Penile Prosthesis (Penile Implant) in Turkey

Penile prosthesis (happiness stick) is a medical implant used in the treatment of erectile dysfunction and surgically placed. It helps restore sexual function by providing a permanent solution in patients who do not respond to medication and other treatments.

The topic of how penile prosthesis surgery is performed includes carrying out the procedure under general anesthesia and in sterile conditions. The prosthesis consists of cylinders placed inside the penis, and the operation usually lasts 1–2 hours; patients can return to their daily lives in a short time.

When evaluated in terms of what the types of penile prostheses are, there are two main types: inflatable and semi-rigid. While inflatable prostheses provide a more natural appearance, semi-rigid prostheses stand out with ease of use and mechanical durability.

In the context of to whom a penile prosthesis is applied, patients who especially have advanced erectile dysfunction and do not respond to medical treatments are at the forefront. It offers an effective and reliable treatment option in cases developing after diabetes, vascular diseases, or prostate surgery.

What Is Erectile Dysfunction and Why Does the Need for a Penile Prosthesis Arise?

Erectile dysfunction is the condition in which the penile rigidity required to have a satisfying sexual relationship cannot be achieved, or the rigidity that is achieved cannot be maintained until the sexual act is completed. This condition is a health problem that deeply shakes men’s quality of life, self-confidence, family communication, and partner relationships. When the underlying causes of the problem are examined, it is seen that they are physical, psychological, or a combination of both factors. However, with advancing age, physical causes become much more dominant.

The vascular and nerve networks in our body work together in tremendous harmony. Penile erection also basically requires flawless vascular and nerve function. Along with sexual stimulation, signals from the brain allow the vessels inside the penis to expand and the spongy tissues to fill with blood. However, Diabetes Mellitus, commonly known as diabetes, damages both this sensitive vascular structure and the nerve endings that provide transmission over time. In a large majority of individuals who need penile prosthesis surgery, the main underlying cause is uncontrolled diabetes. In addition, conditions that cause vascular blockage, such as high blood pressure and high cholesterol, also directly impair the erection mechanism. Moreover, extensive surgeries undergone due to prostate cancer, spinal cord injuries, hormonal imbalances, and trauma to the region are also among the physical causes. When methods such as medications, vacuum devices, or needle treatments applied into the penis do not provide results, the need for a penile prosthesis, which is a permanent solution, arises.

Which Methods Are Used in the Diagnosis of Erectile Dysfunction and How Is the Decision for a Penile Prosthesis Made?

The most critical step in achieving success in the treatment process is to correctly identify the real source of the problem and determine the degree of the disease. For this reason, a comprehensive clinical evaluation process is carried out. The individual’s general health history, all prescription or non-prescription medications used, surgeries undergone, and lifestyle habits are examined in detail. Especially smoking, which affects the vascular structure, or blood-thinning drugs are of great importance at this stage. Various tests are used to understand whether the problem is caused by a vascular blockage or nerve damage.

The main methods used in the diagnosis of erectile dysfunction are as follows:

• Detailed blood tests
• Hormone level measurements
• Penile color Doppler ultrasonography
• Nocturnal erection monitoring test
• Intracavernosal drug injection
• Neurological reflex evaluation
• Psychological status analysis

Among these tests, the drug injection method includes giving a vasodilator drug into the spongy tissue of the penis. In this way, the response of the penile tissue to the medication, its blood supply capacity, and structural disorders are observed. As a result of all these evaluations, if it is determined that the tissues no longer respond to medications, the patient is offered the penile prosthesis option directly without wasting time with other temporary methods. At the decision stage, it is important to establish transparent communication about the patient’s expectations and the nature of the surgery.

What Are the Types of Penile Prostheses and Which Type of Penile Prosthesis Is More Advantageous?

With the development of medical technology, various penile prosthesis models suitable for different anatomical structures and budgets have been developed today. The prosthesis to be preferred in urological surgery is determined individually according to the person’s general health condition, manual dexterity, daily life activities, and expectations. According to their basic operating principles, these devices are divided into two main groups. The first group is malleable, also known as semi-rigid prostheses. The second group is inflatable, that is, pump prostheses, which work with fluid dynamics inside them. There is no single correct answer to the question of which prosthesis is more advantageous. For some patients, mechanical simplicity is at the forefront, while for others, natural appearance and the ability to fully deflate are indispensable. Therefore, device selection is decided as a result of joint evaluation.

What Are the Main Features of Malleable Penile Prostheses?

Prostheses called malleable or semi-rigid consist of two silicone-coated flexible rods placed into the spaces inside the penis. These devices do not contain any fluid, pump mechanism, or complex system. Due to their structure, they always have a certain level of rigidity. When sexual intercourse is desired, the user grasps the penis with the hand and brings it into a straight position. When the process is completed, the penis is bent downward or to the side with the help of the hand and placed inside the underwear. Thanks to the mechanism inside, it has the feature of staying in the position to which it is bent. This offers great comfort especially for elderly individuals or people with joint disorders.

The main advantages offered by malleable prostheses are as follows:

• Ease of use
• No risk of mechanical failure
• Shorter surgery time
• Lower operation cost
• Being ready for use at any time

Along with these advantages, there are also some limitations that should be known. The penis can never return to its soft and naturally flaccid state. It constantly creates a certain sense of fullness. This may cause concern about being noticeable from the outside when wearing thin clothing.

How Does the Working Mechanism of Inflatable Penile Prostheses Function?

Inflatable penile prostheses are advanced systems that today imitate the natural erection process anatomically in the closest way to reality. Although these systems are divided among themselves into two-piece and three-piece models, the model that provides the highest level of satisfaction is the three-piece inflatable prosthesis. This advanced system works with a dynamic mechanism that is completely hidden inside the body and is not noticeable from the outside in any way.

The main components of the three-piece inflatable prosthesis system are as follows:

• Inflatable cylinders
• Scrotal control pump
• Fluid reservoir
• Connection tubes
• Pressure relief valve

These parts, which form the heart of the system, work in perfect harmony. Two durable cylinders are placed in the right and left inner spaces of the penis. A small control pump that can be easily felt with the fingertips is hidden inside the scrotum. A reservoir filled with sterile saline is positioned in the lower part of the abdominal cavity. When the desire for sexual intercourse arises, the user presses and releases the pump in the scrotum a few times. This movement allows the fluid waiting in the reservoir inside the abdomen to move toward the cylinders. The cylinders expand by filling with fluid just like natural tissues, creating maximum girth and complete rigidity in the penis. When intercourse ends, the system is released by pressing the small deflation valve on the pump. The fluid inside the cylinders returns to the reservoir, and the penis becomes completely soft and returns to its flaccid state.

What Should Be Considered During the Preparation Process Before Penile Prosthesis Surgery?

The success of penile prosthesis surgery depends not only on the surgical technique but also on the meticulous preparations made before surgery. This preparation stage is carried out in order for the operation to proceed safely and to prevent undesirable situations such as infection. The individual’s suitability for anesthesia is evaluated by specialists. If the person has diabetes, blood sugar levels must be brought under control before surgery. It must also be ensured that there is no active infection anywhere in the body.

The important steps to be considered before surgery are as follows:

• Stopping blood-thinning medications
• Stopping alcohol consumption
• Stopping smoking
• Ensuring fasting status on the night of surgery
• Detailed genital area cleaning
• Informing the physician about regularly used medications
• Leaving the shaving procedure to the morning of surgery

Especially the issue of shaving the genital area is very important in terms of infection control. Patients are asked not to do this procedure days before the surgery; in order to prevent bacterial growth in micro-cuts that may occur on the skin, it is requested to be done in the hospital environment on the morning of the surgery.

How Is Penile Prosthesis Surgery Performed and Which Surgical Techniques Are Preferred?

The surgical procedure is carried out entirely under sterile operating room conditions, with maximum precautions taken against the risk of infection. During the surgery, general anesthesia or numbing below the waist is preferred so that the patient does not feel pain. After appropriate anesthesia is provided, the surgical area is sterilized with antiseptic solutions. Different incision methods are applied according to the anatomical structure for the placement of the prosthesis. The most common of these are the penoscrotal and infrapubic approaches.

In the penoscrotal approach, a midline incision is made below the point where the penis and scrotum meet. This method provides direct access to both the inner chambers of the penis and the scrotum. In this way, the placement of the cylinders and the pump is completed safely. In the infrapubic approach, the incision is made just below the pubic bone. The most distinct advantage of this technique is that it provides direct access to the fluid reservoir to be placed into the abdomen and offers comfort in sitting after surgery due to the absence of sutures in the scrotum. The incision site is generally planned to remain under the pubic hair. In both methods, the basic rule is to place the prosthesis parts into the correct anatomical spaces by causing the least damage to the tissues and to completely hide the system inside the body.

What Is Experienced During the Recovery Period After Penile Prosthesis Surgery?

The recovery process that begins after the surgery is completed requires the patient to be patient and to follow the given recommendations exactly. Patients are generally kept under observation in the hospital for one or two nights after the surgery. During this time, intravenous antibiotic treatment is continued and painkillers are administered. During the first few weeks, swelling, color changes, and sensitivity to touch in the penis, scrotum, and groin area are a natural reaction. In order for this swelling to subside quickly, a special compression dressing is applied before discharge.

The recommended practices for a comfortable recovery process are as follows:

• Regular antibiotic use
• Painkiller medication support
• Cold compress application
• Plenty of fluid consumption
• Physical rest
• Use of tight and supportive underwear
• Avoiding heavy lifting

For the tissues to heal completely, it is essential to stay away from sexual intercourse and heavy exercises for approximately four to six weeks after the surgery. Toward the end of this waiting period, the patient is invited to the clinic. If an inflatable prosthesis has been inserted, the patient is shown in practice how to use the device. The patient is taught in detail how to find the pump, how to squeeze it, and how to deflate it. After this training process is completed, the person can return to an active sexual life.

What Are the Possible Risks and Complications of Penile Prosthesis Surgery?

As with any surgical intervention, penile prosthesis operations also have some unique risks. Although risks have been reduced to very low levels in specialized clinics, patients must be informed about these issues before the operation. The most serious complication that may be encountered is infection. Since a foreign material is placed in the body, bacteria attaching to this device may lead to infection.

As with every surgical procedure, the possible risks involved in this surgery are as follows:

• Development of infection
• Bleeding within the tissue
• The device causing erosion in the skin
• Mechanical parts malfunctioning
• Injury to the urinary tract
• Fluid accumulation in the surgical area
• Formation of scrotal hematoma

Mechanical devices may wear out over time or rarely malfunction. When situations such as fluid leaks, breakdown of the pump button, or weakening at the connection points occur, the system is generally made operational again by replacing only the problematic part with simple revision surgeries.

How Does the Use of a Penile Prosthesis Affect Sexual Pleasure and Partner Satisfaction?

One of the issues that most occupies the minds of people researching penile prosthesis surgery is how sexual sensations, orgasm, and ejaculation will be affected. It should be known that penile prostheses do not touch the nerve endings or the sexual pleasure centers; they only imitate the erection function of the vessels inside the penis. Therefore, the individual’s feeling of sexual arousal, ability to orgasm, and ejaculation function remain the same after the surgery as they were before the surgery. The device does not increase or decrease the man’s sexual desire; it only forms the basis required for this desire to turn into a physical act.

Clinical data show that penile prosthesis applications are among the procedures with the highest patient and partner satisfaction rates among surgeries. For a man who constantly carries concern about erection, being able to obtain permanent rigidity whenever he wants is a great source of self-confidence. This strengthens the communication between the couple and eliminates anxiety. From the partners’ perspective, the fact that the device is completely hidden inside the body and gives a natural feeling raises satisfaction rates to the highest level.