the urethra or injury to the dorsal nerves, veins and arteries.

Phalloplasty operation to construct or reconstruct a penis

Phalloplasty is the construction or reconstruction of a penis, or the artificial modification of the penis by surgery. The term phalloplasty is also occasionally used to refer to penis enlargement.

Metoidioplasty or metaoidioplasty is a female-to-male sex reassignment surgery.

Tumescence is the quality or state of being tumescent or swollen. Tumescence usually refers to the normal engorgement with blood of the erectile tissues, marking sexual excitation, and possible readiness for sexual activity. The tumescent sexual organ in men is the penis and in women is the clitoris and other parts of the genitalia like the vestibular bulbs.

Nocturnal penile tumescence is a spontaneous erection of the penis during sleep or when waking up. Along with nocturnal clitoral tumescence, it is also known as sleep-related erection. All men without physiological erectile dysfunction experience nocturnal penile tumescence, usually three to five times during a period of sleep, typically during rapid eye movement sleep. Nocturnal penile tumescence is believed to contribute to penile health.

Venous leak, also called venogenic erectile dysfunction and penile venous insufficiency, is one category of vasculogenic impotence -a cause of erectile dysfunction in males. It affects all ages, being particularly awkward in young men. Much about venous leaks has not reached a consensus among the medical community, and many aspects of the condition, particularly its treatment strategies, are controversial. The prevalence of the condition is still unknown, although some sources claim it to be a common cause of erectile dysfunction.

Penile implant

Penile implants are urological surgical procedures, primarily for the treatment of erectile dysfunction and Peyronie's disease as opposed to enlargement as is commonly believed. Although there are many distinct types of implants, most fall into one of two categories: malleable and inflatable.

Erection Physiological phenomenon in which penis becomes firm

An erection is a physiological phenomenon in which the penis becomes firm, engorged, and enlarged. Penile erection is the result of a complex interaction of psychological, neural, vascular, and endocrine factors, and is often associated with sexual arousal or sexual attraction, although erections can also be spontaneous. The shape, angle, and direction of an erection varies considerably in humans.

Human penis size Measurement of the human penis

Human penises vary in size on a number of measures, including length and circumference when flaccid and erect. Besides the natural variability of human penises in general, there are factors that lead to minor variations in a particular male, such as the level of arousal, time of day, room temperature, and frequency of sexual activity. Compared to other primates, including large examples such as the gorilla, the human penis is thickest, both in absolute terms and relative to the rest of the body.

Gary J. Alter is an American plastic surgeon. His specialties include sex reassignment surgery, genital reconstruction surgery and facial feminization surgery. He appeared in two episodes of the reality television series, Dr. 90210. PRNewswire reported on June 5, 2015 that Dr. Gary J. Alter performed the body work plastic surgery on Caitlyn Jenner. He has a practice in Beverly Hills, CA.

Ronald Virag, is a French cardiovascular surgeon, specialized in andrology. Inventor of the first medical treatment for impotence, andrology he designed many of the modern techniques of diagnosis and treatments for erectile dysfunction; and also a preventive program for the harmful effects of ageing in the cardiovascular, hormonal, sexual, urologic and nutritional areas. He is the author of several publications, scientific and popularization books.

Penile Artery Shunt Syndrome

Penile Artery Shunt Syndrome (PASS) is an iatrogenic clinical phenomenon first described by Tariq Hakky, Christopher Yang, Jonathan Pavlinec, Kamal Massis, and Rafael Carrion within the Sexual Medicine Program in the Department of Urology, at the University of South Florida, and Ricardo Munarriz, of Boston University School of Medicine Department of Urology in 2013. It may be a cause of refractory Erectile Dysfunction in patients who have undergone Penile Revascularization Surgery.

Culley Clyde Carson III is an American retired urologist who specializes in Peyronie's disease, penile prostheses and erectile dysfunction. After serving two years as a flight surgeon with the United States Air Force, he took on a urology residency at the Mayo Clinic and then taught at the Duke University Medical Center as an assistant professor, subsequently gaining full professorship.

Zephyr Surgical Imlants (ZSI) is a Swiss-based medical device manufacturer that produces and distributes artificial urinary sphincters and penile implants worldwide. ZSI products are used in the management of moderate-to-severe urinary incontinence in men, erectile dysfunction, Peyronie's disease, penis enlargement, female-to-male gender reassignment surgery.

References

  1. Sadeghi-Nejad H. Penile prosthesis surgery: a review of prosthetic devices and associated complications. J Sex Med 2007; 4: 296-309.
  2. Garber B. Inflatable penile prostheses for the treatment of erectile dysfunction: an update. Expert Rev Med Devices 2008; 5(2): 133-144.
  3. British Journal of Urology International, Volume 100, Number 4, pp 899-905, Reconstructive Urology: Total phalloplasty using a musculocutaneous latissimus dorsi flap, Sava V. Perovic, Rados Djinovic et al., School of Medicine, Belgrade University
  4. Simmons M, Montague D. "Penile prosthesis implantation: past, present, and future". Int J Imp Res 2008; 20: 37-444.
  5. "penile implant types". International society of sexual medicine. 2015-12-16. Retrieved 2018-08-14.
  6. Scott B, Bradley W, Timm G. "Management of erectile impotence: use of inflatable prosthesis". Urol 1973; 2: 80-82.
  7. Wilson S, Delk J, Salem E. "Long-term survival of inflatable penile prostheses: single surgical group experience with 2,384 first-time implants spanning two decades". J Sex Med 2007; 4: 1074-1079.