Prosthetics of the male member. Evaluation of the effectiveness and optimization of penile prosthesis techniques in patients with severe forms of erectile dysfunction. Classical treatments

Penile prosthesis is a surgical procedure for implanting implants into the cavernous bodies of a penis that mimic erectile function. With the help of this operation, a man can get rid of the most severe ones without compromising the processes of ejaculation and urination, without disturbing the appearance of the genital organs and their sensitivity.

Falloprosthetics (endofalloprosthetics) is a radical method of restoring erectile function, involving the destruction of the contents of the cavernous bodies of the penis. Removing the implants will result in complete and irreversible impotence, as a natural erection will not be possible. For this reason, penile prosthetics is performed only in cases where all other methods of treatment are meaningless or do not cause positive dynamics (like modern medicine).

Indications for surgery for penile prosthetics:

Diabetes.
Operations in the pelvic area, resulting in serious damage to the nerve plexuses and tissues.
Injuries of the pelvic bones.

Urologist-andrologist Alexei Plekhanov on the treatment of erectile dysfunction with penile prosthesis

Pathologies leading to a curvature of the penis or a change in its cavernous bodies: Peyronie's disease, underdevelopment of the penis, cavernous fibrosis.
Endocrine and vascular disorders that cannot be corrected with conservative therapy.
Inefficiency of reconstructive surgical interventions.
neurological diseases.

Inracavernosal penile prosthesis solves the problem of pharmacological impotence caused by the need to constantly take medications that suppress erectile function. The operation is also effective for uncorrectable psychogenic erectile dysfunction. There is no exhaustive list of indications for penile prosthetics. The decision to carry out the procedure is made on the basis of diagnostic findings.

Contraindications for the installation of penile prostheses for impotence include symptomatic and arterial (arbitrary painful erections), the presence of foci of infections.

Types of implants

The choice of the type of implant for penile prosthetics depends on the physiological parameters of the man, his ability to pay and personal wishes. At the consultation, the doctor offers the patient to get acquainted with demonstrative models that can be evaluated in action. In many clinics, computer simulations are performed that reflect the condition and size of the penis after the installation of one or another version of the penile prosthesis.

By design, implants are divided into 3 groups:

Semi-rigid silicone (unmanaged rigid) that do not change their shape and size. The penis is constantly in a state of erection, so it has to be pressed under underwear. Such models are the cheapest, but inconvenient, therefore, they are almost never used in penile prosthetics;
Plastic (controlled rigid)- also made of silicone, but inside there is a flexible rod that allows you to fix the position of the phalloprosthesis with your hand. Examples include AMS Spectra, Coloplast Genesis;
Inflatable (hydraulic), which are a biosystem of cylinders, tubes and a pump. This is the most physiological version of the implant, providing an almost natural penis erection.

Plastic penile prostheses are easy to install and use, they are the best option for men with the following pathologies:

Severe form of diabetes.
The presence of a colostomy.
abdominal obesity.
Diseases accompanied by violations of the movements of the hand.

The downside of semi-rigid falloprostheses is a reduction in the penis by 2-4 cm from the erect state. This is due to the lack of an erection of the head and the longitudinal static nature of the cylinders. Some men with decreased elasticity of the cavernous membranes (eg, Peyronie's disease) and an initial penis size of less than 10 cm before implantation are recommended to perform penis stretching exercises.

Most patients prefer hydraulic phalloprostheses. Depending on the configuration, they can be of two types: two, as well as three-component. Two-component (for example, AMS Ambicor) include 2 silicone inflatable cylinders (each of which is placed in the cavernous body of the penis) and a pump implanted in the scrotum. The design is communicated through flexible silicone tubes. The pump and cylinders are partially filled with sterile saline, which is why the penis never completely goes limp. When you press the scrotum (3-5 times), the liquid fills the cylinders, they increase in size, providing a full erection. After intercourse, you need to press the pump valve once and lightly squeeze the penis.

In three-component penile prostheses(AMS 700 CX or AMS-700LGX) e-liquid reservoir (60-75 ml) included. Due to this, the penis becomes completely relaxed after intercourse, which eliminates excessive tension of its tissues and bedsores. The reservoir is placed behind the pubic bone, without causing any inconvenience to the man. In the Titan OTR model from Coloplast, 1 press on the pump is enough to activate.

The non-return valve, which is equipped with modern phalloprostheses, excludes spontaneous filling of the cylinders. Managing the pump when properly installed (preferably in a dedicated scrotal pocket rather than between the testicles) is not difficult. When a pump is placed between the testicles, there are often problems finding it, especially in men with obesity, hydrocele, inguinal hernia.

Andrologist, Doctor of Medical Sciences Akhvlediani Nika Dzhumberovich talks about the design of the most common implants

Hydraulic phalloprostheses of the latest generation serve from 20 years. The structures are highly reliable, so there is no need for reimplantation before the end of the service life. AMS and Coloplast provide a lifetime warranty on their models. Products from these manufacturers have additional protection against infection: AMS has a patented antibacterial shell, Coloplast has a porous coating impregnated with antiseptics.

After penile prosthetics with some hydraulic models, the penis also loses 1-2 cm in length. But in modern implants (AMS-700LGX), the cylinders increase not only across, but also along, which allows you to increase the size of the penis.

Preparation for penile prosthetics

The preparation program for penile prosthetics includes:

Analysis of urine and blood;
Ultrasound of the peritoneum, penis, scrotum;
Assessment of the state of the vessels of the small pelvis and penis;
An interview with an anesthesiologist.

Any information regarding the presence or recent treatment of infectious foci is important to the doctor. For example, there is a known case of implant rejection a year after penile prosthetics. The reason is the concealment of information about the surgical intervention for purulent periodontitis, performed 5 days before the operation.

To prevent prosthetic infection the following protocol is observed before penile prosthetics:

Prophylactic antibiotic therapy (one day before surgery).
Washing the patient's body with an antiseptic (in the evening before the operation).
Shaving the operating area around the penis and antiseptic treatment.

On the day before the penile prosthesis procedure, the patient does not eat or drink anything. It is desirable to minimize food intake for a day so that during the operation it does not cause problems with the gastrointestinal tract that has relaxed from anesthesia (it is possible to throw the contents into the respiratory tract).

Methods for penile prosthetics

Phalloprosthesis takes 1-2 hours depending on the implant model being installed. The most complex in this regard are three-component prostheses.

Implantation of any model produced with minimal tissue damage. The prosthesis is inserted into the body in an empty state and only after installation is pumped with liquid, so a small incision is sufficient. After placing and filling the system, it is sealed.

Computer simulation of the operation

With the scrotal method of penile prosthesis, a longitudinal incision is made (in some cases directly along the natural suture of the scrotum) 4-5 cm long. Subpubic access involves dissection of the skin above the penis. This method allows you to speed up the rehabilitation period. Men in some cases go home the very next day after the operation. With scrotal access, 3-4 days of inpatient observation will be required.

With phalloprosthesis, part of the cavernous tissue can be preserved (Zilberman's technique), then the so-called complementary erection occurs in men. It enhances the effect of the implant by giving the penis additional volume and density.

If the volume of the penis is insufficient even under the condition of expanding cylinders of the penile prosthesis, then a combined operation is possible: implantation of the implant with simultaneous injection of the PLGA polymer. The substance forms a framework around the cavernous bodies, which subsequently acquires its own tissue.

Rehabilitation and complications

Immediately after the operation, the implant is activated and emptied the next day. The first days after penile prosthetics, the patient is in the hospital, then the observation is carried out on an outpatient basis. For several days, minor pain persists, which is stopped by analgesics. For 2 weeks, prophylactic antibiotic therapy is carried out. After the operation, you will have to take a sick leave for a period of 2 weeks to eliminate the risk of injury to the organ, not to provoke the formation of hematomas and edema.

Possible complications after penile prosthetics:

Occurring during the procedure: damage to the bladder, urethra, walls of the cavernous bodies. The degree of risk depends on the qualifications of the surgeon, the effectiveness of compensation for concomitant diseases;
Upcoming postoperative: scrotal hematomas, prosthetic infections. The risk of development in men with decompensated diabetes mellitus, cysto- and colostomy is increased;
Remote: periprosthetic infection, damage to the integrity of the corpora cavernosa, prosthesis displacement, penis deformity, pain. Proper selection of the implant size will help prevent such consequences of penile prosthetics. Patients with Peyronie's disease require more careful postoperative monitoring.

Prosthetic infection during penile prosthetics occurs in 0.5% of cases and always requires replacement of the implant. It can be manifested by severe redness, swelling of the scrotum and penis, protrusion of prostheses and pump, pain. With such symptoms, you should immediately consult a doctor.

When a penile prosthesis is performed by a competent specialist, complications rarely occur. These are mainly hematomas of the scrotum, inflammation of the suture, lymphostasis. Hematoma is treated conservatively for 2-3 weeks. Elimination of lymphostasis can take several months.

In some patients, after penile prosthetics, implant breakage occurs in the form of damage to silicone tubes or a pump. In such cases, an isolated replacement of parts is performed. Occasionally the pump fails. Usually the reason lies in the sticking of the needle. To eliminate it, you need to massage the scrotum, activate and deactivate the implant several times.

You can have sex after surgery after 1-2 months(with the prior approval of a doctor). Usually the first activation is allowed from 3-4 weeks. If the hydraulic penile prosthesis is not used for a long time, then a fibrous capsule may form around the cylinders, which subsequently will not allow them to expand. That's why in the absence of intimate relationships, prophylactic injection of fluid into the penis is necessary.

Cost of penile prosthesis

The price of penile prosthetics depends on the status of the clinic, the qualifications of the doctor and the chosen implant model. The cost of an operation to install (only for the work of a doctor) one-component plastic implants starts from 35 thousand rubles, two-component ones - from 60 thousand rubles. Installation of a hydraulic three-component - 100-350 thousand rubles.

The latest generation hydraulic implant AMS 700 LGX costs from 350 thousand rubles. One-component AMS Spectra - from 60 thousand rubles. A phalloprosthesis can be purchased directly from the clinic, from dealers or directly from the representative office of the manufacturer.

Currently penile prosthesis (prosthetic penis) is a radical treatment erectile dysfunction. Treatment involves the introduction of a silicone prosthesis into the cavernous bodies of the penis. Several types of prostheses have been developed, which will be discussed in detail below.

Indications for penile prosthetics:

Fibrosis of the corpora cavernosa

age-related erectile dysfunction

penis injury

Erectile disorders after operations on the pelvic organs and prostate (prostatectomy, cystectomy, TURP, adenomectomy)

Currently, several types of phalloprostheses (prostheses of the penis) have been developed and used:

The rods can be placed up (during sexual intercourse) or covered down (in a normal situation).

In preparation for sexual intercourse, straighten the penis, fully straightening the rods in it. To hide the penis in normal life, bend the rods down. The penis can be bent along its entire length, so that it more comfortably surrounds the scrotum from top to bottom.

Advantages:

Ease of management for patient and partner.
The simplest implantation operation is of particular importance for patients with severe comorbidities, when the operation must be performed with minimal trauma (severe diabetes mellitus, after spinal injury, in colostomy patients).
May be the best choice for a patient who finds it difficult to perform precise hand (hand) movements - after a spinal injury, with rheumatoid arthritis, hand contracture, missing (traumatic) phalanx or whole finger on the hand.
Few mechanical parts, and therefore the risk of mechanical failure is minimized.
In most cases, a one-day stay in the hospital is possible (if it matters to the patient, however, subject to the hygienic and therapeutic regimen outside the hospital).

Three-component hydraulic penile prosthesis AMS 700 Ultrex

This phalloprosthesis (endofalloprosthesis) consists of three components (hence the name - three-component) connected by tubes: a reservoir, 2 cylinders and a pump. The reservoir is implanted under the abdominal muscles and filled with sterile saline. The cylinders are implanted into the cavernous bodies. The pump is placed in the scrotum between the testicles.

To achieve an erection, the pump is compressed, which pumps fluid from the reservoir into the cylinders and brings the penis into a state of erection.

To relax the penis, it is necessary to squeeze the closing valve on the pump, which will empty the cylinders and refill the reservoir.

Advantages:

Recognized by all experts as the "gold standard" of implant surgery for erectile dysfunction
Erectile function returns to the patient, and he can cause an erection, of any duration, at will, at any time, as many times as he likes, which is not achieved with any other method of treating erectile dysfunction (impotence).
All components are inside the body and there is no need to use any external devices (such as a vacuum pump) to induce an erection. Moreover, inflating the prosthesis in many couples becomes part of the sexual ritual.
Most closely to the natural imitates the erection and relaxation of the penis, which makes it almost invisible even to a sexual partner.
In the inflated state, it has a more filled and stressed state.
Very high mechanical reliability despite the complexity of the device.

Flaws:

To create an erection and relaxation, a certain precision of finger movements is required, which is sometimes difficult for elderly patients and patients with neurological disorders. In this situation, the help of a partner will be necessary.
Contains a greater number of mechanical parts, which slightly increases the likelihood of breakage of the prosthesis
Somewhat difficult to implant.
The high price of a phalloprosthesis (endofalloprosthesis).
As with any operation, when implanting a penile prosthesis

Incomplete monoprosthetics of the residual penis.

Phalloprosthetics is the installation of implants in the region of the cavernous bodies of the penis. Radical therapy, which is used for impotence, if other methods do not give the desired effect. The inability of a man to achieve an erection and maintain it during intercourse is a problem for men of mature age.

But often it is faced by younger people. Modern medicine has in its arsenal various methods of healing the disease.

Classical treatments

The cause of impotence is the poor filling of the cavernous bodies and the rapid outflow of blood, leading to the inability to complete sexual intercourse. The main methods are aimed at restoring this function.

Most often, the patient is prescribed complex therapy. You should not engage in healing and try out pills and devices from advertising on yourself, you can worsen your condition.

impotence treatment

An integrated approach combines not only various methods, but also psychological assistance. Often the cause can be far-fetched problems. Therapy for such an ailment is a consultation with a sex therapist.

Treatment with drugs has different directions. It can be tablets, ointments, rectal suppositories. Their action is to eliminate the causes.

Vacuum treatment is the injection of blood to the genitals with the help of a pump and fixing it with a special ring at the base of the penis. This is enough for 20-30 minutes to complete the act. The operation of the device is not therapeutic.
Genital and perineal massage is part of complex therapy. Improves blood circulation, increases sensitivity, relieves nervous tension.
intracavernous method. Injections of medications into the cavernous body of the penis to stimulate an erection.
Shock wave therapy. Improves blood circulation, promotes the growth of new blood vessels.
Physiotherapy exercises are necessary for those who lead a sedentary lifestyle. Special exercises improve blood circulation in all organs. Relieve tightness of the muscles that affect erection, has a urological effect.
Surgery is the last opportunity to restore potency. Used when other treatments have failed.

erectile dysfunction

An erection is a necessary condition for sexual intercourse. When a failure occurs, not only physical, but also psychological problems arise. In the penis, the cavernous bodies are poorly filled with blood during arousal.

She quickly leaves the organ. The entire process is controlled by the central nervous system. If it fails, nerve impulses are interrupted, impotence occurs.

In addition, there are a number of other reasons leading to this problem. Dysfunction indicates a deterioration in overall health.

Often men turn to a specialist for help late. The main method of treatment remains radical. Phalloimplantation is successfully used in all countries.

The recovery rate reaches 90%. For many, this method is a salvation from the disease. The condition before and after implantation is very different.

Varieties of penile prosthetics

The operation is the installation of a special device in the genital organ. Implant - what is it? What types does it have?

Rigid, elastic - these are cylindrical silicone rods. Used at the beginning of prosthetics. The disadvantage of the method is that the penis is permanently erect. This negatively affects the psychological state of the patient.
Semi-rigid, plastic with memory, one-piece prosthesis. Inside, there are additional metallic silver threads that help to ensure the location of the penis during intercourse. The man independently raises it with his hand after intercourse lowers it. The difficulty lies in the fact that the body is constantly in a solid state.
Inflatable or hydraulic. They are of three types. They are made up of different parts.
One-component - hard, low quality.

Two-component - contain a liquid that moves inside the prosthesis. The patient himself can regulate the entire process of intercourse.

For excitation, press it several times to start the filling process. After finishing, bend the penis and hold it for a while so that the liquid comes down and the excitement subsides.

A three-piece implant is made from anti-allergenic, durable materials. It consists of three parts:

Two cylinders in the form of cavernous bodies of the penis.
An oblong-shaped reservoir that is filled with a sterile liquid in a volume of not more than 100 ml. It is placed next to the bladder (adipose tissue).
Liquid transfer activator. Located in the scrotum.

The principle of operation is to start it, which controls the flow of fluid from the reservoir into the cylinders, gradually increasing the erection.

Turning it off reverses the process. Component is considered the most modern, closest to natural sexual intercourse.

Indications

If complex conservative treatment did not bring positive results.
The effect of Peyronie's disease, when a strong curvature leads to impotence.
Unsuccessful surgical operations on the genitals, prostate, bladder, rectum.
Severe course of diabetes.
Sequelae of prostatectomy, adenomectomy. Restoration of erectile function.
Underdevelopment or atrophy of the penis.
Deterioration of the blood circulation of the organ, vascular pathologies.
Fibrous disorders of the inner layers of the penis.

Contraindications

There are medical indicators when the operation is not possible.

The presence of venereal and infectious diseases.
Poor blood clotting.
Chronic pathologies of the genitourinary sphere.

Pros and cons

Like any surgical operation, the introduction of a prosthesis is a difficult test for the patient. About 10% of those operated on will be dissatisfied with its outcome.

After the implant is installed, the integrity of the cavernous bodies of the penis is violated.
There is no way back.
The organ will stand only with the help of a pump.
Another disadvantage is the high price.
If the implant fails, the operation is repeated to replace it. There are no other treatments.

The positive side of plastic is:

Restoration of erection, the ability to have children.
The establishment of a three-component prosthesis is as close as possible to natural intercourse.
A woman may not even be aware of its presence. Conception is possible, fertilization occurs naturally.

Training

The operation is carried out according to the doctor's prescription, after a thorough examination. Many people need psychological counseling.

The surgeon who will perform plastic surgery must explain to the patient how it is performed, possible complications, the risk of relapse, and the duration of rehabilitation.

Pick up implants together, analyze the mechanism of action. The anesthesiologist determines the type of anesthesia. Selected according to the length of the penis.

You need to know that during the operation, it decreases slightly. This happens least of all with three-component plastics (up to 1 cm).

Operation

Implant technology is a serious procedure that must be carried out in a medical facility under sterile conditions to avoid infection.

It is done under general or spinal anesthesia. Its course will depend on the number of components. The most difficult and lengthy consists of three stages.

Bougienage (removal of cavernous bodies). A necessary process for any plastic surgery. Cylinders made of soft materials are inserted into these cavities. An incision is made at the base of the penis.

With a special tool, cavities from the cavernous bodies are released (bouginated). The patient must know that they are not subject to recovery. There are two cylinders.

The second stage is the implantation of the pump into the adipose tissue of the scrotum, combining with the help of special tubes. To do this, you need to make another incision on the scrotum.

The third stage is the installation of a reservoir with liquid, which is installed at the bottom of the peritoneum behind the pubis. Make the last cut. All objects are connected by tubes.

For seams, special threads are used to minimize external cuts.

Benefits of prostheses

Plastic gives an almost 100% guarantee of the treatment of the disease. The use of modern materials and technologies provides hope for those who have tried all sorts of methods.
Sexual contact is allowed after two months.
Does not require constant medical supervision.
The penis and head remain sensitive.
Gives the chance to conceive a child. The long-awaited pregnancy is coming.
The ability to control the duration of sexual intercourse until the partners are completely satisfied.

Complications

As a result of unsuccessful prosthetics, there may be:

Rejection of the implant.
Heavy bleeding.
Damage to the urethral canal and head of the penis.
Tissue death (necrosis).
Deformation and curvature of the penis.
Blueness and bruising.

Rehabilitation

After the operation, the patient should be under the supervision of specialists for about a week.
The first two days - bed rest.
Administering an antibiotic intravenously, then in the form of tablets to avoid infection.
There will be swelling and pain for about a month.
Before starting sexual relations, you need to consult a surgeon.

Price

The operation is quite complicated. Its price depends on the complexity and implants that will be implanted. The cheapest ones are single-component.

Their cost is from 500 to 800 USD. Of the two - 1300-1600 USD Expensive ones consist of three devices - 8-15 thousand USD.

Erectile dysfunction today is understood as the impossibility of sexual intercourse. At the same time, the man cannot enter the penis and finish intercourse due to insufficient tension of the penis or due to the disappearance of the tension state. There are quite a few causes of dysfunction and far from always they can be eliminated by a surgical or therapeutic method.

penile prosthesis

The cause of erectile dysfunction is insufficient fullness of the cavernous bodies. With normal filling, the penis becomes quite tense, retains firmness for some time, sufficient for sexual intercourse. With low fullness, there are difficulties with erection. With an excessively rapid outflow of blood, the penis loses its hardness too early, which leads to the inability to complete sexual intercourse.

There are several methods of treating impotence today.

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

Conservative method - involves taking special drugs that enhance the filling of the cavernous bodies and thereby reduce the manifestation of impotence.
Surgical - in the usual case, it involves surgery on the vessels. At the same time, to fill the cavernous bodies, another artery is connected or some veins are blocked, which prevents the outflow of blood. However, with a complete loss of erection, this method is powerless.
Restorative - actually phalloprosthesis. In this case, special devices are introduced into the penis and installed to achieve an artificial erection.

Phalloprosthesis 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, the partners of former patients are not even aware of the presence of implants in the penis. The only contraindication to prosthetics is the possibility of cure by conservative or surgical methods.

There are several restoration methods associated with different shapes and types of prostheses.

Indications

If the cause of erectile dysfunction is damage and organic changes in tissues, it is impossible to restore normal blood flow. Only in such cases, and resort to phalloprosthesis.

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 the normal tissue of the organ with a non-functional fibrous one;
scarring of the cavernous bodies - also refers to irreversible changes;
- pathology of the albuginea, leading to dysfunction;
complications after injuries or operations on the pelvic organs - the rectum, bladder, which led to the appearance of impotence;
dysfunction against the background of severe diabetes mellitus;
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 of the course of treatment, and the results of surgical intervention become less impressive over time.

The choice 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.

Consider what prostheses are:

One-component plastic - the most affordable, but somewhat inconvenient to use. There are 2 types of such devices:
- resilient or flexible. Made from silicone or vinyl. They are flexible tubes. One phalloprosthesis is inserted into each cavernous body. With this form of prosthetics, the member, as it were, is in an erect state all the time. Since the prosthesis is flexible, in clothes the penis is simply pressed with shorts. The cost of such prostheses is the lowest, so they are installed most often. There are no special indications for the choice of this particular species;
- semi-rigid - or with a memory effect. Such a prosthesis is a multilayer silicone cylinder, inside which a wire tourniquet is placed. The penis in an erect state is provided by the latter: for this, before copulation, the penis is raised by hand. In the normal state, the penis 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 look. In addition, it must be taken into account that after the installation of a semi-rigid prosthesis, the length of the penis decreases by 2–3 cm.
Two-piece prostheses - hydraulic. The implant mimics the natural reaction, which provides a more natural erection and a normal state of rest. 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, the pump is placed in the scrotum. 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 remove 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, as it is clearly unnatural.

Three-component - inflatable. Today they are considered the best models and, accordingly, are the most expensive. This option provides the maximum aesthetic effect: the erection looks quite 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 tank fills the rigidity chambers and the penis "gets up". There are protruding strips on the pump, which are quite audible to the touch under the skin. To relieve an erection, the strips must be compressed with constant pressure so that the water from the rigidity chambers returns to the reservoir. Such a device is more complicated, and therefore the risk of mechanical damage is higher.

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

Falloprosthesis 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.

The course of the operation and rehabilitation

The operation is performed only if all other means of treatment, both medical 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, it will also be possible to restore erectile function only with the help of a second reconstructive operation.

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

First of all, the possibility of prosthetics is established: in a number of diseases, especially the genitourinary system, the implantation of an implant may be undesirable, if not impossible.
A general examination is carried out to exclude such diseases as tuberculosis, cancer, sexually transmitted diseases, as well as cardiovascular pathologies.
Psychological preparation - as already mentioned, after the installation of the prosthesis, a 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, while 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. It depends on the state of the body and the complexity of the prosthesis: three-piece models require more extensive surgical intervention, so the operation takes longer. If penile prosthetics is performed under general anesthesia, the patient is forbidden to eat and drink 8-12 hours before the operation.

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

removal of 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 area of the scrotum 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 just as important as the achievement of functionality, therefore, during the operation, techniques and suture material are used, which ensures maximum invisibility of the sutures.

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 the maximum success of prosthetics, after the operation, it is necessary to follow a number of medical prescriptions:

The first 2 days - sometimes more, the patient must observe strict bed rest.
Depending on the presence of concomitant diseases, the urologist selects an antibiotic. The drug is administered intravenously for 48 hours. In 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, suture healing occurs in 2 –3 weeks. In this case, there may be pain, almost always there is swelling. As a rule, these symptoms completely disappear in 4 weeks.
It is necessary to refrain from sexual intercourse for 6-8 weeks. Before resuming sexual activity, you need to visit a surgeon and listen to his recommendations.

On the video, the operation of phalloprosthesis:

Possible Complications

Penile prosthesis does not affect fertility, seminal fluid production, or the act of urination. This is the most important advantage of the reconstructive operation. The main disadvantage is the impossibility of restoring the natural mechanism of erection.

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

The main risk is infection. To minimize it, use only absolutely sterile preparations. In addition, a course of antibiotics is prescribed to prevent the possibility of infection.
There is a small but risk of implant failure. If within 2 weeks after the intervention there is pain, fever, a second operation and cleaning is necessary.
If the implant is chosen incorrectly, the prosthesis after some time begins to squeeze the head of the penis, which can lead to necrosis. Unfortunately, this complication cannot be identified immediately.
According to statistics, about 20% of prostheses fail after 10 years. In this case, it is necessary to repeat the penile prosthesis.

Phalloprosthetics is a rather complicated operation, leading to irreversible changes in the genitals. It is carried out only in cases where conservative or surgical methods cannot restore erectile function.

Phalloprosthesis is a modern surgical technique. The first attempts to install prostheses in the penis were made in the 30s of the last century, but the method gained practical significance only after the use of silicone implants began. Bioinert silicone rarely caused complications and was well suited for the manufacture of various designs. Since then, the field of penile prosthesis began to develop rapidly, first rigid, and then semi-rigid and inflatable multi-component prostheses appeared. Today, implantation of a prosthesis is a routine operation, carried out in most large clinics and specialized departments of andrology.

Indications

Indications for intervention are Peyronie's disease, fibrosis of the cavernous bodies, congenital anomalies and underdevelopment of the penis, post-traumatic deformities of the penis. Phalloprosthesis is performed for erectile dysfunction caused by atherosclerosis, angiopathy in diabetes mellitus, other vascular disorders in arterial diseases and persistent metabolic disorders. The method is also used for impotence resulting from interventions on the pelvic organs.

Psychogenic impotence, resistant to repeated courses of conservative therapy, is considered as an indication for penile prosthetics. The intervention is carried out in the presence of medical contraindications to drug and non-drug methods of erection stimulation and if the listed methods are personally unacceptable for the patient. In addition, penile prosthetics is performed after the creation of an artificial penis when changing sex.

Contraindications

The list of general contraindications includes acute respiratory diseases, severe chronic somatic pathology, decompensated diabetes mellitus, blood clotting disorders and local purulent processes (abscesses, boils, etc.), regardless of their location. Contraindications to phalloprosthesis from the genitourinary system include purulent processes in the scrotum and penis, acute inflammatory diseases, exacerbation of chronic pathologies of the genitourinary organs (cystitis, urethritis, orchitis, balanoposthitis, etc.), as well as priapism.

Preparation for penile prosthetics

The andrologist examines the patient and draws up an examination plan taking into account the identified pathology. When determining indications, the results of cavernosography, cavernosometry, papaverine test, ultrasound of the penis, caverject test are used. After analyzing the results of the examination, the doctor selects the prosthesis of the right size, taking into account the anatomical structure of the male penis. On the evening before and in the morning on the day of penile prosthetics, the area of the external genitalia should be treated with a disinfectant solution. Hair in the area of operation must be removed. Intervention is performed on an empty stomach.

Methodology

There are three main types of penile prostheses: rigid, plastic and inflatable. Rigid structures are practically not used at present. Elastic and inflatable (two- or three-component) implants are used. Falloprosthetics with an elastic (one-component) prosthesis is carried out by implanting multilayer silicone cylinders, in the center of which there is a metal rod with shape memory. The presence of such a memory allows the prosthesis to maintain a certain position. Before the onset of sexual intercourse, the patient raises the penis with his hand, and after the completion of sexual contact, lowers the organ downwards.

Phalloprosthetics with an inflatable two-component prosthesis is carried out using a design that includes a pump and two cylinders with reservoirs. The pump is installed in the scrotum, the cylinders are placed in the cavernous bodies of the penis. For the onset of an erection, the patient presses the pump several times, the liquid enters the reservoirs through the tubes, the penis becomes hard and increases in size. To return the penis to a non-erect state, the patient bends the organ and holds it for several seconds until the fluid moves back into the pump.

Installing an inflatable three-component prosthesis is the most modern way to provide an artificial erection. A three-piece prosthesis consists of hollow cylinders, a pump and a fluid reservoir. The cylinders are placed in the cavernous bodies, the pump is implanted in the scrotum, the reservoir is placed behind the pubic joint. To achieve an erection, the patient repeatedly presses on one area of the scrotum, to eliminate an erection - on another.

The installation of all types of prostheses is carried out under general anesthesia. In most cases, a subpubic, penoscrotal, or subcoronal approach is used to install a prosthesis in the penis; less commonly, ventral, dorsal, perineal, or suprapubic approaches are used. During phalloprosthetics, the fascia of the penis is peeled off to the albuginea, then the cavernous bodies are dissected and channels are formed for the installation of implants.

In patients with fibrosis of the penis, if necessary, the reconstruction of the cavernous bodies is performed. When using an inflatable prosthesis, a pump pocket is formed in the scrotum. When phalloprosthesis with a three-component implant, a cavity for the reservoir is created in the area of the pubic joint. The bleeding vessels are coagulated, the components of the prosthesis are placed, and the operability of the implant is checked. Wounds are sutured and covered with sterile dressings. The duration of the operation is 1.5-2 hours.

After penile prosthesis

For several days, the patient is advised to stay in bed. Dressings are carried out, parenteral administration of analgesics and antibacterial agents is carried out. The sutures are removed on the 7-10th day. The duration of hospitalization varies from 2-3 to 7-10 days, depending on the specific clinic and operation technique. Sexual intercourse is allowed after 1.5 months.

Abundant bleeding, damage to the urethra and neurovascular bundles are rare. In the early postoperative period, pain, swelling and infection of the wound are possible. Excited penis after the operation on average becomes shorter by 1.5 cm. Feelings of partners correspond to a natural erection. Within 10 years, about 20% of inflatable penile prostheses fail. It is possible to replace the device with another implant. Phalloprosthetics cannot cure impotence, after the removal of the implant, an independent erection is impossible.