Penile prosthesis placement

On the basis of the constructive and operating criteria, the devices can be subdivided into two large categories: non-hydraulic and hydraulic. Non-hydraulic prostheses, also called semi-rigid, include soft, malleable and mechanical prostheses (now rarely used). Hydraulic prostheses are subdivided according to the criterion of design and realization of the inflation mechanism into single-component (no longer used), two-component and three-component models. Malleable and mechanical prostheses both consist of a silicone body with a moldable support structure inside, the patient can position the penis in any direction by simply bending the prosthetic implant, simulating erection and detumescence. The malleable model is made with an extremely ductile core of steel or silver wires braided or spirally arranged. Inside the silicone body, the mechanical model, instead, has a longitudinal structure constituted by polyethylene segments kept articulated between them by a steel cable with spring and covered by polytetrafluoroethylene. These devices find their ideal use in the surgery of penile induratio associated with erectile dysfunction with removal of plaques, so large and extensive that the use of hydraulic prostheses is impossible, and in patients with reduced manual ability not able to activate the hydraulic implants. In addition to the easy handling by the patien, the advantages of semi-rigid prostheses are: very low breakage rate, good penetrative capacity, relatively low costs and extremely reduced operating times. The disadvantages are the imperfect simulation of penile detumescence, with the penis remaining in a semi-horizontal position and always of the same length, and the lack of subjective sensation of erection. To compensate for these inconveniences, it is preferred to implant hydraulic prostheses, by far the most widely used. They are distinguished in bi- and tri-components. The former are composed of two inflatable cylinders that fit inside the two cavernous bodies and a pump-tank placed in the scrotum. Tricomponents additionally have a larger reservoir that fits into the abdomen, in the pre-vesical space. The latter are to be preferred because they offer the best result both from the aesthetic and functional point of view, offering a perfect dissimulation both with erect and flaccid penis, also by virtue of the fact that the implant is inserted through a small scrotal or suprapubic incision perfectly camouflaged. In hydraulic prostheses, both bi and tri-component, the mechanical erection occurs through the activation of the pump located in the scrotum, which conveys the liquid (saline solution) from the reservoir into the cylinders placed in the two cavernous bodies that then stiffen and remain so until their detumescence activated by pressing a micro valve located on the pump itself at the scrotal level. The surgical procedure, technically not challenging, is conducted under spinal or general anesthesia. Typically, the patient leaves the operating room with a complicating dressing and bladder catheter.