Penile prosthesis surgery in young men is a medical procedure aimed at treating severe erectile dysfunction (ED) when other treatments, such as medications or lifestyle changes, have failed. This surgery involves the implantation of a device within the penis that allows men to achieve an erection sufficient for sexual intercourse.

There are two main types of penile prostheses: inflatable and malleable. Inflatable prostheses consist of cylinders implanted in the penis, a pump placed in the scrotum, and a reservoir containing fluid. When the pump is activated, the fluid fills the cylinders, creating an erection. Malleable prostheses are semi-rigid rods that can be manually adjusted to an erect or flaccid position.

Young men may require this surgery due to various conditions such as severe diabetes, vascular disease, spinal cord injuries, or psychological issues causing chronic ED. The procedure is generally considered when ED significantly impacts quality of life and mental health, and when other treatments have proven ineffective or unsuitable. Penile prosthesis surgery can provide significant improvement in sexual function and overall satisfaction, helping to restore confidence and quality of life for young men facing this challenging condition.

Indications of penile prosthesis surgery in young men

Penile prosthesis surgery in young men is typically indicated under specific conditions where ED significantly affects quality of life and cannot be effectively treated with less invasive methods. Key indications include:

• Severe Erectile Dysfunction: Persistent and severe ED that does not respond to oral medications (such as PDE5 inhibitors like sildenafil), intracavernosal injections, or vacuum erection devices.
• Peyronie’s Disease: Severe cases of Peyronie’s disease, where the development of fibrous scar tissue inside the penis leads to curved, painful erections and significant erectile dysfunction.
• Trauma or Injury: Penile prosthesis may be considered for young men who have sustained traumatic injuries to the pelvis, penis, or spinal cord, resulting in permanent erectile dysfunction.
• Congenital Abnormalities: Conditions such as congenital penile curvature or other anatomical abnormalities that cause erectile dysfunction and are not correctable with other treatments.
• Psychogenic Erectile Dysfunction: Chronic and treatment-resistant psychogenic ED, where psychological factors lead to persistent erectile dysfunction and other treatments have failed.
• Failure of Conservative Treatments: Young men who have not found success with, or are unsuitable candidates for, other conservative treatments for ED due to medical or personal reasons.
• Diabetes Mellitus: Severe diabetes mellitus leading to neuropathy and vascular damage that causes irreversible erectile dysfunction.
• Post-Prostatectomy Erectile Dysfunction: Men who have undergone radical prostatectomy or other pelvic surgeries leading to permanent ED and for whom other treatments have been ineffective.

Penile prosthesis surgery is typically considered after thorough evaluation and counseling, ensuring that the patient is aware of the potential risks, benefits, and implications of the procedure. The decision is often made collaboratively between the patient, urologist, and sometimes a psychologist.

How is quality of sexual life after penile prosthesis surgery in young men?

The quality of sexual life after penile prosthesis surgery in young men is generally reported to be significantly improved, with high levels of satisfaction for both patients and their partners. Here are some key points regarding post-surgical sexual quality of life:

• Restored Sexual Function: The primary benefit is the restoration of erectile function, allowing for spontaneous and satisfactory sexual intercourse. This often leads to improved sexual confidence and performance.
• Natural Erection Feel: Inflatable penile prostheses, in particular, provide a more natural-looking and -feeling erection, contributing to a better overall sexual experience.
• Psychological Benefits: Successful surgery can alleviate the psychological distress associated with chronic erectile dysfunction, enhancing self-esteem, reducing anxiety, and improving overall mental health.
• Partner Satisfaction: Studies have shown that partners of men with penile prostheses also report high levels of sexual satisfaction, as the ability to engage in sexual activity is restored.
• Spontaneity: While the process of inflating the prosthesis requires some preparation, it still allows for a degree of spontaneity that is valued by many men and their partners.
• Durability and Reliability: Modern penile prostheses are designed to be durable and reliable, providing consistent results over many years, which contributes to long-term satisfaction.

However, there are also some considerations:

• Surgical Risks: As with any surgery, there are risks of complications, such as infection or mechanical failure, which can affect the outcome and satisfaction.
• Adjustment Period: Patients may need some time to adjust to the prosthesis, both physically and psychologically. Proper counseling and realistic expectations are important for a positive outcome.
• Mechanical Nature: Some men and their partners might be initially aware of the mechanical nature of the device, which can require a period of adaptation.

Overall, penile prosthesis surgery is considered a highly effective solution for young men with severe ED, leading to significant improvements in sexual function and quality of life.

Which type of penile prosthesis in young men is preferred?

The preferred type of penile prosthesis for young men is generally the inflatable penile prosthesis (IPP). There are several reasons why IPPs are often favored over malleable (semi-rigid) prostheses for this population:

• Natural Erection: IPPs provide a more natural-looking and -feeling erection compared to malleable prostheses. When inflated, they closely mimic the natural process of an erection, and when deflated, they allow the penis to return to a flaccid state, which is more comfortable and discreet.
• Discretion: Inflatable prostheses can be deflated, making it easier for the penis to look and feel more natural when not in use. This can be particularly important for young men who might be concerned about concealment and appearance in non-sexual situations.
• Improved Functionality: IPPs offer better rigidity when inflated, which can lead to more satisfactory sexual intercourse. This is crucial for young men who might be more sexually active and desire a prosthesis that closely mimics natural erectile function.
• Psychological and Emotional Satisfaction: The ability to achieve a more natural erection can have significant positive effects on self-esteem and psychological well-being, which is particularly important for younger men who might be more affected by erectile dysfunction.
• Technological Advancements: Recent advancements in the design and technology of IPPs have improved their reliability and longevity, making them a more viable long-term solution for young men.

However, the choice between an inflatable and a malleable prosthesis depends on several factors, including the patient’s medical condition, manual dexterity, personal preference, and the surgeon’s recommendation. For instance, patients with limited manual dexterity or those who prefer a simpler, maintenance-free option might opt for a malleable prosthesis. Ultimately, the decision should be made after a thorough discussion between the patient and their urologist, considering all the potential benefits and drawbacks.

Summary

Penile prosthesis surgery in young men is a procedure used to treat severe ED that has not responded to other treatments. This involves implanting a device inside the penis to enable erections. There are two main types: inflatable and malleable prostheses, with inflatable ones generally preferred for their more natural look and feel. Indications for the surgery include persistent ED due to conditions like severe diabetes, Peyronie’s disease, trauma, congenital abnormalities, or after pelvic surgeries. The choice of prosthesis depends on individual circumstances and preferences, and the procedure can significantly improve quality of life and psychological well-being.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE