Penile Prosthesis

What is a Penile Prosthesis (Penile Implant)?

A penile prosthesis, commonly known as a "happiness bar," is an implant surgically placed inside the penis. This method is generally used for patients experiencing advanced erectile dysfunction who have not benefited from other treatment methods.

Today, there are two main types of prostheses: three-piece inflatable implants (reservoir, pump, cylinders) and single-piece malleable/rigid implants. The leading implant manufacturers most widely used and trusted worldwide are AMS (Boston Scientific) and Coloplast.

Who is a Candidate for Penile Prosthesis?

Penile prosthesis surgery is considered the third-line and most definitive option in erectile dysfunction treatments. A prosthesis comes into consideration in the following cases:

Failure of Other Treatments: Patients for whom oral medications (PDE5 inhibitors), injections, or regenerative treatments such as shock wave/stem cell therapy did not work, or those who do not prefer methods like vacuum devices.

Permanent and Organic Erectile Dysfunction: Individuals experiencing permanent erectile dysfunction as a result of diabetes, prostate cancer surgery, radiotherapy, spinal cord injury, or neurological damage.

Seeking a Permanent Solution: Patients who do not want to lose time with other temporary treatments and desire a more definitive, permanent solution for their sexual life.

Device Types: Inflatable and Malleable Prostheses

There are two main types of penile prostheses selected according to the patient's anatomy and lifestyle:

Inflatable Implants

These are three-piece systems consisting of a reservoir in the pelvis, a pump in the scrotum, and two cylinders in the penis. It works by pumping the fluid inside. In this group, there are models that only expand the penis girth-wise, as well as models that provide both girth and length expansion (e.g., AMS LGX).

Advantages: It provides the closest feeling to a natural erection. When the device is deflated, the penis looks completely natural and soft.

Disadvantages: The surgery is more detailed than single-piece models, requires reservoir placement, and the cost is slightly higher.

Malleable (Rigid) Implants

These are sturdy rods made of silicone or metal alloy that maintain their shape at all times. They do not need to be inflated; the patient manually bends the penis into position for intercourse and then bends it back down afterward.

Advantages: Due to its simple structure, surgery is faster, and the risk of malfunction (mechanical failure) is almost non-existent. It is ideal for patients with limited manual dexterity or mental capacity (advanced age, stroke victims, etc.).

Disadvantages: The penis remains in a semi-rigid state constantly; a "completely flaccid" state is not possible. Concealing it may be slightly more difficult compared to inflatable models.

According to medical guidelines, there is no difference between the two systems in terms of infection risk. However, three-piece inflatable prostheses are more frequently preferred due to their aesthetic and functional naturalness.

Preoperative Evaluation

A detailed medical history is taken from every guest before the operation, and physical examinations and laboratory tests are performed. Diabetes, cardiovascular diseases, neurogenic damage, previous pelvic surgeries (e.g., prostate surgery), and psychosocial status are meticulously evaluated. Realistic expectations are clarified by discussing all treatment alternatives, along with the advantages and disadvantages of the prosthesis, with the patient.

Anesthesia Choice and Surgical Process

This operation, planned in line with the joint evaluation of the surgeon and anesthesiologist, is performed under spinal (numbing from the waist down) or general anesthesia depending on the patient's general condition. The surgical process is carried out with great care using the "no-touch" technique, where sterility standards are kept at the highest level and contact between the skin and the implant is completely prevented.

During the procedure, the penoscrotal (the area where the scrotum and penis meet) or infrapubic (groin) approach is preferred as the incision site, both of which have clinically high success rates. Following this operation, which lasts an average of 1 to 2 hours, individuals are usually hosted at the clinic on the day of the procedure and are safely discharged after the follow-up dressing the next day.

Postoperative Care and Return to Sexual Life

The mild levels of pain and swelling that can be observed after the operation are part of a normal healing process and can be effectively controlled with prescribed painkillers. During the first days covering the early recovery period, it is of great importance for the patient to rest and strictly avoid heavy physical activities.

After the 4 to 6-week period during which the tissues complete the healing process, the 'activation' (start of use) phase begins. In this stage, the usage training given to the patient by the physician is extremely simple; an erection is achieved by squeezing the pump mechanism, and the penis returns to its natural resting state by pressing the release button. This practical operation for daily use can be easily mastered by the person within just a few minutes.

Satisfaction: According to guidelines, when appropriate patient selection is made, 92–100% of patients and 91–95% of spouses/partners report being satisfied with the implant. Increased self-confidence and a regular sexual life are the most important gains.

What are the Possible Complications?

As with any surgical procedure, penile prosthesis surgery has risks:

Early Period: Bleeding (hematoma) at the surgical site, temporary pain, or difficulty urinating may rarely be seen.

Infection (1-3%): This is the most significant risk. Thanks to the strict surgical measures and antimicrobial-coated implants applied in our clinic, this risk has been reduced to very low levels of 1-3%.

Mechanical Failure: In current designs, the probability of device failure within the first 5 years is less than 5%. The lifespan of the device is generally between 15-20 years.

Frequently Asked Questions (FAQ)