WHAT DOES PENILE IMPLANT SURGERY CONSIST OF?
There are various methods for implanting a prothesis. The average surgery time is 45 minutes with local or loco-regional anaesthesia. There are three types of incisions: the infra-pubic incision (in the abdomen, above the penis), the incision on the penis, and the scrotal incision (in the scrotum, under the penis).

HOW LONG IS POST SURGERY IN-CLINIC STAY?
As it is a minor surgery, the post-operation period does not require specific care: the patient can leave the clinic within the 12-24 hours after the intervention, except diabetic patients who are recommended a minimum in-clinic stay of 48 hours. The patient may restart a normal sexual activity after approximately 3 or 4 weeks.

IS A PROTHESIS THE BEST SOLUTION FOR IMPOTENCE?
No, but in 10% of cases it is the only solution to ED problems that were untreatable some years ago. It is a relatively new discovery in medical science that solves many ED problems.

HOW MANY TYPES OF PRÓSTHESIS ARE AVAILABLE?
There are five main types of prothesis:

• Flexible
• Malleable
• Hydraulic (one piece)
• Hydraulic (two pieces)
• Hydraulic (three pieces)

Each of these types has its own characteristics, it’s advisable to consult the doctor to make an informed choice.

MALLEABLE PROSTHESIS
The malleable prosthesis consists of two cylinders that are implanted inside the corpora cavernosa. The position of the cylinders is adjusted upwards for sexual intercourse or downwards for daily activities.

Advantages:

• Easy to use (best option for men with impaired dexterity).
• Simple surgical procedure, due to the absence of mechanical components.
• It is the least expensive prothesis.

Disadvantages:

• The penis is permanently rigid, (not evident when clothed).
• The penis does not have such a natural appearance like in some other hydraulic prothesis.

HYDRAULIC PROSTHESIS (ONE PIECE)
Two cylinders are implanted in the corpora cavernosa of the penis. The cylinders contain a sterile saline solution that moves in its interior to give rigidity and flaccidity to the penis, allowing the patient to control the erection.

Advantages:

• Simple surgical procedure.
• The erection is more natural than with a malleable prothesis.
• More natural appearance in flaccid state than with a malleable prothesis.

Disadvantages:

• The erection and flaccid states are not as rigid as with a 3 piece hydraulic prosthesis due to the smaller quantity of liquid inside the rods.
• Around 5% chance of mechanical failures due to liquid leaks or breakage. This is more frequent than in a 3 piece prosthesis.
• Some ability is required to active the implant, there is a learning curve.
• Involuntary erections may take place.

HYDRAULIC PROTHESIS (TWO PIECES)
This prosthesis consists of two components: a pair of cylinders interconnected by tubes and a pump. The pump is implanted in the scrotum, between the testicles, and the cylinders are implanted in the corpora cavernosa. The device is filled with a sterile saline solution.

Advantages:

• Small pump, comfortable and easy to use.
• More physiological than a malleable or one piece hydraulic prosthesis.
• The flaccid stage is achieved easily and quickly in only 4 or 5 pumping actions.

Disadvantages:

• Some ability is required to active the implant, the activation / deactivation system is easier than in a one piece prosthesis.
• It has more mechanical components than a malleable prosthesis.

HYDRAULIC PROTHESIS (THREE PIECE)
This prosthesis has three components: a reservoir, two cylinders and a pump, connected between them by tubes. The reservoir is implanted under the abdominal muscles and behind the pubis and it is filled with a sterile saline solution. The cylinders are implanted in the corpora cavernosa of the penis, and the pump is placed in the scrotum, between the testicles.

Advantages:

• It provides the most natural-looking erection.
• With more liquid in the reservoir, the cylinders are expanded in width and length.
• Firmer, more complete erections than with previously described prothesis.
• When deactivated, the penis is softer and more flaccid than with other penile prothesis.
• Its management is easier than other penile prothesis.

Disadvantages:

• There is a learning curve to operate the prosthesis.
• It has more mechanical components than the other prothesis.
• There is a possibility for involuntary erections to take place.

WHICH IS THE MORE SUITABLE PROSTESIS?
The selection of the best-suited prosthesis for every case will depend on the anatomy of the penis as well as on the pathology that causes ED. The patient’s type of sexual activity will also be taken into consideration.

IS THE PROSTHESIS NOTICEABLE TO OTHER PEOPLE?
There is a difference between hydraulic prosthesis and the malleable ones. Hydraulic ones are totally unnoticed, being having a shower in the gym or with his partner. Malleable prothesis or non-hydraulic ones are more noticeable since they always maintain the penis in an erect state. They become comfortable as soon as the patient becomes used to it.

CAN NORMAL SEXUAL ACTIVITY BE PERFORMED WITH A PROSTHESIS?
Yes. The prothesis provides erections of optimum rigidity.

DOES THE PROSTHESIS CAUSE AN ERECTION TO BE PAINFUL?
No, by no means, once the recovery period post surgery is though, the patient will not experience pain.

IS IT NECESSARY TO CHANGE THE PROSTHESIS AFTER A PERIOD OF TIME?
Prosthesis have a lifetime guarantee however, it is impossible to predict the exact number of years they will continue to work with no flaws. As is the case with any another biomedical device, penile implants are subject to the wear and tear failures that occur in time in approximately 6 % of cases. If you an penile implant and you notice any change in its functioning, you should consult your urologist-andrologist.

WHAT ARE THE RISKS OF PENILE IMPLANT SURGERY?
The surgery involves little risk if it is done by an expert surgeon. It is necessary to avoid the possibility of infection at all costs. Under normal circumstances surgery is done with local anaesthesia and in occasions it is ambulatory.

Do you suffer from any of these problems?
Do you have a relative or a friend that may be experiencing any of these symptoms?