Prosthetics of the male penis with consequences. Penile prosthesis: procedure and possible complications

Most effective method therapy for erectile dysfunction caused by incurable causes - surgery. If the dysfunction is long-term and permanent, caused by damage to the blood vessels of the penis, the results radiation therapy and injury, then except surgical intervention Nothing else will help you.

In our medical center successfully perform operations to introduce prostheses. Penile prosthetics, price which will undoubtedly delight you, is carried out by high-class specialists. Thanks to effective therapy, we guarantee the return of the lost harmony of your intimate life after prosthetics. The peculiarity of the procedure is based on the restoration of the elasticity of the genital organ, and involves the implantation of silicone rods or inflatable cylinders into the cavernous bodies.

Types of penile prostheses

Highlight:

A semi-rigid prosthesis is simple, but uncomfortable for a man due to its constant “erective state” on the implanted prosthesis. It greatly complicates the patient's adaptation and brings cosmetic inconvenience. Similar penile prosthetics, price which is very low, lies in the ease of implantation.

A plastic penile prosthesis is a silicone cylinder made of several layers, inside of which there are silver wire strands that provide the required strength. They also keep the penis in the required condition. After the stage of implantation of the prosthesis, if necessary, the man simply raises the penis up, and at the end of sexual intercourse, lowers it. The advantages of this model are the strength of the mechanism, the absence of breakdowns and low cost.

An inflatable (functional) prosthesis is ideal from the point of view of the natural nature of an erection and the softness of the organ when it is not tense. This penile prosthesis contains inflatable cylinders (implanted into the corpora cavernosa), a container (installed behind the pubis) and a pump placed in the scrotum. All components are connected to each other by tubes.

Penile prosthesis surgery is the last stage in the treatment of erectile dysfunction, because after removal of the prosthesis it is no longer possible to restore the natural function due to the destruction of the cavernous tissue. To achieve an erection, a man only needs to squeeze the pump a couple of times. The rigidity of the penis is maintained by sterile water entering the cylinders. To relieve an erection, you just need to press the same pump. An important advantage of such a model is the ideal aesthetic and functional result.

Rehabilitation period

As a rule, even before the operation, specialists should talk with the patient in order to explain to him all the advantages and disadvantages of penile prosthesis. Surgery is a very difficult, painstaking process that has many features. This surgical intervention requires great skill of the doctor in the field of penile surgery, ideal knowledge of the anatomy of the organ and its physiological characteristics.

In addition, not all interventions follow the standard, so difficulties that arise during the process can only be resolved by a specialist of the highest category. Such an intervention is carried out provided that all requirements are met to prevent infection from entering the wound. During postoperative period, the man is obliged to comply with the requirements of the specialist. For the first three days, men are instructed to lie down. Approximately 7 days after the procedure, moderate pain and swelling of the penis are felt. Specialists usually prescribe antibiotics to prevent infection.

In about half a month a person can return to work, and sex life begins only after two months. There are no special differences in intimate life after surgery; it can be as vibrant as in men who do not have problems with erectile function. Penile prosthesis does not impair the sensitivity of the organ and does not have any effect on ejaculation.

Possible side effects

Like any surgical procedure, penile prosthesis has risks and some complications:

Impossibility of engraftment and infection (no more than 3% of cases).

If the penile prosthesis malfunctions, a new operation becomes necessary (about 0.5% of situations).

Change in the length of the penis (shortens by about 1 cm).

In the case of implantation of a semi-rigid prosthesis, aesthetic inconveniences arise.

All of the above complications are minimized when the procedure is carried out by the most experienced doctors in compliance with the standards.

The entire available arsenal of means that are aimed at improving potency and growth of the male reproductive organ does not always give the desired effect. In addition, sometimes physiology comes into play. Now the problem can be solved with the help of penile prosthesis. This procedure is called penile prosthesis. This operation involves the use of special implants that simulate an erection. healthy person. Penile endoprosthetics will allow a man to maintain his personal life; the effect after the procedure remains for a long time.

Prosthetics of the male genital organ is a necessary measure for people who have already tried all available methods conservative treatment. These methods include traditional massage, the use of biological active additives, expensive medicines, folk remedies and visits to a psychologist for correction psychological trauma related to problems in intimate life. In addition, penile replacement is required for people whose erection is impossible due to physical pathologies of the male reproductive organ.

Operations related to prosthetics must be carried out in the following cases:

• in the presence of a micropenis. This disease is associated with an insufficiently developed genital organ;
• problems at the psychological level that cannot be corrected in any other way;
• Peyronie's disease. With this disease, deformation of the genital organ may occur. In addition, during sexual intercourse a man experiences discomfort and often pain;
• impaired blood flow in the penis area;
• unsuccessful completion of surgical intervention in the male genital organ or prostate;
• impotence due to diabetes or another type of disease.

Men who have physical defects of the penis or suffer from lack of erection decide to undergo surgery.

For men who decide to undergo penile surgery, you need to know some facts:

1. If prostheses are inserted into the cavernous bodies of the penis, their structure will be destroyed. Even if these implants are then removed, the natural way of having an erection will not be possible in the future.
2. After the operation, there will be a change in the size of the genital organ. It will decrease within 10-40 millimeters. Penis reduction will occur depending on the prosthesis used. The higher the price of the prosthesis, the smaller the penis reduction will be. A preliminary examination of the reproductive organ cannot give an accurate answer about the size of the penis that will be after prosthetics.
3. To carry out penile prosthetics, you will need to do a comprehensive examination. This is due to the fact that problems may arise with the person’s condition after the phallus is replaced. During this period, under no circumstances should infection be allowed to enter the body.

Another contraindication may be priapism, which is a very prolonged erection. She can create painful sensations for a man.

Types of penile prostheses

There are three types of reproductive organ prosthetics. They can be one-, two- and three-component. The grade of implant available influences the type of surgery.

The simplest prostheses are single-component ones. They can be rigid or flexible. Rigid dentures have a significant drawback - they are unsightly. appearance. The penis appears to be in a permanent erect state. This creates certain problems in Everyday life person. The advantages of this artificial penis include its relatively low cost, short period of time required for rehabilitation, and reliability in use.

Currently, rigid prostheses are practically not used. There are several alternatives that are significantly better than a hard penis.

These include a semi-rigid implant with plastic memory. It is made from medical silicone, in the form of many cylinders. In the thickness of such an implant there are various tourniquets, distinguished by their thinness. Before having sex, you need to guide the penis into the desired position using your hands. After intimacy it is necessary to return the member to its original position. The main disadvantage of this method is the tension in the muscles of the penis after ejaculation.

Appearance of a two-component implant

A hydraulic implant with two components can also be used. It consists of two inflatable cylinders and a pump. Their operation is as follows: the cylinders are connected to the pump using thin tubes. The pump contains saline solution. The cylinders are sewn into the right and left body of the penis. The pump is located in the scrotum.

Before having sex, you need to press on the scrotum where the pump is attached. After this, the penis becomes erect. This occurs by pumping saline solution from the pump into the cylinders. After this, the penis increases in size. After the end of intimacy, the reverse process occurs. The saline solution from the cylinders returns to the pump.

Three-component implants based on hydraulic force are also available. Unlike a two-component hydraulic implant, another reservoir of saline solution is added. The volume of this reservoir does not exceed 100 milligrams. It is located behind the pubic bone in the bladder area. The advantage of this prosthesis is the absence of pressure from the cylinders on the tissue of the penis. But if you have Peyronie's disease, this prosthesis cannot be installed under any circumstances.

The structure of a three-component penile prosthesis

Preparing for surgery

To install a prosthesis, preoperative preparation is required.

First you need to find out whether an implant can be installed. There are some types of diseases for which implantation is contraindicated. It is necessary to conduct a comprehensive examination of the body for the presence of such types of ailments as tuberculosis, cancer and other types of cardiovascular pathologies.

You need to prepare for the procedure psychologically as well. As you know, after surgery a man will no longer be able to have a natural erection.

Should be given Special attention selection of prosthetic models depending on the length of the penis.

Progress of the operation

The process of penile prosthesis occurs under general anesthesia. The operation procedure depends on what anatomical features available in men, and on the types of prostheses they choose for themselves. They can be installed via foreskin, in the scrotum or above the pubis.

The operation itself takes 40-120 minutes. This depends on the patient’s health condition and the type of prosthesis chosen.

After surgery, you should not drink or eat food for 10-12 hours.

Rehabilitation

After surgery is performed, the patient should remain in the hospital for no more than 5 days. The seams come apart imperceptibly. The sexual partner will not notice the operation performed if he does not know about its fact.

After three days from the moment of surgery, the patient will forget about the feeling of discomfort. The ability of the penis to have an erection will return after 21 days. In the first two months, a decrease in the sensitivity of the head of the penis may occur. There is no need to worry about this, she will recover in any case. Sexual activity can be resumed no earlier than after 60 days, otherwise problems may arise with the use of the prosthesis.

Experience with implants is gained over time. But in the presence of hydraulic models, the most important thing is dexterity when using the pump before starting intimacy. Also, do not press the valve to drain the saline solution after the contact ends.

Implants do not have a serious effect on ejaculation itself.

Possible complications and contraindications

Penile prosthetics cannot affect a man’s reproductive functions or the process of producing seminal fluid. A significant disadvantage may be the inability to recreate the natural way an erection occurs.

The main risk is associated with the penetration of infections during prosthetics. This can lead to harmful consequences. To reduce the risk of infection, sterile instruments must be used during surgery. It is imperative to take a course of antibiotics. This will prevent any infection from occurring.

It is also necessary to ensure that the implant takes root correctly. If a person experiences pain within 14 days after surgery, heat body, it is necessary to clean and perform the operation again.

Choosing the wrong prosthesis will also cause pain. The prosthesis will begin to compress the head of the penis. This can lead to necrosis. There is no way to independently determine that the prosthesis will not fit and will lead to necrosis.

Available statistics indicate that every fifth prosthesis fails after a decade. In this case, you will need to do prosthetic phallus again.

Cost of the procedure

Many people are interested in how much a prosthesis costs. The price of penile prosthesis depends on which implant a man chooses. The most expensive prostheses are three-component hydraulic ones. The price of the procedure is also affected by the qualifications of the doctors. For example, if you install the most expensive prosthesis in an expensive clinic, the approximate price will be about 1 million rubles. But this will allow you to get rid of possible complications and discomfort in the future.

The effectiveness of penile prosthetics

Penile prosthesis is a complex operation that will lead to significant changes in the reproductive organ. It should only be carried out if traditional methods should not give any effect.

Not always surgical methods can restore erectile function to its full extent. Prosthetics allows a man to regain self-confidence and save his marriage or intimate relationship.

Erectile dysfunction is a common male disease. According to various estimates, up to 16% of men of all ages suffer from it. In a number of situations, and this is approximately 5-10% of all patients with erectile dysfunction, the severity of the disease and its cause do not allow one to restore one’s own erection with the help of drug therapy. But what to do in such cases? Forget about sex life? And if a man is 20 years old or older, but does not want to give up sexual relations? Is there a way out? The civilized world came up with a solution long ago, but it comes to our country with very great difficulties. About what we're talking about? Of course, about penile prosthetics or penile prosthetics. The very name of the surgical procedure, which is guaranteed to completely restore sexual functionality, is frightening for some reason Russian men. Indeed, prosthetics sounds impressive, to put it mildly. At the same time, a considerable number of Russians have dental implants, which are also prosthetics, but for some reason they are not perceived with hostility. What is the reason?

Based on long experience in managing patients with erectile dysfunction, the obvious conclusion arises that in Russia penile prosthesis is not so popular, primarily due to the low awareness of the population about what it is. Few people know that today two types of implants are used for penile prosthetics: semi-rigid and hydraulic. It should be noted right away that in developed Western countries the largest number of implantations (about 98%) are carried out using hydraulic penile prostheses, despite their significantly higher cost.

There are at least two reasons for this. Firstly, in the USA and most countries of Western Europe there is a very developed medical insurance system, and if you have medical insurance, and most workers have it, permanent job citizens, then this expensive operation will be performed completely free of charge. Secondly, due to the fairly high awareness of the population, patients who undergo such an intervention when necessary know that only hydraulic implants create sensations during sexual intercourse that are completely identical to natural ones. After all, many studies have proven that up to 97% of men and their partners are satisfied with the results of this treatment. What is this connected with? The answer is simple. Erection is essentially a hydraulic process. Arterial blood during sexual arousal, it is pumped at high speed into the cavernous bodies of the penis, limited by the tunica albuginea, and is blocked there using a special mechanism that blocks the outflow through the veins. If we compare this process with something closer and more understandable, then the easiest way is to imagine how we inflate a balloon, tying its mouth so that the air does not escape. So, hydraulic implants used in penile prosthetics are a closed system made of extremely durable synthetic material. It usually contains 3 components. The first and most important are 2 working cylinders, which are essentially artificial cavernous bodies that are inserted into the penis and filled with saline solution. The second component of the penile implant is a reservoir, the capacity of which does not exceed 100 ml. The special round or oblong shape allows the tank to occupy a small volume. It is usually placed during surgery in the fatty tissue near the bladder just behind the anterior abdominal wall. It is in the reservoir that the saline solution is stored when the implant is not activated and the penis is in a calm state. This fluid can be quickly transferred into the working cylinders using a special pump or a third component of the implant, which is placed under the skin of the scrotum for the patient's convenience. Just pumping saline solution into the penis allows you to activate the implant and obtain the hardness and shape of the organ completely indistinguishable from the natural one. Based on this, it is quite clear that the process of activation of the penile prosthesis is based on the same hydraulic principle as during a normal full erection. For greater convenience, there is an easy-to-touch button at the top of the pump, which allows you to start the process of evacuating fluid from the working cylinders with one touch, quickly deactivating the implant and bringing the penis into calm state. Many patients, being candidates for penile prosthetics, are perplexed when they see a three-component implant and how it is placed into the body through a single small incision. Everything is very simple. After all, the prosthesis before implantation is completely emptied, does not contain liquid and occupies a very small volume. It is filled only after all components of the implant have been inserted and at the end of the operation the entire system is sealed using special connectors.

Many patients are afraid that the skin incision may leave a rough scar that will raise questions from their partner. But that's not true. Today, two methods of penile prosthetics have been developed. The most common method (scrotal) is implemented through a 4-5 centimeter incision on the scrotum, which can be made longitudinally directly along the natural skin suture. As a result, no one will ever suspect the presence of a penile prosthesis. The second method (subpubic) is less common, since it is used only by advanced genital surgeons. The essence of the method is to place the implant through a transverse 3-4 cm incision 3 cm above the base of the penis. This area was not chosen by chance, since the pubic hair that has grown after the operation will completely hide the neat postoperative scar. Its small thickness is achieved by a special technique for applying a cosmetic intradermal suture.

Uninformed patients are also afraid of pain during or after surgery. But these fears are unfounded. High-quality general anesthesia (narcosis) and postoperative administration of non-toxic modern painkillers minimize the risk of any discomfort. Probably the best confirmation of this is that not one of the hundreds of patients we operated on on the first day after the operation regretted the penile prosthesis at all. To be fair, it should be noted that the subpubic method of implantation can significantly reduce postoperative rehabilitation. Suffice it to say that after using this technique, I send patients home for 1-2 days. After the scrotal penile prosthesis method, patients are usually discharged from the hospital within 3-4 days. Another common misconception is the myth that hydraulic implants are unreliable due to their structural complexity. But this statement was true for the first generation of refillable prostheses, the service life of which did not exceed 5-7 years. But at present, the two largest companies producing such implants, AMS and Coloplast, are no longer producing their second or even third generation. Modern hydraulic three-component prostheses, based on materials and technological solutions, can function without problems for 20-25 years. And taking into account the fact that penile prosthetics is performed more often after 45 years, taking into account the average life expectancy of the male population in Russian Federation Repeated prosthetics may simply not be necessary. Additional confirmation of the ultra-reliability of modern hydraulic penile implants is the lifetime warranty provided by both AMS and Coloplast. Patients coming for a consultation about the possibility of penile prosthesis often ask about the likelihood of prosthesis rejection, more correctly called prosthetic infection. But it should be noted that developed medical institutions, in particular in our clinic, the incidence of such a complication does not exceed 0.5%. First of all, this is due to the fact that modern hydraulic implants have either a factory antibacterial coating (AMS has a patented Inhibizon shell) or a special absorbent surface that can be saturated with the most potent antibacterial drugs during surgery (a hydrophilic capsule from Coloplast). The age-old question of which implants are better: AMS or Coloplast does not have a clear answer. Both manufacturers, as already mentioned, provide a lifetime warranty on prostheses. And the pricing policies of companies in 2015, at the height of the global financial crisis, were almost equal. Selecting a hydraulic implant to a greater extent the task facing the patient himself. This is the position of advanced implantologists. Our task is to bring objective information to patients, and the final decision is theirs.

And finally, in conclusion, a few words should be said regarding another misconception that penile prosthetics with hydraulic implants is unaffordable for the majority of patients in need in the Russian Federation. In our clinic, we generally ignore the price of implants, since patients purchase them independently at the representative offices of AMS or Coloplast. Although this, of course, is not done in all andrological institutions.

It should be said that both manufacturers have one sales office in Russia, which is located in Moscow. Speaking about the cost of the operation, it is fair to note that it varies greatly depending on the chosen andrologist surgeon who will perform it. A logical trend is clearly visible: the more experienced the surgeon, the higher the cost of the intervention. But on average, the cost of penile prosthetics in Russia does not exceed (taking into account the implant, hospitalization and rehabilitation) the cost of an average B class car, which many can afford today. The only difference is that the cars do not have a lifetime warranty. It should be understood that such a completely humane pricing policy is observed only in Russia. For example, in the USA, penile prosthesis using a hydraulic three-component prosthesis costs about 35 thousand dollars. And in Western Europe, a similar operation costs approximately 20 thousand euros. But why is this, you ask? Why in Russia are the costs of penile prosthetics with fillable implants significantly, or rather, several times lower? Maybe they bring here prosthetics that are different from those implanted in the West? Definitely not, since I had the opportunity to undergo internships both in Europe and in the USA. The implants are the same, it’s just that the AMS and Coloplast companies, having studied Russian reality, understand that without reducing the cost of penile prostheses to almost the minimum acceptable value (only 30% higher than the cost), it will be practically impossible to sell them in our country. And losing the sales market, despite its small size, is unacceptable for large global corporations, which include both global manufacturers of prosthetics. So the Russians are certainly lucky. But with the increase in the welfare of the population of our country, which is inevitable over time, the cost of implants will also undoubtedly increase significantly.

Quite often, patients from regions of the Russian Federation contact us and ask us to recommend specialists in penile prosthetics at their place of residence. But the whole point is that this operation refers to high category complexity and it is carried out by a few specialists in our country, who are mainly concentrated in Moscow. In addition, the result of such an operation significantly depends on the impeccability of the technical execution of all its stages, and therefore it is better to perform penile prosthetics by specialists who have the most experience. Another feature of recent years, apparently due to the financial crisis in the country, is the desire of patients that we perform the operation in the city where they live. But it should be understood that even in Moscow, penile prosthetics is not feasible in every operating room. The main requirement is exceptional cleanliness of the air in the surgical unit of the clinic, which is mainly achieved by a special ventilation system that creates laminar air flows that “beat” dust and bacteria into the operating room floor. But such systems are prohibitively expensive and equipping regional clinics with them is simply unprofitable. That is why my employees and I do not travel to perform penile prosthetics outside of Moscow. Neglecting the rule to operate in a super-clean operating room quite often results in a prosthetic infection, which will force removal of the prosthesis in the immediate postoperative period.

As for semi-rigid prostheses, frankly speaking, this is an obvious compromise option. In fact, they are hard-to-bend cylinders that are implanted instead of the corpora cavernosa. The appearance of the penis and the sensations during sexual intercourse are not comparable to natural ones. At the same time, such prostheses perform their main function. They reliably create axial hardness of the penis. But wearing such implants creates significant difficulties precisely due to the constant hardness of the organ. In addition, these prostheses can lead to significant shortening of the penis over time. The only advantage of semi-rigid penile implants is their relatively low cost.

In general, it should be emphasized once again that penile prosthesis is a rather complex and painstaking surgical intervention, which is necessary only if there is no effect from conservative treatment of severe erectile dysfunction. After all best surgery This is an operation that the surgeon may refuse due to its unnecessaryness. But with regard to penile prosthetics, the patient is always involved in making this decision, because only the man himself has the right to decide for himself whether he wants to be sexually complete or whether sex life is already “a long-read and forgotten book” for him.

Professor Nika Akhvlediani

Three-component hydraulic penile prosthesis

Of the currently available penile prostheses, these prostheses are the most advanced in terms of natural erection and maintaining a state of rest of the penis. They contain two cylinders placed in the corpora cavernosa, a reservoir placed in the area behind the pubis, and a pressure pump placed in the scrotum. All components are connected to each other by tubes. To obtain an erection, you need to squeeze the pump several times, and to transfer the penis to a calm state, press the deflation valve of the pump.

Such prostheses are produced by companies:

• AMS 700 CX
• AMS 700 LGX
• Coloplast Titan OTR
• Coloplast Titan Touch

The clear advantage of these penile prostheses is their best functional result and the appearance of the penis. Product warranty is 30 years.

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Two-component hydraulic penile prostheses

This type of prosthesis consists of two cylinders with built-in reservoirs installed in the corpora cavernosa, and a pump installed in the scrotum. The pump is connected to the cylinders using tubes. To achieve an erection, you need to squeeze the pump several times, while fluid from the reservoirs enters the cylinders and gives them hardness. To relieve an erection, the penis must be bent and held in this position for several seconds until maximum relaxation is achieved.

This type penile prosthesis has a more natural erection and a more natural state of rest. However, two-component prostheses are inferior in quality to three-component ones, and therefore are used quite rarely today.

Two-component hydraulic penile prostheses are produced by AMS Ambicor.

Semi-rigid (plastic) penile prosthesis

This prosthesis consists of two silicone cylinders, each of which is inserted into its own cavernous body. Unlike rigid prostheses, a plastic prosthesis contains metal guides, so it has a plastic memory that ensures that the specified position of the penis is maintained. When the moment of sexual intercourse comes, the direction of the penis is changed by hand. The advantage of a plastic prosthesis is a more natural appearance of the penis while maintaining its functions. The disadvantage of these prostheses is their constant rigidity.

Examples of such penile prostheses are prostheses produced by the following companies:

• AMS Spectra Concealable (Spectra);
• Coloplast Genesis Malleable Penile Prosthesis (Genesis);
• Promedon Tube Malleable Penile Prosthesis

Cost of prosthesis implantation surgery
penis - 120,800 rubles

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Dr. Menshchikov Konstantin Anatolievich

Erectile dysfunction today refers to the inability to have sexual intercourse. In this case, the man cannot insert the penis and complete intercourse due to insufficient tension of the penis or due to the disappearance of the tense state. There are quite a few causes of dysfunction and they cannot always be eliminated by surgical or therapeutic methods.

Penile prosthetics

The cause of erectile dysfunction is insufficient filling of the cavernous bodies. With normal filling, the penis becomes quite tense and remains hard for some time, sufficient for sexual intercourse. With low fullness, difficulties with erection occur. If the blood flows out too quickly, the penis loses hardness too early, which leads to the inability to complete sexual intercourse.

There are several methods for treating impotence today.

The goal of most of them is to organize the normal filling of the cavernous bodies and retain blood in them for a sufficient period of time:

• Conservative method - involves taking special drugs, which enhance filling cavernous bodies and thereby reduce the manifestation of impotence.
• Surgical – usually involves surgery on blood vessels. In this case, to fill the corpora cavernosa, another artery is connected or some veins are blocked, which prevents the outflow of blood. However, if there is a complete loss of erection, this method is powerless.
• Restorative – actual penile prosthetics. In this case, special devices are inserted and installed into the penis to achieve an artificial erection.

Penile prosthetics is the most reliable method. Implants are made from different materials, but always hypoallergenic. In 90% of cases, reconstructive surgery leads to a complete cure.

As practice shows, when using soft prostheses, partners of former patients do not even realize the presence of implants in the penis. The only contraindication to prosthetics is the possibility of treatment with conservative or surgical methods.

There are several recovery techniques associated with different shapes and types of prostheses.

Indications

If the cause of erectile dysfunction is damage and organic changes in tissue, it is impossible to restore normal blood flow. Only in such cases do they resort to penile prosthetics.

Direct indications for surgery are:

• atherosclerosis of the cavernous bodies of the penis and arteries, in this case it is impossible to restore blood flow;
• fibrosis of the cavernous bodies - replacement of normal organ tissue with non-functional fibrous tissue;
• scarring of the cavernous bodies – also refers to irreversible changes;
• – pathology of the tunica albuginea leading to dysfunction;
• complications after injuries or operations on the pelvic organs - rectum, bladder leading to impotence;
• background dysfunction diabetes mellitus in a severe stage;
• congenital pathologies or underdevelopment of the penis;
• Prosthetics are also prescribed for psychogenic impotence, if all other methods have exhausted themselves.

The undoubted advantage of penile prosthetics is the long-term result - literally until the end of life, while therapy requires constant repetition course of treatment, and the results of surgical intervention become less impressive over time.

Selection of prostheses

Today there are several types of prostheses. They are made from special hypoallergenic materials, but they differ in design. How it is selected depends mainly on the financial capabilities of the patient.

Let's look at what types of prostheses there are:

• One-component plastic ones are the most affordable, but somewhat inconvenient to use. There are 2 types of such devices:
  • elastic - or flexible. Made from silicone or vinyl. They are flexible tubes. One penile prosthesis is inserted into each cavernous body. With this form of prosthetics, the penis seems to be in an erect state all the time. Since the prosthesis is flexible, the penis is simply pressed with underpants while wearing clothes. The cost of such prostheses is the lowest, so they are installed most often. There are no special indications for choosing this particular type;
  • semi-rigid - or with memory effect. This prosthesis is a multilayer silicone cylinder, inside of which a wire harness is placed. The penis in an erect state is ensured by the latter: for this, before copulation, the penis is raised up by hand. In the normal state, the genital organ is lowered. Such a prosthesis is also quite affordable, has good mechanical strength, and is much more convenient. The disadvantages of this option include the constant hardness of the penis, which gives the organ a somewhat unnatural appearance. In addition, you need to take into account the fact that after installing a semi-rigid prosthesis, the length of the penis decreases by 2–3 cm.
• Two-component prostheses are hydraulic. The implant imitates the natural response, which provides a more natural erection and normal condition peace. The prosthesis is a cylinder of rigidity; a reservoir with sterile water is built into its base. The cylinders are placed inside the cavernous bodies, and the pressure pump is placed in the scrotum. The cylinders and pump are connected by tubes.

The state of erection is ensured by pumping water from the reservoir into the rigidity chambers. To do this, it is enough to squeeze the pump placed in the scrotum several times. To relieve an erection, you need to bend the penis and hold it in this state until the organ reaches relaxation. This feature is considered a disadvantage, since it is clearly unnatural in nature.

• Three-component – ​​inflatable. Today they are considered the most the best models and, accordingly, are the most expensive. This option provides the maximum aesthetic effect: the erection looks completely natural, the penis is relaxed at rest and does not present any inconvenience in everyday life.

The prosthesis also consists of three parts, but in this case the components are placed in a more natural way: the rigidity cylinders are implanted in the cavernous bodies, the reservoir is placed behind the pubis, and the pressure pump is placed in the scrotum. The elements of the prosthesis are connected by flexible soft tubes. When you press the pump 6–8 times, sterile water from the reservoir fills the rigidity chambers and the penis “stands up.” There are protruding stripes on the pump that are quite audible to the touch under the skin. To remove an erection, the strips should be squeezed with constant pressure so that the water from the rigidity chambers returns to the reservoir. Such a device is more complex, and therefore there is a risk mechanical damage his is higher.

Manufacturers began to offer three-component prostheses with antibacterial coating.
This model significantly reduces the risk of infectious complications after surgery or implant failure.

The penile prosthesis does not significantly affect the sensitivity of the penis, orgasm and ejaculation. But it is worth noting that the more complex the model and the more flexible the material, the less the prosthesis affects the quality of sexual intercourse.

Progress of the operation and rehabilitation

The operation is carried out only if all other means of treatment, both medicinal and surgical, have been exhausted. The patient must understand that after installing the prosthesis, it is impossible to return to a natural erection: the implant destroys the cavernous bodies. This means that if the prosthesis breaks or is injured, erectile function can also be restored only with the help of repeated reconstructive surgery.

The introduction of a prosthesis is a rather complex surgical operation, which requires careful preoperative preparation:

• First of all, the possibility of prosthetics is established: for a number of diseases, especially genitourinary system implantation may be undesirable, if not impossible.
• A general examination is carried out to exclude diseases such as tuberculosis, cancer, sexually transmitted diseases, and cardiovascular pathologies.
• Psychological preparation - as already mentioned, after installation of the prosthesis, natural erection becomes impossible, even if the cause leading to impotence is discovered and eliminated.
• A model is selected according to the length of the penis, taking into account certain features of the devices: a two-component implant, for example, has a greater effect on the length of the penis, a three-component one, as a rule, reduces the length by no more than 1 cm.

The operation can be performed under general or spinal anesthesia and takes from 40 minutes to 2 hours. This depends on the condition of the body and the complexity of the prosthesis: three-piece models require more extensive surgical intervention, so the operation takes longer. If penile prosthesis is performed under general anesthesia, 8–12 hours before surgery, the patient is prohibited from eating and drinking.

Depending on the type of implant being installed, the operation may include 3 stages:

• Removal of the cavernous bodies by bougienage is a mandatory step. Then cylinders of soft or semi-rigid prostheses or rigidity chambers are implanted in this area;
• an incision is made in the scrotum area and an inflating pump is implanted - for a two- or three-component prosthesis;
• When installing an inflatable implant, an incision is made in the lower part of the peritoneum, the reservoir is installed behind the pubic bone, which minimizes the risk of damage.

Since the aesthetic effect in this case is as important as achieving functionality, therefore, during the operation, techniques and suture material are used that ensure maximum invisibility of the seams.

When implanting plastic one-component devices, the price varies from $400 to $700. When installing a prosthesis with a memory effect - up to $1,500, when choosing a three-component model - from $7,000 to $10,000. The cost of the operation itself depends on the type of prosthesis and the complexity of the intervention.

To ensure maximum success of prosthetics, after surgery it is necessary to follow a number of medical instructions:

• The first 2 days – sometimes more, the patient must observe strict bed rest.
• Subject to availability concomitant diseases The urologist selects an antibiotic. The drug is administered intravenously over 48 hours. Over the next 5 days, the patient takes the drugs orally.
• The patient spends 4 days in the hospital. Then, if there are no contraindications, recovery occurs at home.
• In general, healing of sutures occurs within 2 –3 weeks. In this case, painful sensations may be present, and swelling almost always occurs. Typically, these symptoms completely disappear within 4 weeks.
• It is necessary to abstain from sexual intercourse for 6–8 weeks. Before resuming sexual activity, you should visit a surgeon and listen to his recommendations.

Video of penile prosthesis operation:

Possible complications

Penile prosthesis does not affect fertility, seminal fluid production or urination. This is the most important advantage of reconstructive surgery. The main disadvantage is the impossibility of recovery natural mechanism erections.

In addition, the operation may be accompanied by some complications:

• The main risk is infection. To minimize it, only absolutely sterile preparations are used. In addition, a course of antibiotics is required to prevent the possibility of infection.
• There is a small but risk of implant failure. If pain or fever is observed within 2 weeks after the intervention, it is necessary reoperation and cleaning.
• If the implant is not selected correctly, after some time the prosthesis begins to compress the head of the penis, which can lead to necrosis. Unfortunately, this complication cannot be determined immediately.
• According to statistics, about 20% of prostheses fail after 10 years. In this case, repetition of penile prosthesis is necessary.

Penile prosthetics is enough complex operation, leading to irreversible changes in the genitals. It is carried out only in cases where conservative or surgical methods cannot restore erectile function.