What is Erectile Dysfunction?
Erectile dysfunction in men is defined as the inability to achieve or maintain an erection sufficient for a satisfying sexual encounter and is one of the most common sexual dysfunctions, alongside premature ejaculation. Nearly one in three men will encounter this issue at some point in their lives. Additionally, with age and the addition of chronic conditions such as hypertension, diabetes, and heart disease, the frequency of this problem increases. Despite being such a prevalent issue, many men in our country unfortunately do not view it as a health problem and avoid seeking medical help. However, erectile dysfunction alone can be an early indicator of more serious health issues that may develop later.
What is the Treatment Protocol for Erectile Dysfunction?
As with any health issue, accurate diagnosis is crucial before planning treatment. Initially, a detailed medical and sexual history taken by a specialist doctor, followed by a comprehensive physical examination, forms the foundation of the approach. During the examination, scales filled out with the doctor also provide valuable data. Subsequently, tests such as blood pressure measurement, penis-testis-prostate examination, cholesterol and blood sugar measurements, and determination of testosterone levels may be necessary. It is also important for the patient to be evaluated by other specialists like cardiology, psychiatry, and endocrinology, if required.
Currently, almost all urology guidelines suggest a stepwise treatment algorithm for erectile dysfunction. The first step involves lifestyle changes for the patient. These include losing excess weight if possible, limiting alcohol intake, avoiding smoking, following a balanced diet such as the Mediterranean diet, living free from stress and anxiety, and maintaining proper communication with the sexual partner.
In the initial stages of medical treatment, some medications (PDE5 inhibitors), ESWT (shock wave therapy), and self-injection (where the patient administers injections before intercourse) are included. Most patients benefit from these treatments. However, there are resistant cases where erectile dysfunction persists despite these measures.
Who is a Candidate for Penile Prosthesis?
Patients who do not benefit from other treatment options in the initial stage are considered candidates for penile prosthesis. However, sometimes, due to safety, effectiveness, or cost considerations, penile prosthesis may be recommended as the first option for patients who are not suitable for other treatments. Additionally, in cases of trauma (penile fracture), Peyronie’s disease, or prolonged priapism, prosthetic surgery may be the first choice.
What is the Success Rate of Penile Prosthesis Application?
With appropriate patient and prosthesis selection and a successful surgical process, patient satisfaction with the prosthesis application exceeds 95%, and this satisfaction continues for a lifetime if no complications occur.
What is the Surgical Process Like?
Depending on the type of prosthesis, the average duration of the surgery varies between 1-2 hours. The prosthesis is placed inside the body through a 3-4 cm incision in the genital area and is not noticeable from the outside. This procedure is performed under general anesthesia or spinal anesthesia (numbing from the waist down). If there are no additional complications, a one-day hospital stay is required. Patients discharged the next day are advised to avoid sexual intercourse for at least 6-8 weeks. Risks such as infection, bleeding, and anesthesia-related complications are possible, as with any surgery. However, with the use of modern prostheses, increased surgical experience, and appropriate center selection, these complications can be minimized.
Are There Different Types of Penile Prostheses? Which Prosthesis is Preferred for Which Patient?
Currently, there are single-piece, two-piece, and three-piece prostheses available. However, the most commonly used types worldwide are the malleable (bendable) and inflatable (expandable) types. The choice of prosthesis is based on evaluating the patient’s profile, expectations, anatomy, and any additional health conditions. Therefore, the most suitable model for the patient, rather than a one-size-fits-all model, should be selected.
- Malleable (bendable type): Consists of two main parts, is relatively easier to insert, and is more cost-effective compared to others. It has a lower risk of complications and mechanical failure. A continuous erection, even though it is bendable, can be considered a disadvantage.
- Inflatable (expandable type): This is the most commonly preferred penile prosthesis type worldwide. It consists of three main parts: the inflatable prosthesis, a reservoir, and a pump mechanism. Normally, the prosthesis remains flaccid, but it inflates when pumped and returns to its original state after intercourse. Its greatest advantage is its similarity to a natural erection. Training for use and higher cost compared to other types can be disadvantages. However, it should be remembered that it is a long-term effective treatment, and the prosthesis comes with a lifetime renewal guarantee.
Additional Questions of Interest:
- The application of a penile prosthesis does not affect the person’s ejaculation or orgasm status. The pleasure during intercourse remains unchanged.
- If the partner does not perform a detailed examination like the doctor, they may not notice the presence of the penile prosthesis and will not be disturbed during intercourse.
- The prosthesis does not alter the person’s urination functions.
- It does not increase the risk of prostate, bladder, or penile cancer.
- It does not cause issues with X-ray scans at airports or shopping centers and does not interfere with MRI or tomography scans.