Penile prosthesis
Encyclopedia
A penile prosthesis is a medical device implanted in the penis requiring a surgical procedure
. The device is often used for men with organic or treatment-resistant psychogenic impotence who suffer from erectile dysfunction
. A penile prosthesis is also used in the final stage of plastic surgery
phalloplasty
to complete female to male gender reassignment surgery as well as during total phalloplasty
for adult and child patients that need male genital modification.
, congenital anomalies, iatrogenic, accidental penile trauma, micropenis
or Peyronie's disease
. This implant is normally only considered when less invasive medical treatments have been exhausted or deemed unsuitable. For example, many drugs used to treat erectile dysfunction are unsuitable for patients with heart problems and may interefere with other medications.
Sometimes a penile prosthesis is implanted during surgery to alter, construct or reconstruct the penis in phalloplasty
. The British Journal of Urology International reports that unlike metoidioplasty
for female to male sexual reassignment patients, which may result in a penis
that is long but narrow, current total phalloplasty
neophallus creation using a musculocutaneous latissimus dorsi flap could result in a long, large volume penis
which enables safe insertion of any type of penile prosthesis.
This same technique enables male victims of minor to serious iatrogenic, accidental or intentional penile trauma injuries (or even total emasculation
) caused by accidents, child abuse
or self-mutilation to have penises suitable for penile prosthesis implantation enabling successful sexual intercourse
.
In some cases of genital reconstructive surgery
, implantation of a semirigid prosthesis is recommended for three months after total phalloplasty
to prevent phallic retraction. It can be replaced later with an inflatable one.
Hydraulic, inflatable prosthesis also exist. These use fluid and are inflated or deflated on demand. Almost all current devices perform satisfactorily for a decade before needing replacement. Some surgeons recommend these due to the opinion that they are more easily concealed.
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
. The device is often used for men with organic or treatment-resistant psychogenic impotence who suffer from erectile dysfunction
Erectile dysfunction
Erectile dysfunction is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance....
. A penile prosthesis is also used in the final stage of plastic surgery
Plastic surgery
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...
phalloplasty
Phalloplasty
Phalloplasty refers to the construction of a penis or, sometimes, artificial modification of the penis by surgery, often for cosmetic purposes. It is also occasionally used to refer to penis enlargement....
to complete female to male gender reassignment surgery as well as during total phalloplasty
Phalloplasty
Phalloplasty refers to the construction of a penis or, sometimes, artificial modification of the penis by surgery, often for cosmetic purposes. It is also occasionally used to refer to penis enlargement....
for adult and child patients that need male genital modification.
Reasons for use
A penile implant is used when there is a medical need and when the problem is unlikely to resolve or improve naturally. These problems can include erectile dysfunctionErectile dysfunction
Erectile dysfunction is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance....
, congenital anomalies, iatrogenic, accidental penile trauma, micropenis
Micropenis
Micropenis is an unusually small penis. A common criterion is a dorsal erect penile length of at least 2.5 standard deviations smaller than the mean human penis size. The condition is usually recognized shortly after birth...
or Peyronie's disease
Peyronie's disease
Peyronie's Disease Peyronie's Disease Peyronie's Disease (also known as "Induratio penis plastica", or more recently Chronic Inflammation of the Tunica Albuginea (CITA), is a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis affecting up to 10% of men...
. This implant is normally only considered when less invasive medical treatments have been exhausted or deemed unsuitable. For example, many drugs used to treat erectile dysfunction are unsuitable for patients with heart problems and may interefere with other medications.
Sometimes a penile prosthesis is implanted during surgery to alter, construct or reconstruct the penis in phalloplasty
Phalloplasty
Phalloplasty refers to the construction of a penis or, sometimes, artificial modification of the penis by surgery, often for cosmetic purposes. It is also occasionally used to refer to penis enlargement....
. The British Journal of Urology International reports that unlike metoidioplasty
Metoidioplasty
Metoidioplasty, sometimes referred to as a meto or meta or spelled "metaoidioplasty", is an alternative to phalloplasty for trans men...
for female to male sexual reassignment patients, which may result in a penis
Penis
The penis is a biological feature of male animals including both vertebrates and invertebrates...
that is long but narrow, current total phalloplasty
Phalloplasty
Phalloplasty refers to the construction of a penis or, sometimes, artificial modification of the penis by surgery, often for cosmetic purposes. It is also occasionally used to refer to penis enlargement....
neophallus creation using a musculocutaneous latissimus dorsi flap could result in a long, large volume penis
Penis
The penis is a biological feature of male animals including both vertebrates and invertebrates...
which enables safe insertion of any type of penile prosthesis.
This same technique enables male victims of minor to serious iatrogenic, accidental or intentional penile trauma injuries (or even total emasculation
Emasculation
Emasculation is the removal of the genitalia of a male, notably the penis and/or the testicles.By extension, the word has also come to mean to render a male less of a man, or to make a male feel less of a man by humiliation. This metaphorical usage of the word is much more common than the...
) caused by accidents, child abuse
Child abuse
Child abuse is the physical, sexual, emotional mistreatment, or neglect of a child. In the United States, the Centers for Disease Control and Prevention and the Department of Children And Families define child maltreatment as any act or series of acts of commission or omission by a parent or...
or self-mutilation to have penises suitable for penile prosthesis implantation enabling successful sexual intercourse
Sexual intercourse
Sexual intercourse, also known as copulation or coitus, commonly refers to the act in which a male's penis enters a female's vagina for the purposes of sexual pleasure or reproduction. The entities may be of opposite sexes, or they may be hermaphroditic, as is the case with snails...
.
In some cases of genital reconstructive surgery
Genital reconstructive surgery
Genital reconstructive surgery refers to surgery performed on the genitalia of infants, children, or adults for the purpose of correcting birth defects or other anatomic abnormalities, or for the purpose of transforming normal genitalia of one sex into genitalia resembling the other...
, implantation of a semirigid prosthesis is recommended for three months after total phalloplasty
Phalloplasty
Phalloplasty refers to the construction of a penis or, sometimes, artificial modification of the penis by surgery, often for cosmetic purposes. It is also occasionally used to refer to penis enlargement....
to prevent phallic retraction. It can be replaced later with an inflatable one.
Types of Device
Semirigid devices range from permanently erect ones that cannot be altered to malleable ones that can be bent into position where appropriate. The simplest type of prosthesis consists of a pair of malleable rods surgically implanted within the erection chambers of the penis. With this type of implant the penis is always semi-rigid and merely needs to be lifted or adjusted into the desired position.Hydraulic, inflatable prosthesis also exist. These use fluid and are inflated or deflated on demand. Almost all current devices perform satisfactorily for a decade before needing replacement. Some surgeons recommend these due to the opinion that they are more easily concealed.
Advantages
- Mechanical failure rates are low: 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.
- IPP (Inflatable Penile Prostheses) are easily concealable under clothing including swimsuitSwimsuitA swimsuit, bathing suit, or swimming costume is an item of clothing designed to be worn by men, women or children while they are engaging in a water-based activity or water sports, such as swimming, water polo, diving, surfing, water skiing, or during activities in the sun, such as sun bathing.A...
s or jeanJeanJean may refer to:* Jeans, pants, trousers or high waist overalls made from denimPeople* Jean , pronounced , is the French form of John* Jean , pronounced and sometimes , is the Scottish form of Jane...
s. - The erection can be maintained as long as necessary, or as long as desired without any of the potentially serious complications of organic priapism.
- Psychological and emotional well-being is enhanced in a proportion of men who undergo implant surgery. Some studies indicate a high level of patient satisfaction, attributable in part to improved technology in the prosthesis itself, improved surgical techniques making the procedure less painful, and more reasonable patient expectations.
- Inflation of the device can be accomplished discretely.
Disadvantages
- The glansGlans penisThe glans penis is the sensitive bulbous structure at the distal end of the penis. The glans penis is anatomically homologous to the clitoral glans of the female...
does not enlarge and penetration may be awkward. The penis also may not be as firm as a natural erection. - 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 disorderNeurological disorderA neurological disorder is a disorder of the body's nervous system. Structural, biochemical or electrical abnormalities in the brain, spinal cord, or in the nerves leading to or from them, can result in symptoms such as paralysis, muscle weakness, poor coordination, loss of sensation, seizures,...
s such as strokeStrokeA stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
or Parkinson's diseaseParkinson's diseaseParkinson's disease is a degenerative disorder of the central nervous system...
. - The penisPenisThe penis is a biological feature of male animals including both vertebrates and invertebrates...
may not be completely flaccid, depending upon the model of prosthesis (most usually seen in semi-rigid or malleable implants). - Many men lose between 1–2 cm (.25 to .75 in) in length.
- Following surgery, patients experience one to two weeks of moderate or occasionally severe pain, usually controlled with analgesicAnalgesicAn analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....
s. This is most often due to scrotal swelling, which can be quite profound at times. Normal sexual intercourse can be resumed six to eight weeks post-operatively, pending clearance from the surgeon. - Not all men report complete satisfaction with the prosthesis.
- 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.
- The inflation of the devices is not instantaneous.
- It can be difficult to conceal a prosthesis because the scrotal components are hard and irregularly shaped. A partner feeling the scrotum will notice this.
- Manual stimulation can be painful.
- There is a 2-10% complicationComplicationComplication may refer to:* Complication , an infrequent and unfavorable evolution of a disease, a health condition or a medical treatment* Complication , a special feature in a mechanical clock...
rate, mainly as a result of infection or device failure. Complications include: uncontrolled bleeding after the surgery possibly leading to re-operation, scar tissue formation, erosion (tissue around the implant may break down) requiring removal or mechanical failure leading to re-operation and removal.
External Links
- http://www.emedicine.com/med/topic3047.htm
- http://www.krautgrrl.com/EDI/Erectile-Dysfunction-Treatment/Penile-Implants.html
- http://findarticles.com/p/articles/mi_m1370/is_n1_v28/ai_14990751
- http://cat.inist.fr/?aModele=afficheN&cpsidt=862126