The penile prosthesis (erectile tissue implant) is a treatment option for erectile dysfunction when conservative therapies do not achieve any improvement.
Doctors insert the implant into the penis, where it takes over the task of the non-functioning erectile tissue.
Erectile dysfunction is the inability to achieve and maintain an erection for a satisfying sex life for at least six months.
Frequency of erectile dysfunction
Studies have shown that 18 to 48% of all men between the ages of 40 and 79 have erectile dysfunction. There is, of course, a clear dependence on age:
2 % in the 30-39th year of life
10 % between the ages of 40 and 49
16 % in the 50th-59th year of life
34 % in the 60th-69th year of life
53 % in the 70th-79th year of life
Although it is not a malignant disease, it has a major impact on the quality of life of those affected. This is also because erectile dysfunction can be an early warning sign of a previously unknown disease. Those affected should therefore undergo a medical examination.
Reasons for erectile dysfunction
The causes of erectile dysfunction can be psychological or physical. Often there are also mixed forms.
It is therefore understandable that a physical erectile dysfunction (due to poor blood circulation in diabetics) often leads to psychological problems. These in turn exacerbate the erectile dysfunction.
The most common physical causes are those that lead to changes ("calcifications") in arteries and veins.
Risk factors are
An impaired nerve supply to the pelvic region and the penis is often responsible for erectile dysfunction.
The causes can be
In the case of erectile tissue disease, the venous outflow of blood does not accumulate enough due to the reduced elasticity of the erectile tissue. This prevents the penis from stiffening sufficiently. Experts also refer to this as erectile tissue insufficiency.
A pronounced induratio penis plastica(curvature of the penis) can also lead to potency problems.
There are two types of penile prosthesis. Experts differentiate between flexible (semi-rigid) and hydraulic erectile tissue implants.
As the advantages of the hydraulic system predominate, doctors hardly use semi-rigid penile prostheses any more.
Semi-rigid erectile tissue prostheses consist of a pair of silicone rods with a flexible metal core, which doctors insert into the corpus cavernosum.
The patient can bend the penis into the correct position for sexual intercourse. After the act, he bends the penis back again.
The disadvantage of a flexible erectile tissue implant is the permanent semi-rigid erection. The size of the penis or the expansion of the implants does not change.
Flexible erectile tissue implant. Source: AMS Germany
Today, hydraulic erectile tissue implants are predominantly used. These basically consist of three interconnected components.
There are two silicone cylinders in the erectile tissue. Small tubes connect the hydraulic pump located in the scrotum and a fluid reservoir. Doctors place the fluid reservoir, consisting of saline solution, in the abdominal cavity.
The small pump in the scrotum ensures that the saline solution fills both cylinders. This causes the penis to erect and become erect.
After intercourse, the patient can empty the cylinders again via a small valve. The saline solution flows back into the reservoir in the abdominal cavity. The penis becomes flaccid again.
Hydraulic penile prostheses are very easy for the patient to use and imitate the natural erection mechanism.
Hydraulic erectile tissue implant. Source: AMS Germany
In general, penile prostheses are among the treatment options with the highest satisfaction rate. Individual studies show satisfaction rates of up to 98%. This applies to both patients and their partners.
As the entire implant is concealed in the body, a corpus cavernosum implant is not visible or recognizable to outsiders. Even the sexual partner usually does not notice any difference to a "normal" stiff member.
The implantation of a penile prosthesis does not impairsensation, orgasm or fertility. However, it is clear that both corpora cavernosa are irretrievably destroyed by the procedure.
The most important step is that the doctor and patient have a detailed consultation beforehand. During this consultation, the advantages and disadvantages of various erectile tissue implants are discussed.
The operation itself is relatively complicated, so only experienced surgeons should perform it. It takes one to two hours. The operation is performed under general anesthesia, but can also be performed on an outpatient basis.
As with any operation, there are potential side effects and risks.
Due to the complex technique, mechanical complications are more common with hydraulic penile prostheses than with semi-rigid erectile tissue implants.
Nevertheless, the advantages of hydraulic erectile tissue implants clearly outweigh the disadvantages from the patient's point of view. For this reason, doctors no longer use semi-rigid penile prostheses.
The implants used today consist of medical plastic and silicone parts made from an antibiotic micro-coating. These significantly reduce susceptibility to infection.
The patient can use the implantfour to six weeks after the operation. Provided no inflammation or technical defects occur, the implant remains in the patient's body for life.
The market launch of sildenafil (Viagra®) in 1998 and somewhat later of Cialis® and Levitra® revolutionized the treatment of erectile dysfunction .
These drugs do not cause an erection, they only influence the duration and strength of the erection. This only happens during sexual stimulation.
Tablets are convenient because patients take them shortly before sexual intercourse and they work for up to 36 hours.
Due to the side effects, these tablets should only be taken by patients without cardiovascular disease.
Other drug therapies include intracavernous and intraurethral treatments:
In cavernosal auto-injection therapy (SKAT), the patient injects the active substance directly into the erectile tissue immediately before sexual intercourse.
With intraurethral medication, doctors insert a gel into the urethra using an applicator. In both cases, the active ingredient prostaglandin E1 is usually used.
The prerequisite for drug therapy is always a functioning anatomy and nerve supply.
A penis pump and other aids can support an erection. The patient places the cylinder of the penis pump over the flaccid member and then creates a vacuum by pumping. The vacuum causes blood to flow into the erectile tissue, which leads to an erection. A compressing penis ring then holds it in place.
However, the cumbersome handling means that it is not very popular with patients. However, it has few side effects and can be used for any form of erectile dysfunction.
Extracorporeal shock wave therapy (ESWT) is one of the newer conservative treatment methods for erectile dysfunction. The shock waves lead to the formation of new blood vessels in the penis, which in turn improves blood flow and thus erectile function. Shockwave therapy involves several outpatient sessions and lasts several weeks.
If there are malformations of the blood vessels, vascular surgery can lead to altered blood flow and thus to an erection. However, the long-term results of the surgical methods were generally disappointing. Vascular surgery is therefore currently recommended in individual cases.
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