Penile prosthesis surgery is suitable for patients with severe organic ED refractory to pharmacological treatment. Currently there are two main subtypes of prosthesis: malleable prosthesis (or semi-rigid) and inflatable prosthesis. Inflatable penile prostheses (see image) are available as a two-piece (Ambicor, American Medical Systems) or three-piece devices (AMS 700CX, LGX or CXR or Coloplast Titan, Titan Zero Degree, Titan Touch) The two- and three piece devices utilise a pump placed in the scrotum which controls the inflation and deflation of the device and provides penile girth and rigidity. Complications include infection rates of up to 2% and re-operation rates for mechanical failure of 15% by 10 years. The overall satisfaction rates have been reported as over 90% from both the patients and partners.
The surgery is undertaken under a general anaesthetic and can be performed through a small scrotal incision.
Depending on the cause of the erectile dysfunction, patients undergoing an inflatable prosthesis require a small reservoir which is either placed through an open incision in the abdomen if there has been a previous radical prostatectomy procedure or pelvic surgery or it can be placed through the same scrotal incision used to perform the procedure if there has been no other prior surgery. A urinary catheter is also required for one night and removed the next day when patients are allowed home. Patients with a previous history of priapism or those requiring revision surgery can still undergo the procedure as there are additional instruments available to allow placement of implant cylinders in difficult cases.
Patients are advised not to use the prosthesis for intercourse for 6 weeks however inflation and deflation of the device can be performed from 2 weeks after the procedure.
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