The history of men’s erectile dysfunction (erectile dysfunction) is as old as human history. Giant penises made of leather on the genitals in ancient Roman theaters are generally accepted as the ancestors of penile prostheses used today. The externally attached penile prosthesis, which was designed to be useful, was first put forward by the Renaissance surgeon Ambroise Paree. The main purpose of this device was to enable veterans with genital injuries to urinate standing up.
The idea of inserting a permanent prosthesis into the penis was first realized by Bogoras in 1936. The surgeon placed a rib bone in a flap tube he made for a patient whose penis was ruptured. Although it is reported to be successful in the early period, the stiffness has disappeared since the bone is absorbed by the body in the long term.
The introduction of foreign support materials into the penis was carried out for the first time by Goodwin in 1952. Unfortunately, acrylic cylinders placed in the penis do not have sufficient environmental support, so they are eroded in a short time and come out of the skin.
In 1966, Beheri, an Egyptian surgeon, defined penile prosthesis surgery in today’s sense, and the technique currently used is a modification of it.
With the introduction of hydraulic (pumped) penile prostheses in 1973, the sexual function closest to nature can be offered to patients.
Male Reproductive System
TYPES OF PENILE PROSTHESIS (HAPPINESS BAR)
Penile prostheses can basically be divided into two main groups:
1) Malleable (Bendable) ones
2) Inflatable (Hydraulic inflatable / Pumped) ones
Malleable (Bendable) Penis Prosthesis:
Bendable Penis Prosthesis
Malleable penile prostheses were the first type of penile prosthesis produced. These prostheses are basically a bendable rod. Thanks to this rod inserted into the penis, the patient can have sexual intercourse, while at other times he can bend his penis and hide it out of his pants.
This type of prosthesis, which is used especially in elderly or rheumatic patients who do not have the dexterity to use a pump, is also preferred by patients whose financial situation is not very good because they are cheaper than hydraulic penile prostheses.
The main problem of this prosthesis, which is much easier to surgery and has a lower complication rate, is that the penis, which is always rigid, creates social and physical discomfort in patients, although it can be bent. At the same time, the constant pressure on the surrounding tissues causes erosion more often and causes it to come out of the skin.
Inflatable (Hydraulic inflatable / Pumped) Penis Prosthesis:
Inflatable Penis Prosthesis
Inflatable penile prostheses, consisting of two inflatable cylinders, a pump for inflation and a reservoir where the liquid is stored, and two-piece types without a reservoir, provide the most natural erection in men with erectile dysfunction.
In this type of prosthesis, inflatable cylinders are placed inside the penis (into the Corpus Cavernosum), the pump unit is placed inside the ovary bag, and the reservoir is placed in the abdominal cavity just in front of the urinary bladder. No part of the prosthesis is visible from the outside and it is not obvious that the patient has a penile prosthesis (even when naked), especially when not in an erection.
When the patient wants to get hard for sexual intercourse, he squeezes the pump hidden behind his ovaries 6-10 times, allowing the liquid in the reservoir to pass into the cylinders. After the erection is achieved sufficiently, the patient has normal sexual intercourse and ejaculates normally if there is no problem with ejaculation before. There is no softening in the penis after the patient ejaculates due to the prosthesis. Although some patients continue to have sexual intercourse after ejaculation, it is recommended to take the liquid back from the cylinders to the reservoir with the help of the special button on the pump and make the penis soft again after ejaculation. It should be noted that the penile prosthesis is worn to give you back your normal sex life, otherwise the goal is not to create Don Juan.
The only difference between the erection created by a three-piece penile prosthesis and the natural one is that there is no enlargement of the glans penis seen in natural erections.
Since the amount of fluid stored in two-piece prostheses is limited, the difference between soft state and erection decreases, and although it is much better than flexible prostheses, full softening is still not achieved. Two-piece prostheses are generally preferred in patients who are likely to have problems in fitting the reservoir (for example, patients who have had multiple abdominal surgeries) to avoid this.
WHO ARE PENIL PROSTHESIS (HAPPINESS BAR) CANDIDATE?
Not every man with erectile dysfunction is a penile prosthesis candidate. Patients with erectile dysfunction have undergone a thorough evaluation as described in the section ‘Erectile dysfunction (Erectile dysfunction)’ and only first-line treatments are:
Changing life habits
Elimination of reversible hormonal and additional problems
Oral medication (like Viagra, Levitra and Cialis)
And if the patient still can’t have enough sexual life after the use of vacuum erection devices in suitable patients, the option of penile prosthesis comes to the fore. The patient to be fitted with a penile prosthesis must have a good general health condition and be psychologically stable enough to maintain a regular sexual life after treatment.
Before surgery, patients undergo color Doppler USG examination for both medicolegal reasons and to predict the steps of surgery. Thanks to this procedure, both the penile blood supply can be revealed objectively and the structure of the penile tissues is examined.
Uncontrolled diabetes (diabetes) patients should be evaluated by diabetes doctors at least 2 weeks before the surgery and their diabetes diseases should be controlled.
Before the operation, you will be asked to use antibiotics for 3 days and to wash your genital area with special solutions that will be given to you. It would be more accurate not to shave your skirt. Your skirt shaving will be done in the hospital by your surgeon.
Placement of prosthetic parts in the body
General or spinal anesthesia can be applied for penile prosthesis insertion. Although it is reported in the world that penile prosthesis can be inserted under local anesthesia, our clinical experience is that this reduces patient comfort considerably.
The entire operation is performed through a 2 cm incision made from the area where the penile skin and the ovarian skin meet. Through this incision, the surgeon reaches both cavernosal bodies and inserts inflatable cylinders into them. Then, it creates an area behind the ovaries and places the pump in this area and the reservoir in the abdomen. A three-piece prosthesis operation, which is terminated by connecting all three parts together with special silicone tubes, takes approximately 40-70 minutes. The operations of two-piece and bendable penile prostheses take less time than this.
In order to minimize the risk of infection, the patient is kept in the hospital for one night after the surgery and is treated with intravenous antibiotics during this period. On the same night, approximately 4 hours after the operation, oral feeding of the patients begins.
In the morning following the surgery, the surgeon undresses the patient, removes the urinary catheter inserted during the surgery, and completely deflates the cylinders if an inflatable prosthesis type is fitted. After discharge, the patient takes oral antibiotics and painkillers if necessary for 10-14 days.
For the next 2 to 4 weeks, the prosthesis is kept deflated continuously.
2-4. At the end of the week, the surgeon teaches the patient how to use the prosthesis practically, and the patient inflates and deflates the prosthesis at home for the following 2 weeks, but does not have sexual intercourse.
From the 6th week, sexual intercourse is free.
Penile prosthesis surgery, like other surgeries, includes risks such as bleeding, infection, and damage to surrounding tissues. Among these, infection has the most important place because in case of infection, the penile prosthesis, which is a foreign body, must be completely removed and replaced with a new prosthesis. In addition, penile deformities or mechanical defects of the device may be specific to penile prosthesis surgery and additional interventions may be required for these.
Penile prosthesis operation is a very pleasant surgery. When the three-piece inflatable prosthesis is applied in appropriate centers, patient satisfaction rates reach 98%. Patient satisfaction is reported to be slightly lower with bendable penile prostheses.