How to choose penile prosthesis? Everything you need to know here.

How to choose penile prosthesis? Everything you need to know here.

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Hello Doha!

The decision regarding the placement of a penile prosthesis needs to be made safely and with time to understand the advantages and disadvantages of each device, in addition to the costs that may involve each choice.

The text below will provide consistent guidance on the templates, their installation and appearance after placement.

An important detail: in general, prostheses do not need to be changed every 10 years, as is often heard, they can last much longer and often for a lifetime. So, don’t make hasty decisions, as your choice will have a long-term impact.

Penal implant surgeries are not without complications and all patients should know this. Even when all procedures are performed properly by a specialized professional, there are cases of infection, changes in sensitivity, formation of wounds that may take a long time to heal or that require a new surgical procedure.

When the implant is performed in patients with comorbidities (smoking, diabetes, previous surgeries on the penis, Peyronie’s disease, etc.), attention must be paid to these issues.

However, when everything is well understood and conducted, the satisfaction rates with the procedure and with the marital relationship in the presence of the prosthesis is excellent and can be higher than 95%.

Happy Reading!

How do urologists classify implants?

Urologists and manufacturers sometimes complicate things a bit, but the classification of prostheses is important so that we can explain their differences.

These are: Maleable (or semi-rigid), Articulable and Inflatable (with 2 volumes or with 3 volumes)

Maleable or Semi-Rigid Prostheses

The modern Malleable or Semi-rigid Penile Prostheses no longer have metal alloy filaments inside.

The fact that some prostheses still have this metallic alloy does not make them worse or better, there are advantages and disadvantages of each conformation that need to be understood

So let’s understand better?

It’s simple, the prostheses WITHOUT the metallic wire have a very good stiffness and are very similar to a natural erection. The possibility of folding the prosthesis to hide it, however, is not the greatest. That is, the prosthesis tends to return to its “ready for intercourse” position even after we bend the penis to the side.

In the case of prostheses WITH metallic wire, it is easier to bend the penis to hide it and leave it in the desired position. There is, however, a concern with the durability of the prosthesis, as the wires can break over the years of use.

Price: $

Particularities: there is always a greater fear of breaking the threads that are located internally in this prosthesis model.

Price: $$

Important particularities: those who choose a malleable prosthesis will find it very difficult to practice water sports, as it will be impossible to hide the penile erection using only a swim trunk. There is no problem with the presence of metallic threads, all the material is polymer.

Articulable Penile Prostheses

The articulated penile prosthesis is a more recent option and has the advantage of achieving excellent positioning of the penis. That is, we bend the penis and actually manage to keep it in place.

This prosthesis has excellent vertical and axial rigidity, but presents irregularities to the touch, which may cause it to be rejected by some patients. On the other hand, most patients do not care about these symmetrical irregularities, which ultimately allow the best positioning of the penis.

Its price is higher than that of Malleable Prostheses, but it is not at all absurdly expensive if we compare it to the values of Inflatable Prostheses.

Price: $$$

Inflatable Penile Prostheses

Inflatable penile prostheses are the most recognized in the world and belong to the companies AMS-Boston and Coloplast. Recently, a 3-volume inflatable prosthesis of French origin has also gained confidence in the medical field.

The great advantage of inflatable prostheses is the better adaptation to men’s daily lives, allowing greater freedom to practice contact and water sports. With these prostheses it is possible to choose the moment when we want an erection and outside of these moments, the penis remains flaccid.

2-Volume Inflatable Penile Prostheses
2-Volume Inflatable Penile Prostheses are being used less and less given the better results of 3-volume prostheses.

They consist of two inflatable cylinders connected to a reservoir that is accommodated in the testicular bag. The silicone cylinders are implanted
inside the corpora cavernosa and are filled with saline to produce an erection.

After the sexual act, it is necessary to press the penis downwards for a few seconds causing the liquid to return to the reservoir.

The prosthesis consists of a “hydraulic system” that is not exposed or apparent, but if the scrotum is palpated carefully, it will be noticed that there is something else in the place (the reservoir). This is the place to press to get an erection, with excellent rigidity.

Price: $$$$

3-Pieces Inflatable Penile Prostheses

The 3-Volume Inflatable Penile Prosthesis consists of two inflatable cylinders connected to a pump and a reservoir.

The silicone cylinders are implanted inside the corpora cavernosa of the penis, filled with saline solution, and produce an erection exactly like the 2-volume inflatable ones.

The difference is the presence of a pump installed in the scrotum (more discreet) and the reservoir installed inside the abdomen. All done with just one incision.

When an erection is desired, the system is activated by squeezing the device implanted in the scrotum. It has excellent rigidity.

A closer palpation of the scrotum will also reveal the presence of an additional natural volume (the activation pump)

Coloplast Titan OTR -Manufacturer Information

Inflatable 3-volume prosthesis with a special device that allows the penetration of antibiotics, minimizing the infectious risk, especially in cases of diabetic patients.

It has an exclusive “Resist” coating (Polyvinylpyrrolidone – PVP), which is combined with “Bioflex” (a very durable, resistant material that is less prone to aneurysmal formations).

This model also has a special “Lockout” valve device that prevents backflow and the possibility of involuntary inflation of the cylinders.
New OTR System (“ONE TOUCH RELEASE”), which translated means “single touch to deflate”, allowing greater practicality and comfort to the patient after the sexual act.

The manufacturer has offered a Lifetime Warranty for manufacturing issues.

Price: $$$$$

Coloplast Titan OTR Narrow-Base

The difference with the Coloplast Titan prosthesis is that the Coloplast Titan Narrow-Base has cylinders with a slightly smaller diameter, for selected cases of patients with scars, fibrosis and/or stenoses on the penis and/or cases of penises with smaller diameters of the corpora cavernosa, which justify using this model.

AMS 3-Volume Penile Prostheses – Manufacturer Information

AMS 700 CX
The cylinders of the AMS inflatable prostheses are made of biocompatible silicone. They feature a surface treatment with a special reduction of wear of the “Parylene” coating that increases the reliability and durability of the cylinders.

AMS 700 CX with Inhibizone
The AMS 700 CX 3-volume inflatable penile prosthesis is also available with an “Inhibizone” coating (association of two antibiotics).
It is physically identical to 700 CX, but is safer in terms of the risk of infection, especially for diabetic patients, in studies published by the manufacturer.

The presence of Inhibizone gives the prosthesis a yellowish color

AMS 700 CXR with Inhibizone
The AMS 700 CXR 3-volume inflatable penile prosthesis is physically identical to the 700 CX, but has cylinders with slightly smaller diameters, for selected cases of patients with scars, fibrosis and/or stenoses on the penis and/or cases of penises with smaller diameters of the corpora cavernosa.
Currently, the model is available in Brazil only with “Inhibizone” coating

AMS 700 LGX with Inhibizone
The 3-volume inflatable prosthesis is also available in the “LGX” (“Length and Girth Gain”) model.
When necessary, this model can improve both the length and the caliber (diameter) of the prosthesis cylinders when it is inflated, according to information provided by the prosthesis manufacturer.
This type of penile prosthesis is available with the new “Momentary Squeeze” system, which facilitates the act of deflating the prosthesis, simply pressing a special button developed for this purpose.
Currently in Brazil, this model is available only with “Inhibizone

Price: $$$$$$

Is there a difference in surgery according to the Prosthesis Model?

There are differences regarding the type of incision, but with virtually no practical impact on the patient.

With the implantation of 3-volume inflatable prostheses, discomfort may arise in the groin area, which will pass in a few weeks (this is the place of internal dissection for the installation of the reservoir in the abdomen).

Despite more structures to be installed in inflatable prostheses, for any type of prosthesis, only one incision is made and the recovery time is the same.

The surgery is performed in a hospital with spinal or general anesthesia, or even local anesthesia with sedation. The discharge occurs on the same day or the next day.

In general, patients can start using the prosthesis 4 to 5 weeks after surgery.

And how does it look?

Inflatable prosthesis

3-Piece Inflatable Penile Implant Overview: Cost, Recovery, Before & After | AEDIT

 

 

Semi-rigid or articulable prostheses have the appearance of an inflatable prosthesis but always with a full erection. The articulated ones, among the non-inflatable ones, are the ones that fold up more easily to be hidden.

 

For more pictures and videos click HERE(from USA service)

Contraindications – Who should not have an implant

Implantation procedures are not recommended in the presence of infection anywhere in the body, especially urinary tract or genital infection.

The prosthesis should not be used in patients who have an unresolved problem, such as increased residual urine due to bladder outlet obstruction or neurogenic bladder.

Other contraindications include unresolved urinary problems and any condition that may impair sexual activity (such as severe angina), history of sensitivity to foreign materials, impaired wound healing.

The following should also be considered: compromised immune system, any anatomical or physiological anomaly that could lead to significant postoperative complications, unwillingness to undergo further surgeries for revision, and the patient’s psychological instability.

It’s Important to Know!

The implantation of the device may make latent natural erections, as well as other interventional treatment options, impossible.

Men with diabetes or spinal cord injury, as well as patients with compromised immune systems, may be at increased risk of infection associated with the prosthesis. Failure to assess or promptly treat erosion can result in significant worsening of the condition, leading to infection and tissue loss.

The implantation of a penile prosthesis may eventually result in shortening, curvature or formation of penile fibrosis. Formation of pre-existing abdominal or penile fibrosis or contracture may make surgical implantation more complicated or impractical.

The risks and benefits of implanting this device in patients with lupus, scleroderma, myasthenia gravis, or documented sensitivity to silicone should be considered. The question of the possible relationship between silicone (and other implantable materials) and various diseases has been the subject of debate.

Care to be Observed during the decision process

A thorough preoperative consultation  includes physician-patient discussion of all available treatment options and their risks  Surgeons specializing in penile implants should be familiar with currently available techniques for measuring the patient, determining implant size, and performing the surgery.

Prostheses can be essential for the recovery of penile size and thickness, but all options available for implantation must be clear. In case of any doubt or feeling that something still needs to be decided, stop to reflect and discuss with doctors, friends and family.

The choice of treatment must be made very calmly so that the best possible results are achieved.

Possible complications

Scrotal swelling, discomfort, angulation/curvature, edema, device malfunction, pain, ejaculation difficulty, transient urinary retention, fever, migration, infection, hematoma, wound leakage, bleeding, delayed healing.

Practical Questions for Brazilians and Qataris

Unlike other countries, here most health plans do not have full coverage of erectile dysfunction treatment costs. Thus, the implantation of inflatable devices ends up becoming economically unfeasible. More disappointing is the misunderstanding of this issue as a health problem to be corrected. Leading patients to have requests for malleable prostheses also denied.

Dialogue with operators can resolve part of the denials and, as a last resort, a better described and directly addressed urological reportto the doctor responsible for the authorization, usually resolves the issue.

Avoid any form of friction or wear that could further compromise your health. There is always a viable solution!

Schedule your appointment now, we can help you!

Call Braziliam Medical Center – Doha-Catar +974 6679 6680 or chat in English using the Whatsapp link on this page.[/vc_column_text][/vc_column][/vc_row]

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