Penile prosthesis surgery is the last option for people with erection problems (erectile dysfunction, ED, impotence) that do not respond to existing treatments. There are two types of penile prostheses: inflatable and one-piece. Sometimes it may be necessary to replace these prostheses with another type due to medical reasons and sometimes depending on the patient’s wishes. It is possible to replace these prostheses with others. In this article, I will give general and up-to-date information about other penile prostheses.

What is penile prosthesis?

A penile prosthesis, also known as a penile implant, is a medical device surgically implanted into the penis of a man who has erectile dysfunction (ED) or other conditions that make it difficult or impossible to achieve and maintain an erection suitable for sexual intercourse.

There are two main types of penile prostheses:

• Inflatable Penile Prosthesis (IPP): An IPP consists of two inflatable cylinders that are surgically implanted within the corpora cavernosa, the erectile chambers of the penis. These cylinders are connected to a fluid reservoir placed in the lower abdomen and a control pump usually located in the scrotum. To achieve an erection, the patient manually activates the pump, which transfers fluid from the reservoir to the cylinders, causing them to inflate and create an erection. To return the penis to its flaccid state, the fluid is pumped out of the cylinders and back into the reservoir.
• Malleable or Semi-Rigid Penile Prosthesis: This type of prosthesis consists of two bendable rods that are surgically implanted within the penis. The penis remains permanently semi-rigid, but it can be bent upward for sexual activity and returned to its downward position when not in use. While it doesn’t offer the same level of concealment as an inflatable prosthesis, some men prefer it because it doesn’t involve the need for manual inflation.

Penile prostheses are considered a last-resort treatment for erectile dysfunction when other less invasive options, such as oral medications, vacuum erection devices, or intracavernosal injections, have been ineffective or are not suitable for the patient. They are typically recommended for individuals with severe ED due to conditions like Peyronie’s disease, diabetes, or those who have undergone prostate surgery.

Before considering a penile prosthesis, individuals should have a thorough evaluation by a urologist or sexual medicine specialist to determine the most appropriate treatment for their specific condition. Penile prostheses are typically safe and effective when implanted by experienced surgeons, but they do come with surgical risks and require a period of recovery and rehabilitation. Patients should also be informed about the benefits, limitations, and potential complications associated with these devices.

Changing penile prosthesis

Changing a penile prosthesis, whether from malleable to inflatable or vice versa, typically involves a surgical procedure performed by a urologist who specializes in penile implant surgeries. Here is an overview of the process:

• Consultation: You will begin with a consultation with your urologist to discuss your reasons for wanting to change your penile prosthesis and to assess your suitability for the procedure. Your urologist will review your medical history, evaluate your current penile implant, and discuss your expectations and goals.
• Pre-operative evaluation: Your healthcare provider may perform additional tests or evaluations to ensure you are a suitable candidate for the surgery. This may include blood tests, imaging studies, and possibly a physical examination.
• Choosing the new prosthesis: During your consultation, you and your urologist will decide on the type and model of penile prosthesis that best fits your needs and preferences. You can discuss the advantages and disadvantages of inflatable and malleable options to make an informed decision.
• Surgery: The surgical procedure will involve removing the existing penile implant and replacing it with the new one. The specific steps and techniques used can vary depending on the type of prosthesis and the patient’s individual circumstances.
• Recovery: After the surgery, you will need time to recover. This may involve staying in the hospital for a short period or having outpatient surgery, depending on the complexity of the procedure. Your urologist will provide guidance on post-operative care, including wound care and any restrictions on activities.
• Follow-up care: Regular follow-up appointments with your urologist are essential to monitor your progress, address any concerns, and ensure proper healing. These appointments will also help determine if the new penile prosthesis is functioning as expected.

It’s important to note that, like any surgical procedure, changing a penile prosthesis carries some risks and potential complications, as mentioned in a previous response. These risks should be discussed thoroughly with your urologist during the consultation.

Overall, the decision to change a penile prosthesis should be made in consultation with a qualified healthcare provider who can guide you through the process, address your concerns, and provide you with personalized care.

Is it possible to change malleable penile prosthesis with inflatable prosthesis?

Yes, it is possible to change a malleable penile prosthesis (also known as a semi-rigid penile implant) with an inflatable penile prosthesis through a surgical procedure called penile prosthesis revision surgery. This procedure is typically performed when a patient with a malleable prosthesis desires or requires the benefits of an inflatable prosthesis, such as the ability to achieve a more natural and controlled erection.

Penile prosthesis revision surgery involves removing the existing malleable prosthesis and replacing it with an inflatable one. The inflatable prosthesis consists of two cylinders that are implanted within the penis, a pump placed in the scrotum, and a reservoir usually located in the abdomen. When the patient wants to achieve an erection, they manually pump fluid from the reservoir into the cylinders, causing the penis to become rigid. To return the penis to its flaccid state, the patient releases the fluid back into the reservoir.

This type of surgery should only be performed by a urologist or surgeon experienced in penile prosthesis procedures, as it involves the careful removal and replacement of the device to ensure proper function and minimal complications. It’s essential to consult with a healthcare professional to determine if this type of procedure is suitable for your specific situation and needs.

When malleable penile prosthesis changed with inflatable prosthesis?

The decision to change a malleable penile prosthesis with an inflatable prosthesis is typically made based on the patient’s individual needs and preferences, as well as their medical condition. Here are some common scenarios in which a malleable penile prosthesis might be changed to an inflatable one:

• Desire for a more natural erection: Malleable penile implants provide a permanent semi-rigid erection, which may not feel as natural or allow for the same level of control as an inflatable prosthesis. If a patient wishes to have the option of achieving a more natural-feeling and controllable erection, they may opt for an inflatable prosthesis.
• Improved sexual function: Inflatable penile prostheses can allow for better rigidity control, enabling the patient to achieve a firmer and more satisfactory erection compared to a malleable prosthesis.
• Change in medical condition: Some patients may experience changes in their medical condition that make an inflatable prosthesis more suitable. For example, if a patient initially had a malleable prosthesis due to certain medical constraints but those constraints have changed or improved, they may consider switching to an inflatable device.
• Patient preference: Ultimately, the decision to switch from a malleable prosthesis to an inflatable one may come down to the patient’s personal preference and lifestyle considerations. Some individuals may prefer the convenience and discretion of an inflatable prosthesis.

It’s important to note that the decision to undergo penile prosthesis revision surgery should be made in consultation with a qualified urologist or surgeon who specializes in penile implant procedures. The healthcare professional can evaluate the patient’s specific situation, discuss the pros and cons of each type of prosthesis, and help determine the most appropriate choice based on the individual’s needs and goals.

Changing malleable penile prosthesis with inflatable prosthesis how affect sexual life?

Changing from a malleable penile prosthesis to an inflatable one can have both positive and potentially negative effects on a person’s sexual life. The impact on sexual life can vary depending on the individual and their specific circumstances. Here are some factors to consider:

Positive Effects:

• Improved sexual function: An inflatable penile prosthesis allows for a more natural and controllable erection compared to a malleable prosthesis. This can lead to improved sexual function, including the ability to achieve a firmer and more satisfactory erection.
• Increased spontaneity: With an inflatable prosthesis, a person can achieve an erection by manually pumping the device, which can be done discreetly and relatively quickly. This increased spontaneity can enhance sexual experiences.
• Enhanced sexual satisfaction: Many individuals report higher levels of sexual satisfaction and greater confidence in their ability to engage in sexual activity with an inflatable prosthesis.

Negative Effects:

• Surgical recovery: The process of changing from a malleable prosthesis to an inflatable one involves surgery, and there can be a recovery period during which sexual activity may be limited or temporarily uncomfortable.
• Learning curve: Using an inflatable prosthesis requires a learning curve, as individuals need to become accustomed to operating the device and coordinating its functions during sexual activity.
• Psychological factors: The decision to undergo penile prosthesis revision surgery and adapt to a new device can have psychological implications. Some individuals may experience anxiety or emotional challenges related to the procedure and its impact on their sexual life.

It’s important to note that each person’s experience is unique, and the effects on sexual life can vary. Many individuals report improved sexual function and satisfaction after switching to an inflatable prosthesis. However, it’s crucial for individuals considering this change to have realistic expectations and to discuss their concerns and goals with a qualified healthcare provider.

Before undergoing the procedure, it’s advisable to have a candid conversation with a urologist or surgeon who specializes in penile implants. They can provide guidance, answer questions, and help individuals make informed decisions about whether the change to an inflatable prosthesis is the right choice for their specific needs and circumstances. Additionally, post-operative counseling or support may be beneficial in addressing any psychological or emotional concerns.

Is there risks and complications changing malleable penile prosthesis with inflatable prosthesis?

Yes, there are risks and potential complications associated with changing a malleable penile prosthesis to an inflatable prosthesis through penile prosthesis revision surgery. It’s important for individuals considering this procedure to be aware of these risks and discuss them thoroughly with a qualified urologist or surgeon before making a decision. Some of the potential risks and complications include:

• Surgical complications: Any surgical procedure carries inherent risks, including infection, bleeding, anesthesia-related issues, and wound healing problems. These risks can occur during the surgery to remove the malleable prosthesis and implant the inflatable one.
• Infection: Infection is a significant concern with any type of penile implant surgery. Prosthetic infections can lead to complications and may require device removal and antibiotic treatment.
• Mechanical malfunction: Inflatable penile prostheses have more components compared to malleable ones, which can increase the risk of mechanical malfunction or device failure. If the inflatable prosthesis develops a malfunction, it may require further surgical procedures to repair or replace it.
• Post-operative pain and discomfort: Patients may experience pain and discomfort during the recovery period following penile prosthesis revision surgery. This discomfort can persist for several weeks to months.
• Scarring: Surgical scars may form at the incision sites, which can vary in size and visibility depending on the surgical technique used. Scarring can sometimes affect the cosmetic appearance of the penis.
• Changes in penile sensation: Some patients may experience changes in penile sensation after the surgery, which can affect sexual function and pleasure.
• Risk of complications associated with inflatable prosthesis use: After the conversion to an inflatable prosthesis, there are potential complications related to the use of the device, such as pump or reservoir issues, that may require further intervention.
• Psychological considerations: Patients may experience psychological and emotional challenges related to the decision to undergo penile prosthesis revision surgery, including anxiety, depression, or changes in body image.

It’s essential for patients to have a thorough discussion with their healthcare provider to assess their individual risk factors, expectations, and any potential concerns. Patients should also follow the post-operative care instructions provided by their surgeon to minimize the risk of complications and ensure a successful outcome. Choosing an experienced urologist or surgeon with expertise in penile implant procedures can help reduce the risk of complications and ensure the best possible results.

Is it possible changing inflatable penile prosthesis with malleable prosthesis?

Yes, it is possible to change an inflatable penile prosthesis with a malleable prosthesis through a surgical procedure known as penile prosthesis revision surgery or explantation. The process involves the removal of the inflatable prosthesis and the replacement with a malleable one.

Here’s an overview of the steps involved:

• Consultation: Start by scheduling a consultation with a urologist who specializes in penile implant surgeries. Discuss your reasons for wanting to switch from an inflatable to a malleable prosthesis and your expectations for the procedure.
• Pre-operative evaluation: Your healthcare provider will assess your medical history, perform a physical examination, and may order additional tests to determine your eligibility for the procedure.
• Choosing the new prosthesis: Together with your urologist, you will decide on the specific malleable penile prosthesis model that best suits your needs and preferences.
• Surgery: The surgical procedure will involve removing the existing inflatable penile implant, which includes deflating and removing the cylinders and the pump. The malleable prosthesis is then implanted, typically consisting of two flexible rods that are inserted into the penis.
• Recovery: After the surgery, you will need time to recover. Your healthcare provider will provide post-operative care instructions, which may include wound care and restrictions on certain activities. Recovery time can vary from person to person.
• Follow-up care: Regular follow-up appointments with your urologist are crucial to monitor your progress, address any concerns, and ensure proper healing.

It’s important to discuss the potential risks, benefits, and outcomes of changing from an inflatable to a malleable prosthesis with your urologist before making a decision. Like any surgical procedure, there are inherent risks and complications associated with penile prosthesis revision surgery, so it’s essential to be well-informed and make the choice that aligns with your individual needs and goals.

When inflatable penile prosthesis changed with malleable prosthesis?

Changing from an inflatable penile prosthesis to a malleable prosthesis, also known as penile prosthesis explantation, is typically considered in cases where a patient either no longer wishes to have an inflatable device or experiences complications with their inflatable prosthesis. Here are some common scenarios in which this transition might occur:

• Patient preference: Some individuals prefer the simplicity and ease of use offered by malleable penile prostheses. They may opt to switch to a malleable implant because they find it more convenient or because they do not wish to use the inflation and deflation mechanisms of an inflatable prosthesis.
• Complications: Complications with inflatable penile prostheses can arise over time, such as infection, mechanical issues, or difficulty operating the device. In these cases, a healthcare provider may recommend removing the inflatable implant and replacing it with a malleable one to address the ongoing issues.
• Lifestyle changes: Changes in a patient’s lifestyle or medical condition may make an inflatable prosthesis less suitable. For example, if a person becomes unable to operate the inflation pump due to a medical condition or physical limitations, they may consider switching to a malleable implant.
• Revision surgery: In some cases, individuals may require revision surgery to correct problems with their inflatable prosthesis. During this surgery, it may be decided to replace the inflatable implant with a malleable one if the urologist believes it is the best course of action for the patient.

The decision to change from an inflatable to a malleable penile prosthesis should be made in consultation with a urologist who specializes in penile implant surgeries. The urologist will assess the patient’s specific circumstances, medical history, and preferences to determine if this transition is appropriate and recommend the best course of action. It’s important for patients to discuss their concerns and goals with their healthcare provider to ensure they make an informed decision that aligns with their needs and expectations.

Changing inflatable prosthesis with malleable how affect sexual life?

Changing from an inflatable penile prosthesis to a malleable one can have an impact on a person’s sexual life and experience. The effects will vary from one individual to another and depend on their specific circumstances, preferences, and needs. Here are some potential effects:

• Erection rigidity: With an inflatable prosthesis, you have the ability to control the firmness of your erections by inflating and deflating the device. In contrast, a malleable prosthesis provides a permanently rigid erection. This means that with a malleable implant, you will always have an erection, whether you desire one or not. Some men find this constant rigidity acceptable, while others may prefer the flexibility of an inflatable prosthesis.
• Naturalness of the erection: Inflatable penile prostheses are designed to mimic a more natural erection in terms of appearance and feel. Malleable implants, on the other hand, can result in a less natural-looking and feeling erection, which may impact sexual satisfaction for some individuals.
• Discreetness: Inflatable penile implants can often be deflated, making the penis appear flaccid, which can be more discreet. Malleable implants maintain a consistent rigidity, which may be less discreet in certain situations.
• Adjustability: With an inflatable prosthesis, you can vary the degree of rigidity to match your desired level of firmness during sexual activity. Malleable implants do not offer this adjustability.
• Ease of use: Malleable implants are generally easier to use because they do not require any manual inflation or deflation. Some individuals may find the simplicity of a malleable prosthesis more convenient.
• Satisfaction: The impact on sexual satisfaction varies from person to person. Some individuals find that changing to a malleable implant does not significantly affect their sexual life, while others may experience differences in sexual sensation or satisfaction.

It’s important to discuss these potential effects and your specific concerns with your healthcare provider, including a urologist who specializes in penile implant surgeries. Your urologist can provide guidance, answer your questions, and help you make an informed decision based on your individual needs and preferences. Additionally, counseling and support from a sexual health specialist may be beneficial to address any emotional or psychological aspects of the transition. Ultimately, the choice to change from an inflatable to a malleable penile prosthesis should align with your comfort and satisfaction in your sexual life.

As a conclusion

As a result, it is possible to replace the existing penile prosthesis with another type of prosthesis at the patient’s request or for medical reasons. Patients should be adequately informed about this. This type of surgery should be performed by a urologist who is experienced in this field.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKEY