Malleable prosthesis
It is made up of rods that keep the penis firm. To accommodate or position it for sexual intercourse, the patient moves the penis with his hand.
Surgical treatment of erectile dysfunction
Penile prosthesis placement
A decision made after understanding the case and the alternatives.
Assessment and indication
Every decision starts with understanding the case.
A penile prosthesis is an option for men with erectile dysfunction who have not had a satisfactory response to clinical treatments or who, after learning about the alternatives, opt for surgical treatment. It may also be indicated in some cases of Peyronie's disease accompanied by erectile dysfunction.
Before proposing surgery, I try to understand what is happening, what has already been tried and what the patient expects from the treatment.
01
How do I evaluate
During the consultation, I talk about the beginning of the erection difficulty, its evolution, the associated diseases, the medications in use and the response to previous treatments. I perform a physical examination and assess whether there is curvature, fibrosis or other changes in the penis.
Erection-induced penile Doppler ultrasound is one of the tools I use when I need to better characterize erectile dysfunction. It allows you to evaluate the arrival of blood to the penis, identify signs of difficulty maintaining an erection and observe the response to the medication applied during the exam. It can also help in evaluating changes associated with Peyronie's disease.
This result is interpreted together with the clinical history and physical examination. Doppler helps to choose the path, but it does not alone determine the indication for a prosthesis. The decision also considers the treatments already carried out, the patient's health conditions and goals.
02
What are the types of prosthesis?
inflatable prosthesis
It allows rigidity to be achieved by activating a small pump implanted in the scrotum. After intercourse, the device can be deflated. Its placement involves more components and more complex surgery.
The choice of model takes into account anatomy, manual dexterity, previous surgeries, possible associated conditions and patient preference. During the consultation, I show how each device works and we talk about its limitations.
03
What is the surgery like?
The surgery is performed in a hospital environment, under anesthesia. The cylinders of the prosthesis are placed inside the corpora cavernosa, structures responsible for the rigidity of the penis. In the inflatable model, the pump and other components of the system are also implemented.
The duration and technique vary depending on the type of prosthesis and the complexity of the case. Surgery in a patient with significant fibrosis, Peyronie's disease, or a previous implant may require additional steps.
04
What to expect from the result?
The purpose of the prosthesis is to provide sufficient rigidity for sexual intercourse. It is not surgery to enlarge the penis. Therefore, I talk first about the perceived length, appearance and sensations expected after the implant.
The prosthesis does not increase sexual desire or solve, on its own, other difficulties in sexual life. In general, it does not prevent orgasm or directly alter the sensitivity that the patient already had, but these issues need to be evaluated individually.
As with any implant, there are risks, including infection and mechanical failure. I explain these risks before the decision and discuss what would need to be done if any complications occur.
05
Recovery and post-operative
In the first few days, some discomfort and swelling are to be expected. The return to light activities is usually gradual; physical exertion and sexual activity require more time. In the case of the inflatable prosthesis, I teach the patient how to handle the device at the appropriate time during recovery.
The deadline for returning to work, driving, exercising and resuming your sex life depends on progress after surgery. These guidelines are defined during post-operative follow-up, without anticipating a date that is the same for everyone.
Consultation and planning
The indication is defined for each patient.
During the consultation, I evaluate the diagnosis, explain the alternatives and organize treatment and follow-up according to the needs of the case.