Erectile dysfunction is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse. It is one of the most common sexual dysfunctions, along with premature ejaculation. Nearly one in three men experiences this issue at some point in their lives. Moreover, with aging and the addition of chronic diseases such as hypertension, diabetes, and heart disease, the prevalence of this condition increases further. Despite being such a common problem, many men in our country unfortunately do not consider it a health issue and avoid consulting a doctor for this complaint. However, erectile dysfunction alone can be an early warning sign of serious health problems that may develop later.
As with any health issue, an accurate diagnosis is crucial before planning treatment. A detailed medical and sexual history taken by a specialist doctor, followed by a thorough physical examination, forms the basis of the evaluation. Certain assessment scales, which are completed together with the physician, provide valuable data during the examination. Additionally, tests such as blood pressure measurement, penile-testis-prostate examination, cholesterol and blood sugar levels, and testosterone level determination may be required. From the very beginning, it is also important for the patient to be evaluated not only by a urologist but also by specialists in cardiology, psychiatry, and endocrinology if necessary.
Nowadays, almost all urology guidelines recommend a stepwise treatment algorithm for erectile dysfunction. The first step includes lifestyle modifications that the patient should implement, such as:
- Losing excess weight if possible,
- Limiting alcohol consumption,
- Avoiding smoking,
- Adopting a balanced diet, such as the Mediterranean diet,
- Reducing stress and anxiety,
- Maintaining open and healthy communication with the sexual partner.
The initial steps of medical treatment include certain medications (PDE5 inhibitors), ESWT (shockwave therapy), and self-injection therapy, where the patient injects specific drugs into the penis before intercourse. Most patients benefit from these treatments. However, some cases remain resistant despite these approaches.
Who Is a Candidate for Penile Prosthesis?
Patients who do not respond to other treatment options are considered candidates for a penile prosthesis. However, in some cases, a penile prosthesis may be recommended as the first-line treatment due to safety, efficacy, or cost concerns. Additionally, penile prosthesis surgery may be the primary option for conditions such as trauma (penile fracture), Peyronie's disease, or prolonged priapism.
What Is the Success Rate of Penile Prosthesis Surgery?
With proper patient selection, the right prosthesis choice, and a successful surgical procedure, patient satisfaction with penile prosthesis implantation exceeds 95%. If no complications arise, this satisfaction continues for a lifetime.
What Is the Surgery Process Like?
Depending on the type of prosthesis, the surgery typically lasts between 1 and 2 hours. The prosthesis is implanted into the body through a 3-4 cm incision in the genital area and is completely unnoticeable from the outside. The procedure can be performed under general anesthesia or spinal anesthesia (numbing from the waist down). If there are no complications, the patient usually stays in the hospital for one night and is discharged the next day. It is recommended to avoid sexual intercourse for at least 6-8 weeks postoperatively. Like any surgical procedure, there are risks such as infection, bleeding, and anesthesia-related complications. However, with modern prosthetic designs, increasing surgical experience, and the choice of a well-equipped medical center, these risks have been minimized.
Are There Different Types of Penile Prostheses?
Currently, there are single-piece, two-piece, and three-piece penile prostheses available. However, the most commonly used types worldwide are malleable (bendable) and inflatable prostheses.
- Malleable (Bendable) Type: This consists of two main parts and is relatively easier to implant. It is more cost-effective than other options and has a lower risk of mechanical failure or complications. However, the disadvantage is that it remains in a constantly erect state, although it can be manually adjusted.
- Inflatable Type: This is the most preferred type of penile prosthesis worldwide. It consists of three main parts: the inflatable cylinders, a reservoir, and a pump mechanism. In its normal state, the prosthesis remains deflated. During use, the pump is manually activated to inflate the prosthesis, and after intercourse, it can be returned to its deflated state. The greatest advantage of this prosthesis is its resemblance to a natural erection. However, it requires user training, and its cost is relatively higher than the malleable type. Nonetheless, it provides a long-term effective treatment, and many models come with a lifetime replacement guarantee.
How Is the Right Prosthesis Chosen for a Patient?
The type of prosthesis is selected based on the patient's profile, expectations, anatomy, and underlying medical conditions. In other words, not every model suits every patient; the most appropriate model should be chosen based on individual needs.
Frequently Asked Questions
- Does a penile prosthesis affect ejaculation and orgasm?
No, it does not impact ejaculation or the ability to experience orgasm. The pleasure felt during intercourse remains unchanged. - Can a sexual partner notice the presence of a penile prosthesis?
Unless a detailed medical examination is performed, a sexual partner will not notice the prosthesis, and it does not cause discomfort during intercourse. - Does a penile prosthesis affect urination?
No, it does not interfere with urination. - Does it increase the risk of prostate, bladder, or penile cancer?
No, there is no increased risk of cancer due to penile prosthesis implantation. - Does it trigger security alarms at airports or shopping malls?
No, penile prostheses do not cause any issues during X-ray security screenings. - Does it prevent MRI or CT scans?
No, having a penile prosthesis does not interfere with MRI or CT scans.
Op. Dr. Çağlar YILDIRIM
Urology Specialist
