Penile prosthesis surgery is a suitable treatment option for patients who have erectile dysfunction (erectile dysfunction, ED) and cannot respond to current treatment options. Penile prosthesis surgery is an operation that should be performed sensitively and carefully. It requires experience. There are many questions asked by our patients about penile prosthesis surgery.
Since 1992, we have been performing Andrology-related surgeries, especially penile prosthesis surgery. In this article, I will answer frequently questions (FAQs) about this subject in the light of my own experiences and current literature.

Answers to frequently asked questions about penile prosthesis

What is a penile prosthesis?

Penile prosthesis are special structures that are specially designed, suitable for the shape of the penis, and surgically placed inside the penis. It was first used in the 1970s. Today, more advanced prostheses are available and used successfully.

How many types of penile prosthesis are there?

In general, there are two types of penile prostheses: malleable (permanently erect), flexible prostheses and inflatable prostheses. Inflatable prostheses are also available in transverse and longitudinal extensions.

What is the advantage of penile prostheses being coated with antibiotics?

Penile prostheses are coated with antibiotics. The purpose of this is to provide a protective effect against infection. This way, the risk of infection is reduced. At the same time, we try to reduce the risk of infection by washing the operation area with antibiotics during the operation.

Who can undergo penile prosthesis surgery?

Penile prosthesis surgery is an operation performed on patients who have erection problems and do not respond to current edavile. This surgery is the last option. There is no going back.

Which patients are most often fitted with a penile prosthesis?

Penile prosthesis is fitted to every patient who does not respond to current treatments and whose condition is suitable. The patients we mostly perform penile prosthesis surgery are:
• Those with ED complaints after radical prostatectomy (robotic, laparoscopic, open prostate surgery)
• Those who had radical cystectomy surgery 8 due to bladder cancer)
• Patients undergoing pelvic surgery
• Diabetics
• Patients with paralysis and ED complaints
• Patients with ED problems due to other diseases

Is penile prosthesis fitted to patients undergoing phalloplasty?

Especially in female-to-male conversion surgeries, a new penis is created. This is an operation with features. A penile prosthesis is attached to these patients to create an erection 9-12 months later.

How should the ideal penile prosthesis be?

An ideal penile prosthesis should be in an erection when intercourse is desired, it should return to its normal state at the end of intercourse, and it should be easy to use.

What are the current penile prosthesis brands?

There are three penile prosthesis brands available in the world: Rigicon, Coloplast and AMS.
These companies have malleable and inflatable prostheses.

Which penile prosthesis is applied to which patient?

Factors such as socioeconomic status, age, and ability to use their hands are taken into account in the selection of prosthesis. We prefer this if patients are able to use inflatable prostheses. We attach malleable prostheses to unsuitable patients.

Is there an age limit for penile prosthesis surgery?

No, there is no absolute age limit for penile prosthesis surgery. Generally, patients are over the age of 40 and do not respond to current treatments. The last option is the patients who are suitable for prosthetic surgery. We also fitted prostheses to patients aged 32.33 years for reasons such as diabetes and trauma, but our patients are generally older.

How is penile prosthesis surgery performed?

Penile prosthesis surgery is performed under very sterile conditions. In order not to damage the urethra, a foley catheter is attached to the patient. With a small incision, the inside of the penis is opened. The length of the penis is measured and the prosthesis of the appropriate length is attached to the patient. If an inflatable prosthesis is to be fitted, a pump system is placed near the testicles and a reservoir system is placed in the lower part of the abdomen. These are not visible from the outside. Then, the surgical incisions are closed and the penis is covered with an elastic bandage.

How is the preparation before penile prosthesis surgery?

• If patients use blood thinners such as aspirin before penile prosthesis surgery, they are discontinued one week in advance.
• Routine tests related to anesthesia are taken
• As a result of the examinations, the patients are evaluated by the anesthesiologist.
• Patients with normal tests do not eat or drink anything by mouth for at least 6-7 hours before surgery.
• We do not recommend shaving the pelvic region before surgery due to infection, shaving should be done on the operating table.
• Preventive antibiotics are administered before the operation
• The patient is hospitalized 2-3 hours beforehand. Necessary formalities are prepared and taken into surgery.

How many hours does penile prosthesis surgery take, what type of anesthesia is given, how many days is the hospital stay?

We perform prosthetic surgery under general or spinal anesthesia. The operation takes 1.5-2 hours. Patients are discharged 6-7 hours after surgery. We usually keep our patients in the hospital for one day.

What should be considered after prosthetic surgery?

If it is done with general anesthesia, patients start to take watery food and liquids orally after 4-5 hours. If spinal anesthesia is given, they are taken orally after the operation. Painkillers for pain and antibiotics for infection are started. The foley catheter is removed the next day after surgery. Normal activities are resumed 2-3 days after the surgery. After 2-3 days, we open the bandage. We recommend that they do not stand too long, as edema will occur in the first 2-3 weeks. The wound site should remain dry for 4-5 days, then a bath can be made. After 4-6 weeks, patients can do sports and lift weights.

What are the complications of penile prosthesis?

Penile prosthesis surgery is a delicate procedure. Although rare, complications may occur. These complications are:
• Prosthesis infection
• Failure in the prosthetic pump system
• Problems due to long prosthesis
• Problems due to short prosthesis
• Urethral erosion and prosthesis coming out of the urethra
• Erosion and prosthesis on the glans penis

In whom is prosthesis infection most common?

Infection is one of the worst and undesirable complications in prosthetic surgery. Since we are very careful during the surgery and we do it in appropriate centers, we do not encounter infection. Risk factors and common causes of penile prosthesis infection include:
• Diabetes that is not followed regularly
• People with weak immune system
• Patients with kidney transplant (due to immunosuppressive drugs)
• Paralyzed patients
• Patients who do not pay attention to hygiene
• Elderly patients with nutritional problems

Is high hemoglobin A1C (HbA1c) an indicator for prosthesis infection in diabetics?

HbA1c level gives an idea about whether diabetes has gone regularly in the last 3 months. Its elevation indicates that sugar control is not good. In the past, it was thought that high HbA1c would be an indicator for prosthesis infection. Studies have reported that this alone cannot indicate an infection risk. However, a regular sugar control should be preferred if possible.

How many days after the operation is sexual intercourse possible?

After prosthetic surgery, our patients can have normal intercourse after 4-6 weeks.

What is the cost (price) of penile prosthesis surgery?

The price of the prosthesis varies. Factors affecting the price of the prosthesis;
• Type of prosthesis
• Brand used
• The hospital where the surgery was performed
• The doctor who performed the surgery
• Whether the patient has any other disease

How does the penile prosthesis work?

The way penile prostheses work depends on the shape of the prosthesis. The use of malleable (one-piece) prostheses is quite simple. Patients can have intercourse whenever they want. In inflatable prostheses, when the patient wants to have intercourse, he activates the prosthesis through the pump in the scrotum and enters into intercourse. Finally, the system is brought back to normal by pressing the extinguishing button again.

Is penile prosthesis surgery painful?

Prosthetic surgery is not a painful operation. Surgery is performed with a small incision. Patients have a comfortable period with post-operative painkillers.

How long can the penile prosthesis stay in the body?

Penile prostheses can remain in the body for a long time without any problems. There are some of our patients who use it for 15-17 years without any problems. Information in the literature is also in this direction.

Can there be a malfunction in penile prostheses?

Penile prostheses may fail over time. Failure is most common with inflatable, three-piece prostheses. Malfunctions are usually seen in the form of pump failure. The failure rate is extremely low. In case of malfunction, repair is possible.

How long does the inflatable penile prosthesis take to be ready?

It takes a very short time for these prostheses to be inflated and ready for erection. It is possible to inflate the prosthesis in a few seconds and make it suitable for intercourse.

How long is intercourse with inflatable prostheses inflated?

There is no clear limit on how long to have intercourse with prostheses. Our patients can have intercourse for 30-60 minutes without any problem.

What are the lengths of penile prostheses?

Penis The size of the penile prosthesis varies. There is no such thing as wearing a prosthesis in the length desired by the patients. In the surgery, the length of the penis is measured and a prosthesis suitable for the person is attached.

Is it possible to do sports while wearing a penile prosthesis?

Patients can do sports 4-6 weeks after penile prosthesis surgery. There are no barriers to sports. Patients should be careful not to traumatize the prosthesis area.

Is it possible to have intercourse with a penile prosthesis every day?

There is no limitation in the relationship in those who have prosthetic surgery. Patients can have intercourse as often as they want, provided that it is not too traumatic.

Are penile prostheses visible from the outside in daily life?

No. Penile prostheses are not visible from the outside in daily life. There is no problem in this regard, especially with inflatable prostheses. Since malleable prostheses are bendable prostheses, patients can conveniently hide the prosthesis under their clothes. We generally recommend these patients to use comfortable clothes.

Is it possible to have an orgasm with a penile prosthesis?

Patients with prostheses can orgasm normally. There is no problem about this.

Does prosthetic surgery increase libido (sexual desire)?

Penile prosthesis has no effect on libido. It does not affect the patients’ libido, that is, their sexual desire, positively or negatively. However, with the effect of a normal sexual life, libido can be positively affected.

Do people who have penile prosthesis surgery have children?

Yes. People who have had prosthetic surgery can have children. If there is no problem in semen production and ejaculation, penile prosthesis surgery is not an obstacle to having a child.

Will there be a normal erection after the penile prosthesis is removed?

No, in patients who have a penile prosthesis, an erection does not occur normally after the prosthesis is removed. It is an irreversible surgery. For this reason, penile prosthesis surgery is our last preferred method.

Can an inflatable prosthesis be put on a patient who had a normal prosthesis before?

Some patients have previously had a malleable prosthesis, but may wish to replace it with an inflatable prosthesis. In this way, change is possible. In these cases, extreme care should be taken as there is a risk of infection.

How is the satisfaction of couples with penile prosthesis?

Sexual satisfaction is very high in patients who have penileprosthesis. Satisfaction and sexual satisfaction in both men and women are 95-100% in our patients and in the literature.

Is it possible to lengthen or shorten the penis with a penile prosthesis?

Patients with a penile prosthesis can’t use their penis for a long time due to erection problem, so their penis gets a little smaller. For this reason, patients think that the prosthesis makes the penis smaller. Penile length cannot be extended with penile prosthesis. There may be a slight shortening of the penis.

Is penile lengthening surgery performed on patients who will be fitted with a penile prosthesis?

If there is excess fat in the pubic areas of these patients, these fats can be removed. In addition, it is possible to provide some elongation by loosening the suspensory ligaments of the penis.

Does penile diameter thicken with penile prosthesis?

There is no increase in the diameter of the penis with the penile prosthesis. There may be a small amount of thinning due to previous use.

Is lengthening and thickening surgery performed for those who have prosthetic surgery?

Penile lengthening surgery is not performed on patients who have a penile prosthesis. In this way, it is not possible to lengthen the penis. However, thickening surgery can be performed very carefully in these patients later.

Does penile prosthesis surgery also enlarge the head of the penis?

No. The penile prosthesis is placed inside the penis called the corpus cavernosum. The head of the penis does not change in these patients, and there may even be some reduction.

Is penile prosthesis surgery a genital aesthetic surgery?

No. Penile prosthesis surgery is not a genital plastic surgery. It is a functional surgery. It must be done by a urologist.

Can a penile prosthesis be worn for Peyronie’s disease?

This varies from patient to patient. If the patient does not have an erection problem and only has Peyronie’s disease, special drug treatment or surgical treatment is applied to this disease. If there is an erectile dysfunction (ED) in Peyronie’s disease that does not respond to other treatments, then penile prosthesis surgery can be performed.

Which prosthesis is the most suitable for Peyronie’s patients?

Studies have shown that both malleable and inflatable prostheses are similar in terms of curvature correction and patient satisfaction.

Is penile prosthesis surgery performed in the treatment of priapism disease?

In patients with priapism, if the intervention is delayed and the patient develops a permanent erection problem, then the option to do is penile prosthesis surgery. In these patients, surgery should be performed as soon as possible and without too much delay, as the penis will shorten in length and thinning in diameter over time. There is a risk of problems in prosthesis surgeries performed after 2 weeks.

Which prosthesis is the most suitable for patients with priapism?

Wearing a penile prosthesis in patients who develop erectile dysfunction due to priapism requires experience. Cavernous bodies have gone into fibrosis. There may be problems with prosthesis placement. Studies have reported positive results with both malleable and inflatable prostheses in these patients. Generally, inflatable prostheses are recommended, especially in younger patients. We also prefer the inflatable penile prosthesis in our patients with priapism.

Is penile prosthesis attached in the treatment of penile curvature?

No. Treatment of penile curvature is different. Appropriate treatments are given to the patient. Prosthesis surgery is not performed in patients with penile curvature to correct the curvature.

Can patients with penile prosthesis undergo MRI?

If there are metal-containing implants in the body, prior information should be given during MRI. Penile prostheses do not contain metal. They are special products made of silicone. Since penile prostheses do not contain metal in their structures, a person with prosthesis does not experience any adverse events in MRI.

Summary: There are two main types of penile prostheses, malleable (bendable) and inflatable. Penile prosthesis surgery is a special operation. It is the last option in patients with erectile dysfunction who do not respond to current treatments. It is irreversible. In experienced hands, the success rate is very high and the complications are extremely low. In this article, I have tried to answer frequently asked questions about penile prostheses and prosthetic surgery based on my own experience and observations from my patients.

Prof.Dr. Emin ÖZBEK, MD
Urology Specialist
Istanbul- TURKEY