Penile prosthesis surgery is a surgical procedure used to treat severe erectile dysfunction (ED), especially in patients unresponsive to medication or psychological therapy. This surgery involves implanting a device inside the penis, allowing the patient to actively control erections and restore sexual function. It is primarily indicated for organic ED caused by conditions such as diabetes, surgical trauma, or vascular diseases.
Unlike short-term pharmacological treatments, prosthesis surgery offers a permanent solution but involves surgical risks and subsequent maintenance. This therapy requires careful evaluation, including the patient’s overall health, psychological state, and partner’s willingness.
Currently, there are three main types: hydraulic, inflatable, and semi-rigid. Hydraulic prostheses contain a fluid reservoir, and the patient manually operates a pump to inflate the penis; inflatable types require manual switching between inflation and deflation modes; semi-rigid prostheses maintain the penis in a slight, continuous erection, which can be manually adjusted for angle.
Prostheses are usually made of soft materials and are implanted to fuse with the penile tissue, mimicking the natural erection mechanism. Devices can be two- or three-piece structures, placed between the penile arteries and veins, ensuring stable erection after inflation. Different types suit different patient needs and should be recommended by a physician based on anatomy and lifestyle.
Main candidates include: 1. Those who have repeatedly failed medication (such as PDE5 inhibitors); 2. Organic ED caused by nerve or vascular damage; 3. Patients unresponsive to psychological therapy with no organic issues; 4. Erectile dysfunction following prostate surgery.
It is also suitable for patients with chronic conditions such as spinal cord injury or peripheral neuropathy due to diabetes. However, contraindications include uncontrolled diabetes, local penile infections or ulcers, and severe cardiopulmonary diseases that contraindicate anesthesia.
The procedure typically requires general anesthesia and lasts about 1-3 hours. The surgeon makes an incision below the penis, removes part of the suspensory ligament, and implants the prosthesis. Postoperative hospitalization lasts 1-2 days, with a recovery period of approximately 4-6 weeks, during which sexual activity and vigorous exercise should be avoided.
The size of the device is customized based on the patient’s penile dimensions, and the surgeon adjusts the model according to desired erection angle and hardness. Regular follow-up is necessary, with particular attention to signs of infection or device malfunction.
Compared to medication, prostheses can address irreversible damages such as vascular or nerve injuries and are not limited by blood flow dynamics. For long-term ED patients, this therapy can significantly improve quality of life and self-image.
Immediate risks include: postoperative infection rate of about 5-10%, penile curvature, or device displacement. Long-term risks include prosthesis rupture (potentially requiring replacement after 5-15 years), skin tissue erosion, or hydraulic system failure.
Other complications may include visible surgical scars, pain during intercourse, or psychological adaptation issues. Untreated severe infections may lead to tissue necrosis, so close monitoring for discharge or signs of inflammation is essential.
Contraindications include:
Preoperative assessments include blood tests, penile blood flow scans, and psychological evaluation. Anticoagulants should be discontinued at least 3 months before surgery. Strenuous activities are prohibited within 6 weeks post-surgery, and regular follow-up is necessary to monitor device function.
This surgery is usually considered a last resort after trying medications (such as sildenafil) or vacuum erection devices. Previous penile surgeries may affect prosthesis placement. Combining with psychological therapy can enhance overall outcomes, but the device itself does not treat psychogenic ED.
If the patient is on hormone therapy, medication adjustments may be necessary. Post-surgery, penile injection therapy should be avoided to prevent tissue damage.
Clinical studies show that 90% of patients achieve satisfactory sexual function post-surgery, with device survival rates reaching 95% within 5 years. Long-term follow-up indicates hydraulic prostheses have failure rates below 20%, and semi-rigid types are suitable for those with mild activity needs.
Patient satisfaction surveys reveal that 85% perceive a significant improvement in quality of life, with enhanced communication with partners. However, about 10-15% may require secondary surgery due to device issues.
Non-surgical options include:
Psychological counseling and behavioral therapy can be adjuncts but do not address organic issues. Disadvantages of alternatives include inconsistent effects, daily medication requirements, or pain, whereas prosthesis surgery offers a more permanent solution.
Patients should undergo a comprehensive health assessment, including blood tests, cardiopulmonary function tests, and urological examinations to ensure safety under anesthesia. The surgeon will explain the procedure, potential risks, and postoperative care, and patients are advised to stop anticoagulants at least one week before to reduce bleeding risk.
How long after surgery can daily activities resume? What precautions should be taken?Rest for 2 to 4 weeks is recommended. During this period, heavy lifting and vigorous exercise should be avoided to ensure proper device fixation. After 4 weeks, gradual resumption of light activities is possible, but sexual activity should wait at least 6 weeks and follow the doctor’s instructions for gradual adaptation.
What complications may occur post-surgery? How should they be managed?Possible complications include infection, device displacement, or fibrosis. If redness, swelling, pain, or fever occur, immediate medical attention is necessary. Long-term follow-up can detect abnormalities early, and adjustments or corrective surgeries may be required. Regular check-ups are essential for early detection of issues.
What are the differences among various types of penile implants? What factors should be considered when choosing?They are categorized into "inflatable" and "non-inflatable" types. Inflatable implants require manual operation of an inflation pump, mimicking natural erection; non-inflatable types maintain a fixed rigidity and are suitable for patients concerned about mechanical complexity. The choice depends on age, health status, and lifestyle, with the surgeon providing recommendations accordingly.
What is the long-term satisfaction rate after surgery? What is the success rate?International studies report that approximately 85-90% of patients are satisfied with the results, and implants can last over 10 years. Success depends on thorough preoperative assessment, surgical skill, and adherence to postoperative care. Regular follow-up helps prevent long-term complications and maintains function.
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