Treatment options for male genital conditions – this is the specialist field of Dr Franklin Kuehhas. With this clear focus on an area that is still considered a taboo subject in urology, the specialist in reconstructive andrology and intimate surgery in Vienna has earned an international reputation. As an empathetic, discreet and thoroughly professional expert, he has also made an excellent name for himself within the medical community for his complex surgical procedures on the penis. He granted the Leading Medicine Guide a rare insight into his expertise.
Dr Franklin Kuehhas is an andrologist and is therefore regarded as a rather unusual specialist and expert even within the medical community. Andrology can be simply described as men’s health; it is, in effect, the male counterpart to gynecology, the study of women’s health. An andrologist deals with all matters relating to male reproductive functions. Dr Kuehhas has focused entirely on reconstructive andrology, both medically and in terms of medical technology, and today primarily performs operations on the penis. “I’m tackling a taboo subject,” explains the specialist in urology and andrology, “and not just in the general public’s perception; even among specialists – urologists – the subject of penile medicine is still considered taboo.”
Consequently, it was by no means easy for Dr Kuehhas to specialize in this field and receive proper training. Dr Kuehhas first acquired his specialist knowledge in urology at the renowned university hospitals in Heidelberg and Vienna, and then completed specialist training in reconstructive andrology at University College London. Through further specialist training in the USA, Brazil and England, he keeps himself continuously up to date with the latest scientific and technical developments. “In the USA, there are many experts in the field of reconstructive andrology, and there is also a long history of experience in the manufacture and insertion of penile prostheses,” reports Dr Kuehhas. Although he does not actually like the term ‘penile prosthesis’ and prefers to speak of penile implants. “I find time and again that the term ‘penile prosthesis’ unsettles my patients. And in fact, we are not replacing the penis, but rather the erectile tissue.” With this procedure, he achieves a high satisfaction rate among his patients and – which is certainly just as important in this context – partner satisfaction also stands at a good 98 per cent.
What are the indications for a penile prosthesis or a penile implant?
“The implant is always the last resort,” explains Dr Kuehhas. Only once all conservative methods have been exhausted would he discuss the possibility of an implant with his patients. His many years of experience and his empathy help him to find the right approach for each patient. After all, this is a very sensitive issue. Trust in the treating doctor, a relaxed and friendly environment, and the feeling of being in good hands and receiving expert care are key factors in the overall treatment.
Dr Kuehhas has structured his practice in Vienna entirely around this. Medical equipment meeting the very latest standards ensures precise diagnosis. In trusting conversations, he discusses treatment options with his patients. Conditions such as diabetes, major pelvic surgery, bowel cancer or an aortic aneurysm may make the implantation of a penile prosthesis advisable.
How does a man find the right specialist for his problem?
The first point of contact for a male health issue is always the urologist. Once the diagnosis is confirmed, says Dr Kuehhas, the patient should seek an open and honest discussion with his doctor and ask which specialist he might recommend. This is not an easy conversation, because even within professional circles, the subject of reconstructive andrology is unfortunately still considered taboo. “But such procedures should only be performed by a specialist with extensive experience in this field. In other words, someone who performs such an operation perhaps 300 times a year has a completely different level of confidence than someone who might only do it five times a year,” says Dr Kuehhas, setting out the facts.
He finds it sad that many men are left in the dark for years, left to cope with the issue on their own, unable to find a suitable specialist for their medical problem, or not really taken seriously with their complaints. “It’s not just a health issue, then; it affects the psyche, it shapes one’s sex life, relationships and psychosocial well-being – men withdraw from relationships or don’t dare to enter into a partnership. There is a tremendous amount of psychological distress involved,” Dr Kuehhas observes time and again. And he is glad to be able to help with his expert knowledge and skills. “None of this has to be the case; these men can be helped,” he explains emphatically.
IPP – Induratio penis plastica or penile curvature – a case for a penile implant?
Around ten per cent of men aged between 40 and 60 suffer from IPP, or induratio penis plastica, colloquially known as penile curvature. The likely cause is thought to be minute injuries to the erectile tissue, which can harden over time. Medically, a distinction is made between an acute and a chronic phase of IPP. In the acute stage, small nodules form; the erectile tissue can no longer fully expand during an erection, leading to discomfort and pain, and the penis takes on a curved shape. “See a doctor immediately, don’t wait,” advises Dr Kuehhas to any man who notices such changes in himself. “If treatment is started early, the progression of the condition can be prevented,” he reassures.
Unfortunately, however, he repeatedly finds in his practice that the subject of IPP is neglected, and men come to him who should have received specialist treatment much earlier. “They are often told that nothing can be done about such a curvature. Of course, treatment is not straightforward, but there are various options,” emphasises Dr Kuehhas. A penile implant is not the appropriate treatment option for every case of IPP.
Schematic representation of plaque formation in IPP
How do penile prostheses or penile implants work?
The implant does not replace the penis, but is inserted into the shaft, where it takes over the function of the non-functioning erectile tissue. Nowadays, only hydraulic implants are really used. They consist of three components: two silicone cylinders, a small hydraulic pump and a fluid reservoir. During the procedure, the silicone cylinders are inserted into the erectile tissue and connected via small tubes to the small hydraulic pump, which Dr Kuehhas implants in the scrotum. A fluid reservoir is placed in the abdominal cavity, from which a sterile saline solution can be pumped into the cylinders and drained again as required.
In this way, the penis can be erect, entirely in line with the natural process. After intercourse, the cylinders are emptied again, the saline solution flows back into the reservoir in the abdominal cavity, and the penis returns to a flaccid state. “The hydraulic prosthesis is incredibly easy to use; it simply mimics the natural mechanism of erection,” says Dr Kuehhas, describing the procedure.
In action: advice on penile prostheses
He knows from numerous studies and research that penile prostheses are among the treatment options with the highest satisfaction rates for erectile dysfunction: 98 per cent of patients and their partners are satisfied with the result. As the implant is not visible from the outside, couples do not notice any difference. “And the great thing is: sexual sensation, the ability to orgasm and the ability to father a child are not affected by the implant,” Dr Kuehhas emphasises.
However, one should only entrust this procedure to a specialist. The operation itself is complex and takes one to two hours. The implants used today consist of medical-grade plastic and silicone components and are manufactured with an antibiotic micro-coating, which has significantly reduced the risk of infection. Around four to six weeks after the operation, the healing process has progressed to the point where the implant can be used. “In general, a penile prosthesis can remain in the body for between eight and fifteen years,” Dr Kuehhas notes from experience.
Schematic representation of the penile prosthesis
Dr Franklin Kuehhas would like to see more education and openness, particularly among specialists, regarding this important issue for men. “No man is making a fool of himself if he has problems in this area and is looking for the right person to talk to.”
Dr Kuehhas, thank you very much for the interesting and open discussion.
You can contact our specialist directly via his profile page on the Leading Medicine Guide.
