Penile prosthesis implant: when, what and how

Penile prosthetic surgery represents a valid option in the treatment of different penile diseases. There are several types of prostheses and we have witnessed remarkable developments since their commercialisation in the 1970s. Penile prostheses can be semi-rigid or inflatable. Semi-rigid prostheses can be malleable and mechanical, while inflatable prostheses may have two or three components. A penile prosthesis implant is recognised as a valid approach for treating those cases of erectile dysfunction (ED) where pharmacological agents have not proved useful. This treatment is also indicated in cases of penile fibrosis, priapism, Peyronie's disease and in phalloplasty for sex reassignment or demolition surgery. The implantation of a penile prosthesis is characterised by the relative ease of the surgical technique and by the speed of the procedure. The incision is usually performed at a penoscrotal or infrapubic level for inflatable prostheses, while semi-rigid cylinders are placed through a subcoronal or penoscrotal incision. The procedure is performed by a corporotomy of both sides and the subsequent insertion of the cylinders. The pump is inserted in the scrotum. If the procedure includes the insertion of a three piece prosthesis, then the reservoir is located in the Retzius space and then filled with 65 ml or 100 ml saline solution depending on its size. At the end of the procedure the surgeon inserts a drain in the scrotum, the wound is closed and the device is tested. The first month following surgery can be characterised by variable pain and oedema with spontaneous resolution in most cases. Several complications may occur including mechanical complications, infections and erosion of the cylinders. Penile prosthesis implants represent a valid and safe therapeutic option for achieving satisfactory sexual intercourse in those patients where other approaches have failed. Recent literature has shown that couples’ satisfaction with the use of a prosthesis can reach 97%.