An erection starts in the brain. Something seen, felt, smelled, heard, or thought makes the nerves send chemical messages to the blood vessels in the penis. The arteries relax and open to let more blood to flow in; at the same time, the veins close. Once blood is in the penis, pressure traps it within the Corpora Cavernosa. Your penis expands and holds the erection. When the inflow of blood stops and the veins open, the penis becomes soft.
An erection therefore consists of blood flowing into the Corpora Cavernosa and being trapped there. A problem with either blood getting in or staying in causes Erectile Dysfunction, also known as ED.
Potential causes of Erectile Dysfunction are many and include:
Although medical treatments for erectile dysfunction may provide satisfying results, they do not provide a long-term cure to the problem. They are unfortunately “band-aids” for the symptoms but not a total solution.
Most men ultimately want:
Because of all of these factors, penile implants offer a very compelling alternative to treating ED
What are Penile Implants?
There are several types of implants. In each case, the implant goes into the erection bodies of the penis and converts the non-functioning penis into a functioning penis.
In this case, flexible (a good analogy is a goose-neck lamp) or semi rigid cylinders are placed into the erection bodies. The penis is rigid enough for sex but soft (flaccid) enough that it can be concealed in the clothes.
Good candidates for this type of implant are men with poor hand function (with a condition like multiple sclerosis) or men with buried penis who need a prosthetic to hold on a condom-style catheter.
Advantages of One- Piece Implants
Disadvantages: least natural erection, no antibiotic coating; worst rigidity; worst flaccidity
In this case, the cylinders are filled with fluid, and there is a pump in the scrotum (totally concealed, like a third small testicle). The man uses the pump to get an erection, and bends the penis to move the fluid out and become flaccid again.
Advantages of Two- Piece Implants
Disadvantages: no antibiotic coating; not good for very thin men; not good for larger penises - because of poor flaccidity.
Good candidates for this type of implant are men who have extremely complex pelvic issues that make placement of a three-piece undesirable ( previous trauma)
These implants are by far the most commonly used devices. There are fluid-filled cylinders, a pump in the scrotum (that has parts for both pumping up and deflating the cylinders), and a reservoir in the pelvis/abdomen that holds the fluid when the penis is flaccid.
Advantages of Three- Piece Implants
Disadvantages: need for placement of reservoir
Good candidates for this type of implant are most men with erectile problems, including those from prostate cancer, diabetes, vascular disease, spinal cord injury, pelvic trauma, transplant patients, and others
THE PROCEDURE
This procedure is carried out to correct sexual dysfunction if it is not treatable by other forms of treatment or if you prefer this treatment over others.
Performed under general anesthesia, an incision is made at the junction of the penis and the scrotum, the pubic area (two fingers above the base of the penis), or close to the head of the penis, depending on the type of prosthesis being used. Malleable rods and articulating rods are placed in the penis only.
Two-piece inflatable prostheses have a penile component and pump and reservoir part for placement in the scrotum. Three piece-inflatable prostheses have penile/scrotal (pump) components and pelvic/abdominal (reservoir) components.
This procedure takes about two hours depending on type of prosthesis being inserted.
PREPARATION FOR YOUR SURGERY
Before traveling to Cyprus, as part of your surgery preparation you will complete a detailed specific questionnaire, which will allow our doctors to determine your eligibility for surgery.
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.
Before your departure your records will be reviewed thoroughly by our surgeon. This includes X-rays and a complete medical and surgical history as well as your specific issues.
After traveling to Cyprus, a new set of X-rays will be taken as well as an in person physical examination.
The surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will discuss your procedure and answer any questions.
Preparation for the hospital
Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:
Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:
Morning of surgery
Bring all your medicines in their original containers with you to the hospital. You will meet with the anesthesiologist. This doctor will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery. You will have an IV or intravenous line put in to give you fluid and medicine during your surgery. When it is time for you to go to surgery, your family will be asked to wait in the waiting area. Your doctor will talk to your family there after your surgery is done.
Recovery after surgery
When you wake up after your surgery, you will be in the recovery room. You will stay there until you are awake and your pain is under control. Most patients return to their room after a few hours, but some will need to stay overnight for observation.
You will have an analgesia pump device to deliver pain medication into your IV or epidural space (in your spine). You will also have compression boots on your lower legs to help your circulation. They will be taken off when you are able to walk.
You will most likely be tired and a bit sore for a few days. You may have pain not only from your incision, but also from muscle soreness in your upper back and shoulders. This is from the positioning in the operating room during the surgery. You will have liquid pain medicine in the hospital and a prescription for pain pills at home.
You may have a sore throat. This is a result of the placement of anesthesia tubes during surgery. Throat lozenges and spray usually help.
Your scrotum may be slightly swollen as well. This will improve after a few days but may continue for a week or so.
You may have stinging and possible trouble initiating the urinary stream, however this will be overcome within the first few days post operatively.
Hospital discharge and home instructions
One night hospitalization is the norm for this type of procedure.
Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom etc.
Prior to being discharged, you will receive the following instructions for care of areas of the body that may be affected by lymph node removal:
You will be able to leave the hospital when you are:
LIFE AFTER SURGERY
You will leave the pump in the “down” (deactivated) position for 6 weeks. Gently pull downward on the pump daily to make sure it stays in a good position in the scrotum. The bath is a good place to do this, since the scrotum will be more relaxed.
NO sexual activity (sex or masturbation) for 6 weeks.
It is best if you wear brief or similar snug underwear and have the penis facing “up” (towards the abdomen) for a month after surgery. This will help give the penis the best angle when you are ready to use the prosthesis.
These guidelines give you an overview of what you may expect as part of your care after you leave the hospital. Be sure to follow your surgeon’s discharge instructions if they are different from what is listed here:
If you notice sudden swelling contact our surgeon immediately. This will be monitored through blood tests.
Medications
Your medicines: Take the medicines you were taking before surgery, unless your surgeon has made a change.
Your surgeon will order a prescription pain medicine for you after surgery. As your pain lessens, over the counter pain medicines such as acetaminophen or ibuprofen can be used. They can also be used instead of your prescription for mild pain.
Prescription pain medicines can cause constipation. Your doctor may order a stool softener to prevent this. You should be back to your normal bowel routine in about 2 weeks. If the stool softener does not work, take Milk of Magnesia. If you still are not getting relief, call your surgeon.
FOLLOW-UP
Follow-up after surgery is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need.
Results
Initial success rate is 90 percent. On average, inflatable prostheses function effectively for 10–15 years and semi-rigid a little longer.
Considerations