AMS 700 CX ®
PENILE IMPLANT SURGERY
The last step of treatment options for erection problems is the placement of penile prostheses (penile implants); which have been used in clinical practice successfully for more than 40 years. Penile implants continue to be an invaluable option for our patients when medical treatment is not effective. Penile prostheses were introduced for use in the 1970s. Technological advances over the years enabled patients to attain improved natural and physiological erections with the use of penile prostheses today. Consequently, the satisfaction rates of men with ED and their partners were improved, too. Today, potential complications that may occur after penile prosthesis implantation are minimized significantly. However, this type of surgery remains to be a critical type of intervention that needs to be carried out with utmost care. It is greatly beneficial for patients to undergo this type of surgery performed by urologists experienced in this field.
TYPES OF PENILE PROSTHESES (IMPLANTS):
Three-piece inflatable penile prostheses:
1- Cylindrical silicon parts placed along the right and left sides inside the cavernosal bodies of the penis. When these parts are filled with isotonic, the size of the penis gets larger and the penis erects.
2-Reservoir placed in the groin area to be filled with isotonic solution
3-Pump mechanism placed in the scrotum to transfer the isotonic solution from the reservoir to the cylindrical parts in the penis or to transfer the solution from the penis back to the reservoir.
* The AMS 700 series and Coloplast Titan series prostheses are the two types of 3-piece penile prostheses.
Two-Piece Inflatable Penile Prostheses:
1- Cylindrical silicon parts placed along the right and left sides inside the cavernosal bodies of the penis.
2-There is only one scrotal piece comprising both the reservoir and the pump mechanism.
* Since the fluid volume to be exchanged between the cylindrical part and the pump is small, the prosthesis inside the penis will be semi-inflated (semi-rigid). For this reason, they are less physiological and they look less natural.
* These prostheses may be preferred when it is foreseen that placing the reservoir will be difficult especially in patients with adhesions in the groin area due to previous surgical interventions.
* AMS Ambicor and Coloplast Excel models are 2-piece penile prostheses.
One-piece semi-rigid rod type (malleable) penile prostheses:
The use of semi-rigid, bendable, and malleable one-piece penile prostheses in clinical practice decreased considerably over the past years. However, they are sometimes placed in old-age patients with ED because they are still inexpensive and they do not demand manual skills. Also, it may be temporarily necessary to place malleable prostheses in order to prevent the development of corporal fibrosis in rescue procedures.
There are two major FDA approved trademarks of penile prostheses in the world. The implants introduced by Boston Scientific under the AMS brand and the implants promoted by Coloplast with the Titan brand are the most accepted and used products in the world. Neither of these prosthesis brands is superior to the other in respect to quality and patient satisfaction. Patient and partner satisfaction with inflatable penile prostheses is over 90% in almost every study. With developments in technology over the recent years, both the durability of the prostheses and the delicateness of the pump mechanism (MS or touch) have been improved considerably. Thanks to antibiotic-coated prostheses; the most feared complication, the likelihood of infections has decreased to rates less than 1%. Furthermore, the introduction of flat reservoirs significantly minimized the risk of injury in the inguinal region that might develop in association with the penile prosthesis use.
Points to know about penile prostheses:
Penile prostheses surgery is recommended for patients as the last option if adequate erection quality cannot be attained with the first-line (drugs) and second-line (self-injections) treatment options.
Penile prosthesis surgery is the last option for the treatment of ED; however, this is the best and most logical treatment modality for some of our patients who aim to continue their sexual lives.
Today, 3-piece inflatable pump prostheses are mostly preferred because they are much more natural and comfortable. When the button of the pump mechanism is pressed several times, a hard and high-quality erection is achieved within seconds. Erection can be terminated at any time by pressing a single button continuously and by squeezing the penis.
A single 5-6 cm midline incision extending from the lower part of the penis to the scrotum; which is called a penoscrotal incision, is made for the surgical intervention. Therefore, bothersome scars do not usually develop after the operation.
The approximate length of operation time is about 2 hours and the length of hospital stay is usually one day if the clinical course is uneventful.
During the operation, the sponge-like tissue with blood vessel network in the penile cavernous bodies is completely and irreversibly destructed.
If the patient suffers from uncontrolled diabetes, his blood sugar levels must be regulated, starting weeks before the surgery by adopting a strict diet and treatment regimen because diabetes and high blood sugar levels increase the risk of infection and negatively affect the wound healing processes.
Internal and external wounds and sutures are expected to resolve completely within the 6-week period after the surgery. Therefore, the patient can start using the prosthesis at earliest after 6 weeks following the surgery.
It is not possible to know by inspection that someone has inflatable penile prostheses. It is not uncomfortable for the person to wear a swimsuit or tight pants.
Men with penile prostheses enjoy sex completely, can ejaculate, and reach orgasm naturally. There are no obstacles to have children when the individual wishes to do so.
The biggest advantage that a man can obtain by having a penile prosthesis is that he can enjoy high-quality sex as long as he wishes to continue since no erection loss will occur even during ejaculation. After both partners are satisfied, the penis is deflated by pressing the pump and the sexual intercourse is completed only at that time.
The couples should be properly trained about the use of the prosthesis in the postoperative follow-up visits.