Erectile dysfunction is the consistent inability to achieve and maintain an erection adequate for the performance of a satisfactory sexual intercourse.
The therapy for this disease may include the use of oral drugs (“sildenafil”, “vardenafil”, “tadalafil”), or local drugs (“alprostadil”). An alternative is the use of vacuum devices.
The non-prosthetic surgical procedures (vascular arterial and venous surgery) have a reduced rate of success. Another surgical option is represented by implanting of a penile prosthesis in the corpora cavernosa.
The implantation of a penile prosthesis is indicated in all forms of erectile dysfunction that do not respond to other therapeutic aids (see above) or in cases where drug treatments are not advised or have resulted in significant side effects. The prosthesis may be non-hydraulic (semi-rigid, malleable, etc.), and hydraulic (mono, bi or three-component).
The steps of the surgery comprise the incision of the skin, the exposure of the corpora cavernosa, the choice and the positioning of the components of the prosthesis, the filling and emptying of the prosthesis in the case of hydraulic prosthesis. The placement of a prosthesis does not allow the use of any other aid meant to cause an erection of the penis.
The possible skin incisions are the perineal, intra-pubic, under-coronal, penis-scrotal and transversal-scrotal and are related to the type of prosthesis used.
As an example, we consider the application of hydraulic penile prosthesis with three components. The surgery is usually performed under general anesthesia and involves the placement of two expandable cylinders at the level of the corpora cavernosa of the penis, a reservoir at the level of the extraperitoneal space of Retzius and a pump at the scrotal level. The three components will be connected by thin pipes which run at the subcutaneous level.
The occurrence of complications depends on the type of prosthesis used: the improvement of the materials has resulted in a reduction of the risk of complications from about 15% to less than 5% of cases.
The most significant complication is that an infection may require surgical reoperation with removal of the prosthesis. Other potential complications can be divided into surgical: bruising, hematoma, edema, fibrosis, loss of sensation, urinary retention; mechanical, related to the prosthesis: breakage, malfunction, fluid loss, spontaneous activation and deactivation; non-mechanical, related to the prosthesis: re-infection, pain, erosion, necrosis. To remember, not being a complication, the difficulty of concealment under the clothes of the penis prosthesis in case of the non-hydraulic types.