Andrew Siegel MD 2/27/16
With respect to male sexual dysfunction, implantation of a penile prosthesis is a highly effective procedure capable of restoring erectile function in those men who do not respond to simpler treatment measures. In many ways it is as quality-of-life-restoring as a total knee replacement is to one suffering with arthritis, converting a penile “cripple” into a functional male with restored erections and resolution of the psychological and emotional devastation resulting from loss of manhood.
There are two principles that can be pretty much applied to all situations in life:
- If it ain’t broke, don’t fix it. (Pardon the English.)
- If it is broken, try the simple and conservative before the complex and aggressive.
These concepts are commonly applied to medical issues in general and male sexual dysfunction in specific. If erections are satisfactory, no treatment is necessary (but maintaining a healthy lifestyle will sure help keep things that way). However, if erections are flimsy and feeble, the following sensible tiered strategy is in order:
First-Line Approach
Lifestyle makeover. This includes a heart-healthy (and penis-healthy) diet, getting down to “fighting” weight, exercising regularly, drinking alcohol moderately, avoiding tobacco, minimizing stress, getting enough sleep, etc. Aside from general exercises (cardio, core, strength training, flexibility), specific pelvic floor muscle exercises (“man-Kegels”) are beneficial to improve the strength, power and endurance of the penile “rigidity” muscles.
Second-Line Approach
ED meds/Penile vibratory stimulation therapy/Penile pump. Viagra, Cialis, Levitra and Stendra are pharmacological options. As an alternative to medications, penile vibratory nerve stimulation (Viberect device) can be an effective means of helping resurrect erectile function. Alternatively, the vacuum suction device is a means of drawing blood into the penis to obtain an erection; the system uses a constriction band to maintain the erection.
Third-Line Approach
Urethral suppositories/Penile injection therapy. Suppositories are medicated pellets that are placed in the urethra (urinary channel) that increase penile blood flow and induce an erection. Penile injections of vasodilator medications do the same and more effectively so, but require the medication to be injected directly into the penile erectile chambers. (Blog on this subject forthcoming next week.)
Fourth-Line Approach
Penile implant. This is a device made of synthetic materials that is surgically implanted under anesthesia, typically on an outpatient basis. It is totally internal, with no visible external parts and aims to provide sufficient penile rigidity to permit vaginal penetration. For the right man under the appropriate circumstances the penile implant can be a life changer.
There are two types of penile implants: semi-rigid and inflatable. I liken the difference between these two implants to the distinction between a Volkswagon and Mercedes, both effective and functional, but one with many more “bells and whistles.”
A semi-rigid penile implant (a.k.a. malleable implant) is a “static” implant that always remains rigid, not unlike the os penis (penis bone) present in many primates, except that this implant can be hinged. It is bent upwards to put it to use and is bent downwards to conceal it. It consists of two cylinders that are implanted within the penile erectile chambers through a small incision.
(Coloplast semi-rigid penile implant)
The advantage of the semi-rigid implant is its simplicity, the fact that it is less expensive than an inflatable device and its utility for handicapped patients with dexterity issues or those who have limited reaches. Its disadvantage is that it cannot go from a flaccid state to an inflated state as can the inflatable penile implant, thus creating some potential issues with concealment. Furthermore, by virtue of the constant pressure of the implant on the soft tissues of the penis, it can be more uncomfortable than the inflatable variety and has the potential for thinning the penile flesh.
The inflatable penile implant (IPP) is a “dynamic” device designed to mimic the characteristics of a normal erection, with the capacity to inflate and deflate by virtue of a self-contained hydraulic system. Dual cylinders (inner tubes) are implanted in the erectile chambers. The length of the erectile chambers is precisely measured in order to size the implant properly, similar to measuring the size of your feet in order to ensure a good shoe fit. A control pump is implanted in an accessible area of the scrotum. The third element is the reservoir, which contains the fluid necessary for inflation. The reservoir is typically implanted behind the pubic bone or within the abdominal wall. Tubing connects the control pump to the cylinders and to the reservoir.
(Coloplast inflatable penile implant)
When an erection is desired in a man who has an IPP implanted, the scrotal control pump is repeatedly squeezed, which transfers saline from the reservoir into the penile cylinders. As the cylinders fill, an erection develops and with each consecutive squeeze, more fluid is flows into the cylinders, creating a more rigid erection of wider girth. The erection will remain until the release bar on the control pump is activated. After the completion of sexual intercourse, by activating this release bar, the fluid in the cylinders returns to the reservoir where it is again stored, returning the penis to its flaccid state. Some IPPs are designed to increase in girth only, whereas others can increase in length and girth.
IPPs have been available for over forty years and have been improved remarkably over the years. The current devices are well-engineered, sophisticated, highly effective devices. Penile sensitivity, sex drive and ability to ejaculate are essentially unchanged following an IPP implantation. It is important to know that unlike a normal erection, the IPP erection does not result in swelling of the head of the penis nor the erectile tissue surrounding the urethra. Nonetheless, it results in a penetrable and durable erection that can restore sexual function in a man who is incapable of achieving an erection.
Advantages of the IPP are its ability to inflate and deflate, creating no issues with concealment. The penis can be kept inflated for as long as desired, whether it be 60 seconds or 60 minutes and will not deflate after ejaculation, unlike what typically occurs under normal circumstances. Disadvantages include its additional expense (although it is usually covered by insurance), the fact that it requires some degree of manual dexterity to operate, and the fact that it is more susceptible to mechanical malfunction than the semi-rigid variety because of its complexity.
Bottom Line: The penile implant is a fourth-line approach for ED that is a highly effective means of providing erectile rigidity on demand, capable of restoring sexual function in a man who is incapable of achieving a functional erection.
Thank you to the Coloplast Corporation for providing the images.
Wishing you the best of health,
A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com
Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.
Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Arnold Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.
Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store that is home to quality urology products for men and women. Use code UROLOGY10 at check out for 10% discount.
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