Penile replacement pain after 11 months. What is penile prosthesis and the features of treating impotence using a radical method. Two-component hydraulic penile prostheses

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 replacement will allow a man to keep 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 dietary supplements, expensive medicines, folk remedies and visits to a psychologist to correct psychological trauma associated with problems in intimate life. In addition, penile replacement is required for people whose erection is impossible due to physical pathologies reproductive organ men.

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 painful sensations;
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:

If prostheses are inserted into the cavernous bodies of the penis, their structure will be destroyed. Even if these implants are then removed, a natural erection will no longer be possible.
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.
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 - an 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 term, which is required for rehabilitation, 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 penis to its original position. The main disadvantage of this method is the tension in the muscles of the penis after ejaculation.

Appearance 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 area Bladder. 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 surgical procedure depends on what anatomical features the men have and 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 it has been produced surgical intervention, the patient should stay 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 have any effect on reproductive functions men, 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 infectious infection, during the operation it is necessary to use sterile instruments. 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 re-prosthetize the phallus.

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 get rid of possible complications and discomfort in the future.

The effectiveness of penile prosthetics

Penile prosthetics is complex operation, which 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.

(prosthetics of the male penis) is the introduction of an implant into the cavernous bodies of the penis as surgical treatment problems associated with erectile dysfunction.

Indications

There are special indications for penile prosthetics:

, having a vasculogenic (vascular) nature;
erectile dysfunction accompanying a disease such as;
absence positive result after conservative treatment of erectile dysfunction;
cavernous fibrosis;
underdevelopment of the penis.

Contraindications

The following contraindications exist for penile replacement: symptomatic priapism (a disease characterized by pathologically prolonged erection), as well as arterial view priapism.

Penile prosthetics technique

Operation by male penis prosthetics performed under general anesthesia.

Depending on the clinical situation, the incision can be made on the scrotum, on the foreskin or under the pubis. After the surgeon gains access to the cavernous (cavernous) bodies of the penis, the implant is installed. In cases where the patient suffers from severe cavernous fibrosis, the cavernous bodies are subject to mechanical expansion.

Types of prostheses

The following types of prostheses (implants) exist:

rigid dentures– silicone rods with an elastic structure. This type prostheses have a fairly low cost, but are currently used extremely rarely because they do not have plasticity. After implantation of such prostheses, the penis retains its tense shape constantly, which negatively affects psychological condition patient;
plastic prostheses have the advantage of “plastic memory” and allow you to maintain the natural appearance of the penis. When a man needs an erection, the penis with a plastic implant installed in it is raised by hand and remains in an erect state as long as necessary;
inflatable prostheses can change the degree of rigidity when and in the manner desired by the man; in addition, this type of implant does not exert constant pressure on the tissue of the penis.

Inflatable prostheses, in turn, can be one-component And multicomponent. Single-component inflatable penile prostheses are more rigid in the absence of an erection, and the quality of erection is low. Multi-component inflatable penile prostheses contain liquid. During an erection, it moves inside the prosthesis. A man can regulate the quality of an erection using a pump that is sewn into the scrotum.

A wide selection of means that improve potency and promise to enlarge the reproductive organ with regular use does not help in all cases, especially if the reason is physiological.

Today, the problem of the lack of a normal erection is solved by penile prosthetics - penile prosthesis. This is an operation during which implants are inserted into the cavernous bodies, simulating a full erection.

The mechanism of erection

It is necessary to imagine what processes occur inside the reproductive organ in order to understand the essence of the future operation and choose the right prosthesis.

Along the entire length of the penis on the right and left there are two cavernous bodies (paired) of a cylindrical shape, inside of which there are many cavities (lacunae) separated by partitions, pierced vascular network. Around them is a dense and elastic protein membrane, which limits the stretching of the penis during erection. Another cylindrical body consisting of spongy and fibrous tissue, is located below in the groove between the paired ones. The urethra passes through it.

During arousal, the released nitric oxide relaxes the smooth muscles of the cavernous bodies, they fill with blood, due to which the penis increases in size. The muscles of the pelvic diaphragm are responsible for the flow of blood: by contracting, they do not release blood back, and are also responsible for pushing out sperm.

If there are fatal conservative therapy problems with blood circulation or the structure of the cavernous bodies of the penis is disrupted, then a normal erection is impossible.

Indications and contraindications

Penile prosthetics is the only solution for those who have tried the entire arsenal conservative methods: massages, dietary supplements, medications, external remedies, visits to psychologists. And also for people whose erection is impossible due to physical pathology of the genital organ.

Penile prosthetic surgery is performed in the following cases:

a penis that is underdeveloped since childhood (micropenis);
problems on psychological level, not correctable by other means;
Peyronie's disease benign formations, located in the protein tissues of the cavernous bodies of the penis. Plaques can even be felt from the outside. Deformation of the penis often occurs, as well as pain during sexual intercourse;
vasculogenic erectile dysfunction (due to poor circulation in the genital area);
cavernous fibrosis – excessive growth of connective tissue occurs in the cavernous bodies of the penis;
consequences of operations on the genital organ or prostate;
endocrine impotence (for example, due to diabetes).

A man who decides to undergo surgery should take into account some facts:

The introduction of prostheses into the cavernous bodies of the penis destroys their structure. If the implants are removed without replacement, then an independent normal erection will occur. in a natural way will no longer be possible.
The size of the penis after surgery may decrease by 1-4 cm, depending on the type of prosthesis (the more expensive, the less the loss). It is impossible to predict the exact figure upon examination.
Before penile prosthetics, you must undergo full examination, including Dopplerography of the vessels of the penis, since complications may occur. The presence of infections is also unacceptable.

The simplest are one-component prostheses, which can be rigid or plastic

Contraindications are Various types priapism - an abnormally prolonged and painful erection.

Types of penile prostheses and features of the operation

The main types of penile prosthetics: one-component, two- and three-component. The type of operation depends on the class of the selected implant.

The simplest are one-component prostheses, which can be rigid or flexible. Hard ones are inconvenient because they give the penis a constantly erect position, which is a serious obstacle in everyday life. The advantages include low cost, quick rehabilitation, reliability.

Rigid prostheses are currently almost never installed, since there are more convenient alternatives:

Penile prosthetic surgery is performed under general anesthesia

Elastic bendable implants (semi-rigid) with plastic memory. They are made in the form of multilayer cylinders made of medical silicone, in the thickness of which there are thin strands made of a special alloy. Immediately before sexual intercourse, the penis is brought into the desired position by moving the hand, and upon completion of the process, the penis is lowered in the same way. The disadvantage is the long-term residual tension in the muscles of the penis after ejaculation.
Hydraulic two-component implants (for example, AMS Spectra). Consist of two silicone inflatable cylinders and a pump. They are arranged as follows: the balloon cylinders are connected by thin tubes to a pump containing saline solution. The cylinders are sewn into the right and left cavernous bodies of the penis, and the pump is sewn into the scrotum between the testicles. Before sexual intercourse, it is enough to press several times on the place in the scrotum where the pump is installed so that the penis takes an erect position (the solution is pumped from the pump into the cylinders, they will increase). Upon completion, the same procedure.
Hydraulic three-component implants (for example, AMS 700 Ultrex). A separate reservoir of saline solution (maximum volume 100 ml) is added to the cylinders and pump, which is located behind the pubic bone at the level of the bladder during surgery. The operating mechanism is the same as for two-component pumps, but the solution is moved from the reservoir and drained back (by pressing the shut-off valve at the top of the pump). A significant advantage of hydraulic prostheses is the absence of pressure from the cylinders in the deflated state on the tissue of the cavernous body. For Peyronie's disease, the protocol does not establish.

Penile prosthetic surgery is performed under general anesthesia. Surgical access is performed depending on anatomical features each man and the selected type of prosthesis: through the foreskin, suprapubic or scrotal area. The price of the operation depends on how much the implant costs (the most expensive are three-component hydraulic ones) and on the qualifications of the surgeon. Installation of a three-component branded penile prosthesis by a highly qualified doctor will cost approximately the same as an average class B car. But this is a guarantee of competently performed prosthetics and the absence of complications, as well as further comfort.

Three-component dentures

Three-component dentures are the most comfortable, natural and in demand. A small incision is required to install this implant because the compressed cylinders are very small. The system is filled with saline solution only after installation, then everything is sealed with special connectors. Surgical access is carried out through the scrotum (4-5 cm incision, discharge after 3-5 days) or through a subpubic incision (4 cm suture, discharge after 2-3 days).

Sexual activity can begin no earlier than 2 months after surgery

The service life of modern models (from manufacturers Coloplast or AMS) is about 25 years. The product often comes with a lifetime warranty.

There is always a chance of rejection, but with penile prosthetics it is only 0.5%, since the implants are protected with special antibacterial coatings.

Postoperative period

After prosthetics, the patient remains in the hospital for 2 to 5 days, depending on the type of operation. The seams subsequently become invisible. If the partner does not know about the operation, she will not suspect anything.

Discomfort after surgery goes away after about 3 days. The functionality of the penis returns after 3 weeks. During the first 1-2 months, the sensitivity of the head of the penis may decrease slightly, but it will certainly recover. It is better to start sexual activity no earlier than after 2 months.

The skill of handling the implant comes quite quickly. In hydraulic models, the main thing is to get used to working with the pump before contact and pressing the valve for outflow after relaxing the penis.

Implantation does not affect ejaculation in any way. After the operation, 97% of men experience complete sexual satisfaction and forget about past failures.

Do you have serious problems with potency?

Have you tried a lot of remedies and nothing has helped? These symptoms are familiar to you firsthand:

sluggish erection;
lack of desire;
sexual dysfunction.

The only way is surgery? Wait, and do not act with radical methods. It is POSSIBLE to increase potency! Follow the link and find out how experts recommend treating...

Penile prosthetics is a popular service among clients of andrology clinics in Moscow. The operation consists of introducing prostheses into the cavernous bodies of the penis and is aimed at eliminating erectile dysfunction that cannot be treated with conservative methods.

Penile prostheses allow you to achieve high results and permanently solve problems with potency, regardless of the patient’s age. Thanks to their design features, implants give a man the opportunity to achieve a stable, long-lasting erection at any time.

Indications for penile prosthesis are:

cavernous fibrosis,
congenital anomalies penis development,
erectile dysfunction of vascular nature,
lack of potency due to Peyronie's disease,
ineffectiveness of drug treatment.

Despite its high safety, surgical intervention has contraindications. These include priapism, characterized by a pathologically prolonged erection, as well as blood clotting disorders, severe systemic diseases. To avoid complications, before installing a penile prosthesis with a retractable head or another type of implant, comprehensive examination patient.

Installation of three-component penile prosthesis AMS LGX 700

Clinical examples

Prices for installing a penile prosthesis

Prices for the installation of penile prostheses in Moscow are determined taking into account several factors:

country of production and type of prosthesis,
difficulties of surgical intervention.

This method of solving problems with potency is radical and allows you to restore an erection even when other methods are ineffective. Specialists at our andrology clinic in Moscow perform penile replacement using modern implants highest quality, the probability of breakdown of which is excluded. After finishing rehabilitation period the man returns to a full sexual life. The estimated cost of penile prosthetics in Moscow at Andrologist03 is shown in the table.

	the name of the operation	Cost of surgery, anesthesia, stay and treatment RUB.	Hospital stay (number of days)
1	Penile prosthesis (one-component prosthesis Russia)	from 120,000	2
2	Penile prosthesis (US single-component prosthesis)	from 250,000	2
3	Penile prosthesis (three-component prosthesis USA)	from 500,000	2
4	Reimplantation of penile prosthesis (replacement)	60 000-120 000	3
5	Surgical penis lengthening	70 000	0-1
6	Surgical thickening of the penis	70 000	0-1
7	Surgical treatment oleogranulomas (in 1 stage)	70 000	2
8	Surgical treatment of oleogranuloma (in 2 stages)	120 000	2
9	Surgical treatment of congenital curvature of the penis	from 60,000 to 120,000	0-1

To learn more about the procedure for installing a prosthesis, make an appointment with a urologist-andrologist by phone. We are waiting for you at the clinic!

Erectile dysfunction is 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 has long come up with a solution, but it comes to our country with very great difficulties. What are we 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, it suggests obvious conclusion, that in Russia penile prosthetics 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 greatest number 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 health insurance, and most citizens with permanent jobs have it, 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 adipose tissue near the bladder directly 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 a 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 to a 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 straight 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(anesthesia) 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 average duration life 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. The choice of a hydraulic implant is largely a 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 people 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 volume, 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 relates 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 recent years, apparently due to the financial crisis in the country, is manifested by 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 flows air, “nailing” 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 always participates in making this decision, because only the man himself has the right to decide for himself whether he wants to be sexually complete or sex life for him it is already a “long-read and forgotten book.”

Professor Nika Akhvlediani