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Penile implant

Penile Prosthesis: Interview with Dr Hellel Majed on Radio IFM


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Erectile Dysfunction Treatment Methods

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PENILE IMPLANT

(malleable penile prosthesis)

Penile implant: Penile implant surgery


PENILE IMPLANT

(penile prosthesis)

Penile implant: Testimonial of a Tunisian patient
(in Arabic)



The components of the implant are biomaterials inert, known to be generally well accepted by the human body, such as pacemakers,      breast and testicular prostheses.

This intervention is normally reserved for men who have severe and irreversible erectile dysfunction, whatever the cause, and in which other treatments (oral medications, intracavernous injections, other local treatments) have failed, are contraindicated or too restrictive for technical or economic reasons.

No further examination is required before the intervention apart from blood and urine tests (ECBU) usual. Exams specific to your state of health may be prescribed by the anesthesiologist or your surgeon. Doppler ultrasound or MRI of the penis are sometimes requested in cases individuals.

A urinary tract infection may delay the procedure and must be treated before. Treatments Antiplatelet agents or anticoagulants should be discontinued prior to surgery when possible (opinion of the cardiologist or general practitioner) or replaced.                                         

Antibiotic prophylaxis is routinely performed and sometimes associated with the use of antibiotics directly applied on the prosthetic material.

The incision site (approach) depends on the material chosen, the urologist's habits and the conditions anatomical patient. This is specified as much as possible during pre-operative consultations, but may be modified according to last-minute technical requirements. The incision site (approach) depends on the material chosen, the urologist's habits and the conditions anatomical patient. This is specified as much as possible during pre-operative consultations, but may be modified according to last-minute technical requirements.

The most used routes are:

The peno-scrotal incision at the lower part of the penis and the upper part of the bursa

The suprapubian incision, in front of the pubis, above the root of the penis.

The subcoronal incision

Sometimes a mixed path is made, associating the two previous paths.

What are the different types of implants?


Malleable (or semi-rigid) implants

These are silicone implants whose axis is reinforced by a material that gives it the rigidity necessary for sexual intercourse and the "memory" after manual orientation (the implant retains the shape we give it).

  • Advantages :

    Surgical intervention simpler and faster.

    Lower infectious risk.

    Easy to use: simply straighten the penis manually.

  • disadvantages :

    Always remains rigid even outside of sexual intercourse after manual lowering of the penis.

    May interfere with clothing or daily life depending on the patient's activities.


Inflatable implants with 2 compartments

The two bodies of the implant are hollow cylinders connected to a reservoir and provided with a pump. The penis is                                          flexible in flaccidity (at rest) and inflates by repeated pressures on the pump which thus fills the cylinders,                                          allowing the penis to erect. By pressing on another place of the pump or the penile implant                                          (Depending on the model), the cylinders are empty and allow a return of the penis to the flaccid state.

  • Advantages :

    Better flaccidity than the malleable implant.

    Pretty easy to use but requires learning and dexterity.

  • Disadvantages:

    Sometimes difficult to handle.

    Flaccidity less natural than with the 3-compartment implant.

    Possible leaks or pump malfunctions requiring reoperation


Linflatable implants with 3 compartments

Cylinders are placed in cavernous bodies. A pump located in the purses can inflate or deflate the penile implant. The pump is itself connected to a water tank in front of the bladder.

  • Advantages:

    The closest implant to a natural sensation, whether at resting or erect.

    Pump smaller, so less noticeable in the purses.

  • Disadvantages:

    Requires learning and some skill.

    Risk of leaks or malfunctions as with the 2-compartment implant.



What is the cost of a penile implant or penile prosthesis in Tunisia?

In Tunisia, there are two penile prosthesis firms: AMS from Boston scentific (American brand) and Zephyr (Swiss brand).

The price of the semi-rigid penile prosthesis in Tunisia of the Zephyr and the AMS type is 4000 dt.

The price of AMS two-compartment inflatable penile prosthesis in Tunisia is 10 000 dt.

The price of Zephyr three-compartment inflatable penile prosthesis in Tunisia is 16 000 dt.

The price of AMS three-compartment inflatable penile prosthesis in Tunisia is 25 000 dt.