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Persistent erectile dysfunction – Penile prothesis – The spontaneous solution

Χωρίς κατηγορία 2513

 

Erectile dysfunction is the inability to achieve and maintain an erection hard enough to have a satisfactory sexual intercourse in the last six months. In the international study of Massachusetts USA, that consists globally the principal study regarding the evaluation of sexual dysfunction during aging, is mentioned that, in the group of men aged 40-70 years the incidence of complete impotence amounts from 5.1% at the age of 40 to 15% at the age of 70, while the incidence of moderate dysfunction is 17% at the age of 40 and is doubled to 34% at the age of 70. In Greece it is estimated that approximately 450,000 men have a moderate degree of erectile dysfunction. Of them, 11,500 men will deteriorate to complete impotence every year. However, the problem is usually not mentioned to the andrologists, mainly due to reasons of shame. Thus, it worsens over time and it is finally leads to depression and social isolation.

Erectile dysfunction can be purely psychological or it may have an organic origin, on which psychological factors are also added, as its appearance causes major stress in every upcoming sexual attempt, leading to repeated cycles of failure to achieve and/or maintain hard erection. In older men the causes are usually multifactorial and can include diabetes, cardiovascular diseases, surgical operations for prostate, bladder or sigmoid cancer, neurological diseases, medicines mainly psychotropics and medicines for heart diseases especially  antihypertensive and finally hormonal disorders. In the younger people the causes are mostly psychological factors and chronic prostatitis.

The diagnosis of the cause of the disorder can be made by the andrologist. However, the special causal treatment is usually not possible, except some cases of prostate diseases and hormonal disorders. Fortunately there are ways of non special treatments, which can resolve the problem. These include:

  • Orally administered drugs, which improve the blood circulation in the penis and after sexual stimulation they help a week erection to be harder, more prolonged and easier to be achieved. They are generally safe and easy to be used. However, they are not effective in 30% of the cases, particularly in patients with neurological damages, severe vascular diseases and those, who underwent radical prostatectomy. Furthermore, their use is contraindicated in some cases of coronary heart diseases and their frequent use is quite expensive.
  • The injection of drugs in the corpora cavernosa of the penis produces a hard erection in the most of the patients, even without sexual stimulation. This treatment is more effective than the peels and the drugs act only locally, thus avoiding systemic side effects.  However, there can be severe pain, hematomas and hardening of the corpora cavernosa, due to fibrosis in the injection site. Also priapism (prolonged and painful erection) may appear in some cases, which need urgent hospital admission.  Furthermore, patients do not feel comfortable with penile self injections and the effectiveness of the treatment is reduced over time.
  • The placement of a penile prosthesis consists surgically the most effective, permanent and safe treatment for patients, who do not respond to medications, or when there are serious side effects, or when the patients do not wish peels or self injections. Penile prosthesis is a hydraulic implant, which is placed by a relatively simple operation under general or spinal anaesthesia, lasting usually one hour and with one day hospitalization. The incision is small and invisible on the lower ventral surface of the penis and the material is not perceivable even by the patient’s companion during the intercourse. A recent clinical study presented that the placement of penile prostheses resulted to a much higher satisfaction of men (93%), in comparison with drugs (51%) and injections in the penis (40%). Furthermore, a clinical study in 90 of my personal cases, which has been published in the reputable scientific journal “The journal of sexual medicine”,has shown that there is a full correlation between the sexual satisfaction of the patient after the placement of the prothesis and the sexual satisfaction of his companion. The superiority of the penile prosthesis is related to the fact that it is the only treatment that allows spontaneous sexual intercourse at any time, as the erection is achieved within seconds without the need of a “preparation” or the possibility of failure (as in the case of peels and injections), and the erection is maintained for as long as the man desires. Furthermore, the sensation, the ejaculation and the orgasm are completely natural as would be without any intervention.

 

P41a

 

The penile prosthesis consists of three parts. The two cylinders, which are implanted in the corpora cavernosa, which are the two erectile units of the penis, the pump, which is placed within the scrotum and the reservoir, which is placed on the lateral side of the urinary bladder. All these parts are placed into position through a small incision, which is performed on the lower ventral surface of the penis, where the scrotum begins. Nothing is externally visible and only the pump is palpable by the patient in his scrotum. The function of the prosthesis is purely hydraulic. In order to fill the cylinders with the normal saline existing in the reservoir, thus to inflate the cylinders and achieve a hard erection, is only enough to pump up the lower round part of the pump in a way similar to the inflation of a sphygmomanometer. The erection which is achieved is very hard, the orgasm, the pleasure and the ejaculation are normal, and similar to the sexual intercourse without the aid of the device. The prosthesis can be deactivated, only when the patient wishes so. This is accomplished by pressing and holding the upper part of the pump, resulting to the return of the saline from the cylinders in to the reservoir and the relaxation of the penis.

 

The operation is always effective and safe and offers to the patient the possibility to fully recover his lost sexual activity. The implant is never rejected by the human organism. Its lifetime is unlimited, but if there is a mechanical failure, it can be immediately replaced, in the same way it was initially placed, since it has a lifetime guarantee by the providing company. In the very rare case of an implant infection, which is high unlikely, as its surface is covered by an antibiotic film, we remove it and replace it with by a new implant four to five later. Thus, problems from the operation do practically not exist and it is certain that the benefits are outweighing them.