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There are two types of penile implants: semirigid, noninflatable implants and inflatable implants. Semi-rigid implants consist of two bendable rods that are implanted in the erection chambers of the penis. They can be bent into position during sexual activity. With this type of implant, the penis is always semi-rigid, which may be difficult to conceal. Inflatable penile implants are devices filled with fluid which consist of two inflatable cylinders placed in the erection chambers of the penis, a hand-controlled pump placed in the scrotum, and a reservoir which stores fluid when the penis is not erect. The device is inflated by squeezing the pump several times to move the fluid from the reservoir to the cylinders. Afterwards, the pump is also used to move the fluid back to the reservoir. Two companies, American Medical Systems (AMS) and Coloplast manufacture three-piece hydraulic penile implants. Two piece (Ambicor) penile implant consists of a pair of fluid filled cylinders implanted in the penis and a pump implanted in the scrotum. During prosthesis recycling, the pump transfers the solution from small reservoirs located at the proximal end of each cylinder, into each cylinder shaft, thereby causing an erection. It provides controlled length and girth expansion through its bidirectional wave. American Medical Systems (AMS) manufacture two-piece penile implant LGX prosthesis: this three piece implant has the ability to expand in length and girth. AMS 700 LGX is a safe and reliable prosthesis for patients with ED and is effective in preventing penile shortening in patients undergoing IPP implantation, with high patient satisfaction rate. Hovewer, the price is more expensive compared to standard inflatable penile prosthesis. The penile prosthesis implanted by a one hour surgery into the corpora cavernosa. Both types of implants are placed completely inside the body. Inflatable implants are used more often because they mimick a natural erection on the other hand with mallable devices the penis is not as soft as in the flaccid state. Semi-rigid devices is only indicated in patients with manual dexterity. Discuss the choice between the two implants with your urologist.

Do not use the penile implant until your follow-up appointment Most patients follow-up at 6 weeks

1 to 2 weeks requiring pain medication

Penile implants are typically recommended in patients not responding to oral treatment alternatives. Penile implant is permenant solution of erectile dysfunction.

After 48-Hours

It is impossible to predict how long a particular implant will function in a particular patient. As with any medical device, penile implants are subject to wear and mechanical failure over time. A recent study of more than 39,000 patients showed that the 7-year mechanical survival of a Boston Scientific penile implant is 91–94%.12 To prolong the life of your implant, follow the advice of your urologist.

For penile implant surgery, you will receive either general or spinal anaesthesia. Urinary catheter will also be indwelled, which can be removed the day after surgery. Once you are under anaesthesia, the doctor will make a small incision either just above the penis or between the penis and the scrotum. The incision exposes the erectile chambers, and the surgeon measures the length of the chambers in order to implant appropriate size prosthesis. Once the cylinders are in place, the reservoir is placed behind the abdominal wall, and the pump is placed in the scrotum between the testicles to conceal the pump. Finally, all elements of the implant are connected and the incision is sutured. The wounds are cleaned and a compressive bandage is applied. Most surgeons choose to leave the penile implant inflated for one day. Some surgeons prefer to leave a drain which is then usually removed one or two days after the procedure. How to prepare Your doctor will advise you in detail about how to be prepared for the procedure. You must not eat, drink, or smoke for eight hours before surgery to prepare for the anaesthesia. If you are taking any prescribed medication, discuss it with your doctor. You may need to stop taking it several days before surgery. Is it painful: Most patients experience mild pain after the surgery due to inflammation. This is generally short lasting. Once the pain resolves, the patient can be trained to inflate and deflate the device. Most patients and their partners are very happy with the penile prosthesis after learning how to use it. After surgery: After penile implant surgery, you’ll likely need to take medications to ease pain. Mild pain might persist for several days. You might also need to take antibiotics for one week to prevent infection. Your doctor will provide specific instructions about when you can resume normal activities. Most men can resume strenuous physical activity and sexual activity about four to six weeks after surgery. Absorbable sutures are used therefore you don’t to return to your doctor to have your stitches removed.

No heavy activity or lifting No driving while taking pain medication Shower after the dressings are removed. No bathing or swimming for 6 weeks after surgery

Once in place following your surgery for ED, your implant will be completely undetectable. It’s fully concealed in the body. No one will know unless you tell them — even in the locker room.9

Because each type of implant offers unique features, you will want to discuss the risks and benefits of each device with your doctor prior to scheduling your penile implant surgery. Then choose the option that is right for you. AMS 700™ Inflatable Penile Implant Your doctor is your best source for information on the risks and benefits of the AMS 700™ Inflatable Penile Prosthesis. Talk to your doctor for a complete listing of risks, warnings and important safety information. The AMS 700™ Inflatable Penile Prosthesis is intended for use in the treatment of male erectile dysfunction (impotence). Implanting a penile prosthesis will damage or destroy any remaining ability to have a natural erection, as well as make other treatment options (oral medications, vacuum devices or injections) impossible. Men with diabetes, spinal cord injuries or skin infections may have an increased risk of infection. Implantation may result in penile curvature or scarring. Some AMS 700 devices contain an antibiotic (InhibiZone™ Antibiotic Surface Treatment). The device is not suitable for patients who are allergic to the antibiotics contained within the device (rifampin, minocycline HCl or other tetracyclines) or those who have systemic lupus, these patients should use one of the devices that do not contain InhibiZone antibiotic surface treatment. Potential risks may include: device malfunction/failure leading to additional surgery, device migration potentially leading to exposure through the tissue, wearing away/loss of tissue (device/tissue erosion) infection, unintended-inflation of the device and pain/soreness. MH-545411-AD Tactra™ Malleable Penile Implant Your doctor is your best source for information on the risks and benefits of the Tactra™ Malleable Penile Prosthesis. Talk to your doctor for a complete listing of risks, warnings, and important safety information. The Tactra™ Malleable Penile Prosthesis is intended for use in the treatment of erectile dysfunction (impotence) in adult males. Implanting a penile prosthesis will damage or destroy any remaining natural ability to have a spontaneous erection, as well as make other treatment options impossible. Men with diabetes, spinal cord injuries, or skin infections may have an increased risk of infection. Implantation may result in penile shortening, curvature or scarring. Additional information is provided in Patient Literature, available through your doctor. MH-611821-AA

Most common complications after implantation of penile prosthesis are infection and disruption of the hydraulic system. In recent years, complications of penil prosthesis implantation have been reduced significantly bacuse of the technical developments. In order to reduce the prosthetic infection rate, the penile prosthesis is covered with antibiotics, or special material which provide the antibiotic molecules in the solution to bind on prosthesis surface. According to these developments penil prosthesis infection rates reduced <1% from 3-5%. Also, mechanical deterioration rates decreased to around 5% because of development in material technology.

Antibiotics Pain Medications Stool Softener

Penile implants are devices placed inside the penis to allow men with severe erectile dysfunction (ED) to achieve rigid erection. These devices have been utilized since 1973. Most of these men have tried oral medication (PDE-5 inhibitors-tadalafil, sildenafil etc) prior to placement of a penile prosthesis. In addition, penile prosthesis can also be concomittently used in the treatment of the Peyronie’s patients with ED and curvature. Most patients are very happy with the use of the device and the saticfaction rate is 90 % of men and 95 % of the partner. Penile implants can also be used to treat severe cases of a condition that causes scarring inside the penis, leading to curved, painful erections (Peyronie’s disease). Peyronie’s patients with ED also candidates implantation of penile prosthesis.

To inflate a Boston Scientific penile implant, you squeeze the pump in your scrotum, which will send fluid into the cylinders in the penis. This requires good manual dexterity but should not be painful. If you experience pain, contact your doctor.9

When inflated, the implant makes the penis stiff and rigid, similar to a natural erection. Your erection will last as long as you desire. And you’ll still share the same intimate experience. Typically, ejaculation and sensation will feel similar to the way they felt before the implant.10

The international index of erectile function (IIEF) or other validated questionnaires to objectively assess severity of ED and subsequent postoperative outcome Combined injection-stimulation test Penile colour Doppler sonography with intracorporal pharmacologic injection

Have a temperature of 101F Severe pain in the penis or scrotal pain or swelling Severe abdominal pain Nausea and vomiting Unable to urinate

Your doctor will take a medical and sexual history which is typically enough to establish a diagnosis of congenital penile curvature. Patients usually present after reaching puberty as the curvature becomes more apparent with erections, and more severe curvatures can make intercourse difficult or impossible. Physical examination during erection (alternatively photographic or preferably after intracavernous injection [ICI] of vasoactive drugs) is important to document the curvature.

In the presence of a curvature of more than 30 degrees, which makes it difficult to have sexual intercourse, or in patients who apply for personal aesthetic concerns, surgical treatments are applied as the only option. Penile length is usually longer than normal in patients presenting with penile curvature. For this reason, penile shortening techniques (Nespit, plication surgeries) are mostly applied in the opposite direction of the underdeveloped side (curvature direction) with 85% success in experienced hands. After surgical treatment, patients usually stay in the hospital for one day, are called for control 7-10 days later and can have sexual intercourse after six weeks. However, after surgical treatments; There may be numbness in the penis, erectile dysfunction, palpable surgical knots under the skin and recurrent curvatures.

Congenital anomalies of the genital organs usually tend to coexist. The incidence of coexistence of penile curvature and conditions where the urinary opening is lower than where it should normally be (hypospadias) is higher than normal.

Curvature of the penis is an abnormal bend (up,down,left or right) in the penis that occurs during erection.

Congenital penile curvature is a rare condition, with a reported incidence of < 1%.

Penile curvatures can be congenital (penile curvature) or acquired in adulthood (Peyronie’s disease). Congenital penile curvature: The cause of penile curvature is not yet known, but there are some theories put forward. In the structure of the penis; There are two spongy tissues (corpus cavernosum) containing blood vessels that provide erection, and a another tissue (corpus spongiosum) in which the urinary tract (urethra) is located. When growth retardation or disproportionate growth occurs in one of these spongy structures, the penis bends towards the underdeveloped side during erection. Mostly this curvature is ventral, but it can be lateral and rarely dorsal. Acquired penile curvature (Peyronie’s disease): Peyronie’s disease, named after the French surgeon who first described the disease; It can cause deformity in the penis, usually after the age of 50, with calcification (fibrosis) in the outer sheath (tunica albuginea) surrounding the spongy tissues of the penis that provides erection.

Diabetes Hypertension Dyslipidaemias Ischaemic cardiopathy Smoking Pelvic surgery Dupuytren’s contracture, Lederhause disease are risk factors that cause penile curvature to be seen more frequently in men.

Peyronie’s disease often occurs in older men with a typical age of onset of 50-60 years. Prevalence rates of % 0.4 – 20.3. In the prevalence study conducted by the Turkish Society of Andrology, it was determined that it is seen at a rate of 27% in men between the ages of 50-60 and it is estimated that there are approximately 600,000 patients in Turkey.

Among the treatment options in Peyronie’s disease cases; There are two main approaches: drug therapy and surgical treatment. The most important point in the treatment is the stage of the disease at the time of diagnosis. Drug treatments: It is typically preferred in the first stage of the disease and in patients who are not suitable for surgical treatment or do not want surgery. The aim of drug treatment is to reduce pain and plaque formation and to minimize penile curvature. Drug treatments are divided into three main groups; Oral treatments Potaba (Potasyum para-aminobenzoat) Tamoksifen E Vitamini Pentoksifilin Kolşisin Karnitin Fosfodiesteraz tip 5 inhibitörleri Intraplaque injection treatments Verapamil Clostridium kollajenaz İnterferon Steroidler Topical and other treatments Vakum cihazları ESWT (Ekstrakorporeal Şok Dalga Tedavisi) Surgical treatment: Surgical treatments are preferred for patients who have penile curvature that prevents sexual intercourse, who are in the second stage of the disease (chronic phase), who have not progressed in the last six months, whose pain complaint has disappeared or who have plaque calcification. The appropriate surgical method is determined by the urologist, taking into account the length of the penis, the degree of curvature, the localization of the plaque, the presence of erectile dysfunction and the patient’s expectation. Although there are differences in practice, there are basically two types of surgical methods. Excision or suturing (plicating) the unaffected side: This surgery is done either by using small internal “tuck” stitches or by cutting out small pieces of tissues on the outside of the curve and then sewing the remaining tissue closed. This is a good approach for men with good erections who have not lost much length from their Peyronie’s disease. Penile prosthesis and curvature correction surgery: This is the best approach for men with Peyronie’s disease and very poor erections who still want to have sex. If necessary, the surgeon may also perform additional maneuvers to straighten the penis at the same time. Patients usually stay in the hospital for a day. You can go for control within 7-10 days. After six weeks, he is allowed to have sexual intercourse. Before undergoing any type of PD surgery, be sure to discuss all risks and benefits thoroughly with your surgeon. In order to ensure high success and minimum complication rates in the application of these techniques, which are in the class of specialty surgeries, it is recommended to be performed by experienced hands by the European Association of Urology. Prof. Dr. Ateş Kadıoğlu contributes significantly to the treatment guidelines of congenital penile curvature and Peyronie’s disease published annually by international professional organizations, as well as the high success and patient satisfaction he has achieved with thousands of the patients with penile curvature.

The exact cause of Peyronie’s disease is not yet known. Patients usually; they apply with complaints of penile pain, penile curvature, palpable penile nodule (Peyronie’s plaque), erectile dysfunction The disease has two stages. First stage(Acute phase), this phase may be associated with painful erections and a palpable nodule or plaque in the penis. Penile curvature begins to develop. The disease continues for about 6-12 months Stabile stage(Chronic phase), pain tends to resolve, the plaque and curvature start to stabilize, but the penis usually doesn’t straighten. Since Peyronie’s plaques are located on the upper surface of the penis at a rate of 70%, the curvature is upward in most patients. In addition, secondary problems such as decreased sexual desire (libido), low self-confidence and depressive feelings may occur with erectile dysfunction. While this picture remains stable in most of the patients, it may regress and disappear in a very few (2-3%). Patients in general; they apply with one or more of the complaints of pain during erection, curvature during erection, palpable nodule in the penis (Peyronie’s plaque), erection problem. The aim of the initial evaluation is to obtain information on the presenting symptoms and their duration. Clinicians should take a focused history to distinguish between active and stable disease, as this will influence medical treatment or the timing of surgery. An objective assessment of penile curvature with an erection is mandatory. Injection will be used to temporarily make your penis erect for the exam. Your doctor may recommend an ultrasound. The ultrasound will reveal where the plaque is, check for calcium buildup and show how the blood flows in your penis. This test can allow your doctor to determine which treatment options you might be a candidate for.

You may have to start the conversation with your doctor to get an answer to the question, “Do I have ED?” A personal history and physical exam set the groundwork for most conditions. Lab tests and other tests may identify a source such as diabetes, coronary artery disease, or other conditions that affect the nerves and blood flow to the penis.

Erectile dysfunction (ED) is defined as the persistent inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance.1 ED can limit your intimacy, affect your self-esteem, and impact your most important relationships. Beyond the physical manifestations, ED causes emotional damage, and there is a strong link found between ED and depression.2

ED treatment is available to all men with ED. Oral medications are a common first step, but they don’t work for everyone. If men don’t respond to oral medications, they may try other options such as pump devices, injections, and penile implants.

Hardening of the arteries caused by plaque buildup — atherosclerosis — limits blood flow to various parts of the body. The arteries supplying blood to the penis are much smaller than the ones supplying blood to the heart. As a result, heart disease may first show itself as difficulty achieving an erection.5

If the cancer is detected early and patients are treated by an experienced surgeon using nerve-sparing techniques, then sexual activity may return to normal after surgery. This can take 3 to 6 months with continued improvement for 2 or 3 years.8 If sexual activity does not return on its own, there are many different ways to support an active sex life (medications, pumps, injections, and penile implants).

ED is a surprisingly common condition experienced by more than 39 million men in the United States.3

Diabetes damages the blood vessels and nerves that supply the penis with blood to form an erection. The constant change in blood sugar levels can also cause nerve damage, which can lead to loss of sensation in the feet and hands, and can affect having sex.6

While there are real physical and psychological reasons for ED, there’s no single cause. The chart outlines the most common causes of ED.4