Erectile Dysfunction / Penile Prosthesis

Erectile Dysfunction (ED) is a term that has recently been replaced by the word "impotence", i.e. a condition in which it is impossible to achieve and maintain an erection sufficient to perform a full sexual act. ED is one of the most common sexual disorders in men.

The sexual function is a Central part of a man's personality, helping to determine who he is and what his self-esteem is. Sexual function is also a key factor in determining the fullness of a relationship. Erectile dysfunction (ED) has a defining effect on all of this, and, thus, affects a key link in men's health. ED is widespread, especially among older men. Risk factors for ED are similar to those for cardiovascular disease and endothelial dysfunction, especially diabetes mellitus [1]. The prevalence of ED is 20-45%, and the incidence in Western countries has been estimated at 25 to 30 cases per 1000 people per year. Risk factors for ED are age (aging), diabetes and cardiovascular diseases, diseases of the genitourinary system, mental disorders, and other chronic diseases. Smoking, hormonal shifts, and certain medications may be associated with ED. To prevent the occurrence of ED, it is necessary to exclude the influence of harmful factors at the age of 50 years. Two-thirds of men with ED experience feelings of shame and embarrassment when discussing this problem with a doctor, and less than 25% seek medical advice [2].

Today, the most effective method of treating erectile dysfunction is considered to be the surgical method. Such surgical treatment is necessary in cases where there is no other way to restore an erection in a man. These cases include:

diabetes mellitus;
Peyronie's disease (penile curvature);
lesions of the penile vessels;
consequences of injuries and operations performed on the penis, urethra, prostate;
consequences of radiation itself or radiation therapy.

There are no other methods of treatment that can restore an erection in a man if it is caused by one of the above reasons and is also of a long and permanent nature.

Surgical treatment of erectile dysfunction is penile prosthesis or phalloprosthesis. It makes possible to regain the joy of intimate life and returns a man's confidence in himself and his abilities. The operation has a fairly high efficiency index – 97% of 100 patients have a recovery of sexual function after.

There are several types of penile implants:

Semi-rigid single-component plastic prostheses are when one prosthesis is installed in each cavernous body. Prostheses are essentially multi-layer silicone cylinders, in the middle of which there is a wire harness that holds the prosthesis in a certain position. If you are going to have sexual intercourse, then the penis is lifted up with your hand. After the sexual act is performed, the penis is also lowered down by the hand. The obvious advantages of this way are simplicity of operation, reliability and impossibility of breakdowns, low price. However, the penis is constantly hard and cosmetically inconvenient.
Two-component inflatable prostheses - hydraulic version of the prosthesis. Here, two cylinders with built-in reservoirs and a pumped pump are installed in the cavernous bodies of the penis. Arousal of the penis is achieved by the flow of liquid from the tanks to the cylinders, while several times pressing the pump, which is placed in the scrotum. To remove an erection, you need to bend the penis and hold it for a few seconds in this state. Here you can note a more natural erection compared to the previous type of prostheses. However, in terms of the quality of naturalness in a relaxed state, such prostheses are inferior to three-component ones.

This video briefly shows the progress of the falloprosthesis operation with a semi-rigid two-component prosthesis Coloplast GENESIS:

Three-component inflatable prostheses are the most cosmetically perfect prostheses to date. This prosthesis consists of cylinders that are installed in the cavernous bodies, a reservoir that is implanted in the pubic area and a pump located in the scrotum. All components are connected by special tubes. To excite the penis, it is necessary to press the scrotum several times. To remove the erection, you also need to click on the scrotum, only in a different place. Such operations are more expensive, and the result is subject to mechanical failure.

In our practice, we use TUBE ® semi-rigid prostheses of the Argentine company Promedon and GENESIS semi-rigid prostheses of the Danish company Coloplast. In addition, three-component inflatable prostheses Titan ® OTR from the Danish company Coloplast are used also.

REFERENCES:

1. Pommerville P. Erectile Dysfunction: an overview. Canadian Journal of Urology. 2003 Feb;10 Suppl 1:2-6.

2. Droupy S. Epidemiology and physiopathology of erectile dysfunction. Annales d'Urologie (Paris). 2005 Apr;39(2):71-84

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