A penile prosthesis, also known as a penile implant, is a medical device surgically implanted into the penis of a man who is experiencing erectile dysfunction (ED) or other conditions that prevent him from achieving or maintaining a satisfactory erection. The purpose of a penile prosthesis is to enable the individual to have erections suitable for sexual intercourse. In this article, I will talk about the advantages and disadvantages of malleable penile prosthesis.

What is malleable penile prosthesis?

 A malleable penile prosthesis, also known as a penile implant, is a medical device used to treat erectile dysfunction (ED) in men who have not responded to other forms of treatment, such as medication or vacuum erection devices. This prosthesis is surgically implanted into the penis to allow a man to achieve and maintain an erection suitable for sexual intercourse.

Here’s how a malleable penile prosthesis works:

1. Surgical Implantation: The procedure involves the surgical placement of a prosthesis into the penis. This is typically done through a minimally invasive surgical technique. The prosthesis consists of two cylinders that are inserted into the erectile chambers of the penis, along with a reservoir of fluid and a pump that are implanted in the scrotum.
2. Malleable Design: Unlike inflatable penile prostheses, which can be inflated and deflated using a pump, malleable penile prostheses are always semi-rigid or “malleable.” This means that the penis remains in a partially erect position at all times. The man can manually adjust the position of the prosthesis to make the penis erect or flaccid.
3. Discreetness: One advantage of malleable penile prostheses is that they are less noticeable than inflatable ones because there are no visible external components or inflation pumps.
4. Simplicity: Malleable penile prostheses are relatively simple to use, as there is no need for inflation or deflation. The man can bend his penis into an erect position when desired and bend it back to a flaccid position when not in use.

It’s essential to note that the choice between a malleable penile prosthesis and an inflatable one depends on various factors, including the patient’s preferences, medical condition, and the recommendations of their healthcare provider. Each type of prosthesis has its advantages and disadvantages, and the decision should be made after a thorough discussion with a urologist or a healthcare professional specializing in sexual medicine.

What are the advangtages of malleable penile prosthesis?

Malleable penile prostheses have several advantages, which may make them a suitable choice for certain individuals with erectile dysfunction. Some of these advantages include:

1. Simplicity: Malleable penile prostheses are straightforward to use. There is no need for inflation or deflation, as the device remains in a semi-rigid or malleable state at all times. This simplicity can be particularly beneficial for men who may have difficulty operating more complex inflatable devices.

2. Durability: Malleable penile prostheses tend to be very durable and have a long lifespan. They are less prone to mechanical failure compared to inflatable devices, which may require more maintenance and could potentially develop leaks or other issues over time.
3. Reliability: Malleable penile prostheses offer a high degree of reliability. Once implanted, they typically work consistently, allowing the individual to achieve and maintain an erection when needed without relying on medication or other treatments.
4. Concealability: Malleable penile prostheses are less noticeable than inflatable devices, as there are no visible external components or pumps. This can lead to increased comfort and confidence in intimate situations.
5. Lower cost: Malleable penile prostheses are often less expensive than inflatable ones, making them a more cost-effective option for some patients.
6. Suitable for certain medical conditions: Malleable penile prostheses may be recommended for individuals who have certain medical conditions or anatomical factors that make inflatable devices less suitable. For example, they may be a better option for men with a history of pelvic surgery or radiation therapy.
7. Immediate rigidity: With a malleable prosthesis, the penis is in a semi-rigid state all the time, so there’s no waiting for an erection to occur. This can be advantageous for men who want an erection to be readily available when needed.

It’s important to note that while malleable penile prostheses have these advantages, they also have limitations. For example, the inability to adjust the degree of rigidity may be a drawback for some individuals, as the penis is either erect or flaccid, with no in-between. Additionally, some men may find it less comfortable or less natural feeling compared to an inflatable prosthesis. The choice between malleable and inflatable penile prostheses should be made after thorough consultation with a healthcare provider, considering the individual’s specific needs and preferences.

What are the desadvantages of malleable penile prosthesis

Malleable penile prostheses have several disadvantages and limitations that individuals should consider when deciding on the appropriate treatment for erectile dysfunction. Some of these disadvantages include:

1. Lack of spontaneity: Malleable penile prostheses remain semi-rigid at all times, which means there is no ability to achieve an erection spontaneously or without manual manipulation. This lack of spontaneity may be a drawback for some men who prefer the natural, on-demand nature of erections.
2. Fixed rigidity: The penis is either fully erect or completely flaccid with a malleable prosthesis, offering no ability to adjust the degree of rigidity. This fixed state may not be ideal for every sexual encounter and can limit sexual variability and comfort for some individuals.
3. Concealment challenges: While malleable prostheses are less visible than inflatable ones, they can still pose challenges when it comes to concealment in tight-fitting clothing or situations where complete discretion is desired.
4. Potentially less natural feel: Some men find that malleable penile prostheses feel less natural during sexual activity compared to an inflatable prosthesis or a natural erection. This can affect overall sexual satisfaction.
5. Surgical procedure required: Implanting a malleable penile prosthesis involves surgery, which carries inherent risks and potential complications, such as infection, scarring, or mechanical issues with the device.
6. Potential discomfort: Some men may experience discomfort or pain during certain sexual positions or activities due to the fixed rigidity of the prosthesis.
7. Reduced size: The implantation of a malleable prosthesis may result in a slightly shorter penile length when compared to an uninflated natural state, although this can vary among individuals and is not always a significant concern.
8. Limited suitability for certain conditions: Malleable penile prostheses may not be suitable for all individuals, especially those with certain medical conditions or anatomical abnormalities that could complicate the implantation procedure.
9. Limited reversibility: While malleable prostheses can be removed, the process is not as straightforward as deflating an inflatable prosthesis. Revision surgery may be required to remove or replace a malleable implant, which carries its own set of risks and considerations.
10. Psychological Impact: Some individuals may experience psychological or emotional concerns related to the permanent, semi-rigid nature of the prosthesis. It may affect body image or self-esteem in some cases.

Ultimately, the choice between a malleable penile prosthesis and an inflatable one depends on an individual’s unique needs, preferences, and medical history. It is crucial to have a thorough discussion with a urologist or a healthcare provider specializing in sexual medicine to determine the most suitable treatment option for erectile dysfunction based on the individual’s specific circumstances.

What should malleable penile prosthesis patients pay attention to?

Patients who have undergone the implantation of a malleable penile prosthesis should pay attention to several important aspects to ensure the success of their treatment and overall well-being. Here are some key considerations:

1. Post-Surgery Care:

• Follow the post-operative instructions provided by your urologist or healthcare provider meticulously.
  • Keep the surgical site clean and dry to prevent infection.
  • Monitor for signs of infection, such as redness, swelling, increased pain, or discharge from the incision site. If you notice any of these signs, contact your healthcare provider promptly.

• Manual Manipulation:

• Learn how to manually adjust the position of the prosthesis to achieve an erection or return to a flaccid state. Your healthcare provider should provide guidance on this.
  • Practice manipulating the prosthesis to become comfortable and confident with its use.

• Follow-Up Appointments:

• Attend all scheduled follow-up appointments with your urologist to assess the healing process, address any concerns, and ensure that the prosthesis is functioning correctly.

• Sexual Health and Intimacy:

• Communicate openly with your partner about the malleable penile prosthesis and any concerns or preferences related to sexual activity.
  • Explore and experiment with different sexual positions and techniques to find what works best for you and your partner.
  • Understand that achieving and maintaining an erection with the prosthesis may require more manual effort and preparation compared to natural erections.

• Psychological Well-Being:

• Recognize and address any psychological or emotional concerns that may arise due to the prosthesis. It’s normal to have some adjustment period and mixed emotions.
  • Consider seeking counseling or support from a mental health professional or a sexual therapist if you experience anxiety, depression, or self-esteem issues related to the prosthesis.

• Device Maintenance:

• Malleable penile prostheses are relatively low-maintenance compared to inflatable ones. However, it’s essential to keep the device clean and free from debris.
  • Avoid excessive bending or forceful manipulation of the prosthesis, as this can cause damage or complications.

• Lifestyle Modifications:

• Inform your healthcare provider of any lifestyle changes, medications, or health conditions that may affect the prosthesis or your sexual health.

• Potential Revisions or Removal:

• In some cases, revision surgery may be necessary to adjust or replace the malleable penile prosthesis. If you experience any issues or discomfort, discuss them with your healthcare provider.
  • If you decide to have the prosthesis removed, consult with your urologist to plan the procedure and discuss potential outcomes.

• Support Groups:

• Consider joining a support group for individuals who have undergone penile prosthesis implantation. Sharing experiences and information with others who have gone through similar experiences can be valuable.

As a conclusion Ultimately, patients with a malleable penile prosthesis should maintain open communication with their healthcare provider, follow their guidance, and prioritize their overall sexual health and well-being. Being proactive in addressing any concerns or issues that arise can help ensure a positive and satisfying experience with the prosthesis. In our experience so far, we have seen that couples are very happy with the one-piece prosthesis when suitable patients are selected. We have patients who have used it for 18-20 years without any problems.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKEY