Penile prostheses

Penile prostheses are semirigid or inflatable devices that are implanted intopenises to alleviate impotence. The penis is composed of one channel for urine and semen and three compartments with tough, fibrous walls containing "erectile tissue." With appropriate stimulation, the blood vessels that lead outof these compartments constrict, trapping blood. Blood pressure fills and hardens the compartments producing an erection of sufficient firmness to performsexual intercourse. Additional stimulation leads to ejaculation, where semenis pumped out of the urethra. When this system fails, impotence (failure tocreate and maintain an erection) occurs.

Impotence can be caused by a number of conditions, including diabetes, spinalcord injury, prolonged drug abuse, and removal of a prostate gland. If the medical condition is irreversible, a penile prosthesis may be considered. Patients whose impotence is caused by psychological problems are not recommendedfor implant surgery.

Penile implant surgery is conducted on patients who have exhausted all otherareas of treatment. The semirigid device consists of two rods that are easierand less expensive to implant than the inflatable cylinders. Once implanted,the semirigid device needs no follow-up adjustments, however it produces a penis which constantly remains semi-erect. The inflatable cylinders produce amore natural effect. The patient is able to simulate an erection by using a pump located in the scrotum.

With the patient asleep under general anesthesia, the device is inserted intothe erectile tissue of the penis through an incision in the fibrous wall. Inorder to implant the pump for the inflatable implant, incisions are made inthe abdomen and the perineum (area between the anus and the genitals). A fluid reservoir is inserted into the groin and the pump is placed in the scrotum.The cylinders, reservoir, and pump are connected by tubes and tested beforethe incisions are closed.

Surgery always requires an adequately informed patient, both as to risks andbenefits. In this case, the sexual partner should also be involved in the discussion. Prior to surgery, antibacterial cleansing occurs and the surroundingareas are shaved.

To minimize swelling, ice packs are applied to the penis for the first 24 hours following surgery. The incision sites are cleansed daily to prevent infection. Pain relievers may be taken.

With any implant, there is a slightly greater risk of infection. The implantmay irritate the penis and cause continuous pain. The inflatable prosthesis may need follow-up surgery to repair leaks in the reservoir or to reconnect the tubing.

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