Penile Implants, grafts or remnants
The use of penile implants, grafts or remnants are used in situations of lost or partially lost members. The most common recommendation for the penile implant procedure is in case of men who used any sort of filling to increase penis size and presented infection or necrosis due to that. The use of fillings to increase penis size might lead to infection, necrosis or even urinary obstruction associated with infection, which might also lead to skin loss or even damage the area around the anus.
The penile implant surgery will be performed together with an urologist, trained to treat the functional aspects of the penis, which might also be associated with a penile implantation, if necessary.
The recommendations for penile implant surgery include vascular disease, diabetes, bladder or prostate cancer surgery or for benign prostate disease, Peyronie's disease, neurologic disease, hypogonadism, pelvic fractures and impotence related to many medical diseases including chronic renal disease, alcoholism, multiple sclerosis, genital trauma, Parkinsonism, and drug therapy.
When choosing a penile prosthesis, it is important to recognize the options. These include rigid, semi-rigid and malleable rods, which produce varying degrees of rigidity or one of two types of inflatable prostheses a) the multi-component inflatable prosthesis, or b) the self contained inflatable prosthesis.
The main objective is to leave the patient with a penis that allows achievement of sexual intercourse with no complications, when it is desired and in a way that satisfies both partners. There is no single penile prosthesis that is works best for all patients so it is crucial that the urologist determine carefully with the patient and review the risks, benefits, and drawbacks to each type.
When discussing the semi rigid prosthesis, the positive points is having an erection sufficient for sexual penetration. This is called axial rigidity in the urologic spectrum and means the amount of torque that can be placed on the penis. Most of the rigid penile prostheses are related to a low mechanical failure rate because there are no moving parts and a fairly simplistic implantation is possible. The downside is that the penile implants produce an erection that may be noticeably unsightly, and these devices are most likely to create an obstruction that can interfere with urination. Also, if prostate surgery is needed in the future, it can be very difficult because of the penile implant. However, the rigid penile prothesis is good for men with poor hand mobility, who are relatively elderly, or who do not want the increased risk of a malfunction that can result from moving parts.
The one-piece inflatable penile prosthesis offers a compromise between the multi-component inflatable and the semi-rigid penile implant device. The downside to this penile implant device is that it can sometimes be difficult to manipulate. It doesn't become as erect as the rigid one and it doesn't deflate as much as the multi-component inflatable. Additionally, this penile implant device is limited to the "average size penis," and if the patient has an extremely long penis is usually is not adequate.
The multi-component inflatable penile prosthesis is what we call the "Cadillac" device. It gives the best appearance when erect and is the softest when deflated. It is probably the most popular and there are several major manufacturers including American Medical Systems and Mentor.