Penile prosthesis

Editor-in-Chief: Joel Gelman, M.D. [mailto:jgelman@uci.edu],  Director of the Center for Reconstructive Urology and Associate    Clinical Professor in the Department of Urology at the University of    California, Irvine

Synonyms and keywords: Penile implant

Overview
A penile prosthesis is medical device implanted in a penis during a surgical procedure to enable an erection for satisfactory and satisfying sexual intercourse. The device is not used only in men with organic or treatment-resistant psychogenic impotence who fail to achieve and maintain an erection using erectile dysfunction drugs. A penile prosthesis is also used in the final stage of plastic surgery phalloplasty to complete female to male (transman) gender reassignment surgery as well as during total phalloplasty for adult and child patients that need male genital modification because of congenital anomalies, iatrogenic, accidental or intentional penile trauma, and micropenis.

Semirigid or Inflatable
The most common penile prosthesis has been in use for over 25 years. The current technology of these medical devices is quite safe and effective. Semirigid devices range from permanently erect ones that cannot be altered to malleable ones that can be bent into an unnoticeable position when appropriate.

Inflatable devices use fluid, not air, and are inflated or deflated on demand. Almost all current devices perform satisfactorily for a full decade before needing replacement. The leading manufacturers are American Medical Systems Inc., Mentor Corporation and Timm Medical Technologies.

Not Only for Men with Erectile Dysfunction
A penile prosthesis can help men with erectile dysfunction that get no results from erectile dysfunction drugs. In addition, The British Journal of Urology International reports that unlike the limitations of metoidioplasty (metaoidioplasty) for female to male transsexual patients which usually results in an average penis size of 5 cm long and narrow width, current total phalloplasty neophallus creation using a musculocutaneous latissimus dorsi flap results in a long, large volume penis which enables safe insertion of any brand or model of penile prosthesis.

This same total phalloplasty technique enables male victims of minor to serious iatrogenic, accidental or intentional penile trauma injuries (or even total emasculation) caused by motor vehicle accidents, child abuse, animal bites, gun shots, burns, electrocution or self-mutilation to get large penises very suitable for penile prosthesis implantation so they can have successful sexual intercourse.

In some cases of genital reconstructive surgery, implantation of a semirigid prosthesis is recommended three months after total phalloplasty to prevent phallic retraction. It can be replaced later with an inflatable one.

Advantages

 * 1) Mechanical failure is rare: most often inability to deflate the penis because of pump failure; less often inability to inflate the prosthesis; and sometimes disconnection or failure of the reservoir.
 * 2) IPP (Inflatable Penile Prostheses) are unnoticeable and undetectable even under tight clothing such as swimsuits or jeans (see comments of woman partner).
 * 3) The erection can be maintained as long as necessary, or as long as desired without any of the potentially serious complications of organic priapism.
 * 4) Psychological and emotional well-being is greatly enhanced in most men who undergo implant surgery.

Disadvantages

 * 1) The glans does not enlarge and penetration may be awkward. The penis also may not be as firm as a natural erection.
 * 2) Some models do not deflate easily; some degree of manual dexterity is required to operate any of the inflatable models, making them inappropriate for men with other neurological disorders such as stroke or Parkinson's disease.
 * 3) The penis may not be completely flaccid, depending upon the model of prosthesis (most usually seen in semi-rigid or malleable implants).
 * 4) No increase in length normally occurs, and many men lose between 1-2cm (.25 to .75 in)in length. The AMS 700 series of inflatable prostheses, particularly the Ultrex model, allows for girth and distal expansion; the CX model imparts girth expansion only
 * 5) Following surgery, expect one to two weeks of moderate or occasionally severe pain, usually easily controlled with analgesics.  This is most often due to scrotal swelling, which can be quite remarkable and profound at times.  Normal sexual intercourse can be resumed six to eight weeks post-operatively, pending clearance from the surgeon.
 * 6) Only 80-92% of men report complete satisfaction with the prosthesis, although higher figures are often quoted by some physicians.  Some more recent studies, however, indicate a patient satisfaction quotient of 95% or better, attributable, at least in part, to improved technology in the prosthesis itself, improved surgical techniques making the procedure less painful, and more reasonable patient expectations.
 * 7) The inflation of the devices is not instantaneous, but can be accomplished discretely nonetheless.
 * 8) There is a 2-10% complication rate, mainly as a result of infection or device failure.

Some studies indicate a partner satisfaction rate of 70% or less, due, some studies suggest, to heightened or unreasonable expectations. Many surgeons are now recommending that both partners be counseled pre-operatively regarding outcome and expectations.

It can be difficult to conceal that you have a prosthesis because the scrotal components are hard and irregularly shaped. Any woman feeling your scrotum will be puzzled. Manual stimulation can be painful.

Erectile Dysfunction Drugs & External Devices
Vacuum devices (penis pumps) and oral, suppository or injected erectile dysfunction drugs are not penile prostheses. Nor are dildos or any other externally operated device or sex toy.