Penile+Implants

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Mike Glusker

** Penile Implants ** = = **What are penile implants?** Penile implants, sometimes known as penile prosthesis, are devices put inside of the penis that allows men with erectile dysfunction (ED) to get an erection. Penile implants are typically used when there is a clear medical cause for erectile dysfunction and when the problem is unlikely to resolve or improve naturally or with other medical treatments (Mulcahy, 2010).

**Types of Penile Implants** There are two main types of penile implants: malleable implants and inflatable implants, where both are inserted into the penis by surgery (Montorsi, 2004). Malleable implants are the simplest and least expensive, and consist of two rods that are surgically implanted inside the penis that can be folded and bent up or down to be erect. During sexual activity, the penis is straightened, and afterwards can be bent downwards close to the body for concealment. Essentially, the result of this type of penile implant is a permanent erection that can be re-positioned as re quired.Inflatable implants consist of two cylinders, a reservoir and pump, which are placed surgically into the penis. The two cylinders are inserted and connected by tubing to a separate reservoir of fluid. The reservoir is implanted under the groin muscles. A pump is also connected to the system and sits under the loose skin of the scrotal sac, between the testicles. To inflate the prosthesis, the man presses, or inflates the pump. The pump transfers fluid from the reservoir to the cylinders in the penis, inflating them and causing an erection. In order to deflate the penis to its original flaccid state, the man presses on a deflation valve at the base of the pump which returns the fluid to the reservoir. Most men elect the malleable implant because it is simplest of the two implants, and is easy to use, requiring no mechanical parts. Also, there is no waiting time for the penis to become erect. Although the malleable implant is cheaper, some men choose the inflatable because it creates a more natural looking erection and enables the penis to return to a flaccid state, which makes concealment easier.

**Risks and complications associated with penile implant surgery** As with any major surgery, there are some risks. There is also ways a risk of infection. Men with spinal cord injuries or diabetes face greater risk of infection during penile implant surgery. There is a much higher risk of infection during revision surgery, if there needs to be an adjustment or replacement of an implant. Although modern day implant surgeries are safe and reliable, there are rare cases in which there are complications. In some malleable implants, internal parts can break down and not work properly, and in cases where inflatable implants are used, fluid can leak or the pump device can fail. In any of these events, corrective surgery is required (Bettochi, 2008). There have also been several reported side effects following surgery which include uncontrolled bleeding, scar tissue formation, erosion, and mechanical failure leading to re-operation and removal. Although there are some possible risks and complications, around 85% of implants produce full erections, while 77% of men report they are satisfied with the results.

**Peyronie’s Disease and Penile Implants** Another reason penile implant surgery may be performed is to treat a disorder called Peyronie’s disease. Peyronie’s disease is a connective tissue disorder effecting the soft tissue in the penis. This affects nearly 10% of men and can causes pain, abnormal curvature of the penis, erectile dysfunction, indentation, loss of girth, and shortening of the penis. In many cases, doctors will suggest patients with this disease undergo corrective penile implant surgery (Kugler, 2008). The most common symptom of Peyronie’s disease is a curvature in the penis when erect due to chronic inflammation of the tunica albuginea. Under these conditions, sexual intercourse can be difficult and painful for both man and partner. The loss of resilience and subsequent hardening of the penile structure often leads to an increasing reduction of the erection ability. As a result, nearly a third of all men will develop impotence. Furthermore, without corrective surgery, about 30% of men with Peyronies will develop fibrosis in the elastic tissues, which will worsen the condition.

**Alternative to penile implant surgery** Since surgery is considered a last resort by most physicians, men with erectile dysfunction are generally recommended to seek out other methods of treatment. As erectile dysfunction has become more widely discussed in the media, mainstream society has become aware of its frequency among the male population. One of the most common non-surgical options today is the use of External Vacuum Devices (EVDs). These vacuum devices are especially designed to produce erections, and have been successful for many years due to the fact that they are safe, inexpensive, and reliable (Thomas, 2005). The typical vacuum device consists of a plastic cylinder that is placed over the penis, tension rings of various sizes, and a small hand pump. Air is pumped out, causing a partial vacuum, which draws blood into the penis and creates the erection. Once an erection is obtained, a tension ring, which acts as a tourniquet to keep the blood in the penis and to maintain an erection, is placed around the base of the penis. Although these devices are generally safe, bruising can occur and the erect penis may lack some support. Other possible side effects may include pain, lower penile temperature, numbness, no or painful ejaculation, and pulling of scrotal tissue into the cylinder. Since the introduction of the drug Viagra in 1998, the Food and Drug Administration (FDA) has approved two other additional drugs in the same class, those being Levitra and Cialis. These drugs work by blocking an enzyme found mainly in the penis that breaks down a chemical created during stimulation that increases blood flow in the erectile bodies of the penis, which then produce erections. These drugs will not have any effect without sexual stimulation and have shown to work successfully in about 65-70% of all men with erectile dysfunction. Some men who experience erectile dysfunction have low levels of the male hormone, testosterone. In these cases, hormonal replacement may be beneficial, but is typically combined with other treatments because it has not known to make great improvements when taken alone. Other, less common alternatives that are used to treat erectile dysfunction include Penile Injection Therapy (PIT) and Intraurethral Pellet Therapy (IPT).

Bettocchi, C. (2008). //Penile Prosthesis: What Should We Do About Complications?// Advanced Urology Journal. Kugler, M. (2008). //Peyronie’s Disease: A Condition that Affects the Penis.// Health Disease Journal. Montorsi, F. (2004). //Penil Implants in the Era of Oral Drug Treatment for Erectil Dysfunction.// BJU International. Vol.94 Issue 5, p745-751. Mulcahy, J. (2010). //Current Approach to the Treatment of Penile Implant Infections.// Thereauputic Advances in Urology. Sage Journal Online. Thomas, A. (2005). //Nonsurgical Treatment of Erectile Dysfunction.// Sexual Health Journal. E-MedicineHealth. Pictures from []