Penile prosthesis implantation in Turkey

What is erectile dysfunction? What are the causes? How is it diagnosed?

The “happy stick” penile prosthesis implantation can be a treatment option for patients with erectile dysfunction, also known as sexual impotence, which is the inability of a man to achieve and/or maintain sufficient penile erection (rigidity) for sexual performance, whether continuously or repeatedly. Across all age groups, it is seen as mild, moderate, or severe, with approximately 31% affected. One in three men experiences erectile dysfunction early on.

Age, diabetes, hypertension, hyperthyroidism, medications used, previous surgeries, and spinal cord diseases are causes of erectile dysfunction. A thorough physical examination, laboratory tests, and penile Doppler ultrasound are necessary for diagnosis. If needed, advanced tests such as cavernous measurement and angiography should be conducted. In treatment, if there is an underlying treatable disease, it should be addressed; otherwise, medical treatment may be necessary if sufficient rigidity cannot be achieved.

What is a penile prosthesis?

Penile prosthesis surgeries are performed in cases where patients with erectile dysfunction do not benefit from medication. Erectile dysfunction is defined as the inability of the male genitalia to penetrate the vagina or maintain this rigidity even if an erection occurs. This issue affects 52% of men aged 40-70, with varying degrees of severity.

Who is suitable for penile prosthesis implantation?

The prevalence of mild, moderate, and complete erectile dysfunction is about 70%. When evaluated by age, the prevalence of erectile dysfunction is recorded at 50% between ages 40-49 and 95% in those aged 70 and above.

Erectile dysfunction may develop due to diseases such as atherosclerosis, diabetes, hypertension, coronary artery disease, kidney and liver failure, neurological and hormonal disorders, and vascular diseases. It may also arise solely from psychological factors related to the penis. Certain injuries, surgeries, and the use of various medications and substances can also cause erectile dysfunction. Aging, chronic diseases, and smoking are the main known risk factors for erectile dysfunction.

In men who complain of incomplete penile erection, the rigidity resulting from sexual stimulation may not be sufficient for vaginal penetration, or even if it is, it may lose that rigidity shortly after. This issue may also be a symptom of another underlying disease and can worsen depending on the progression of that primary condition. Additionally, the problem particularly increases with age. Factors such as smoking, systemic diseases (vascular diseases, diabetes, etc.), high cholesterol, and hypertension also pose risks for erectile dysfunction and accelerate the disease’s progression.

With penile prosthesis implantation, it is assured to continue a healthy and ongoing sexual life.

Penile prosthesis surgeries can be performed in cases where erectile dysfunction cannot be resolved through medical treatments or certain vascular surgeries, or where these medications or surgeries are harmful or ineffective. Before surgery, blood tests are conducted, and a penile Doppler ultrasound is performed to determine blood flow to the penis. In the condition known as Peyronie’s disease, which presents with clear stiffness and pain in the penis, and curvature of the penis during erection, a specific test may be conducted by injecting medication into the penis. The result of this test can also be used to diagnose the suitability for prosthesis placement.

Penile implants are materials designed to be surgically inserted into the penis as a last treatment option for men suffering from erectile dysfunction.

What are the types of penile implants?

There are fundamentally two groups of penile implants.

1. Flexible penile prosthesis: These are implants that remain firm but have the ability to bend and twist.
2. Inflatable penile prosthesis: These consist of two or three pieces with a pumping mechanism for inflation/deflation.

The fact that implants in the first group are always rigid can be considered unnatural. The ability to inflate and deflate the implants in the second group provides a more natural function.

This surgery can be performed under general or regional anesthesia (lower body anesthesia). Before the operation, the surgical area must be cleaned thoroughly with various special materials. A broad-spectrum antibiotic should be administered via injection. This antibiotic should continue for at least two days after surgery. Hair surrounding the area should be trimmed before the surgery. If penile sensation, orgasm ability, and ejaculation function are normal after the surgery, these functions will continue post-implantation. The penile prosthesis only makes the penis firm, regardless of sexual stimulation. The goal of compensatory surgery is to provide this firmness and an upward angle in the penis.

How long does penile prosthesis surgery take?

This surgery can take between 45 minutes to 1.5 hours, depending on the type of prosthesis to be implanted. On the other hand, the hospital stay after surgery may range from 2-5 days in some cases, but most patients are discharged the day after the operation, depending on the patient’s pain and wound healing. Administering antibiotics as a preservative via injection may also extend this period.

What should be considered after penile prosthesis surgery?

1. After leaving the hospital, water should not come into contact with the area for a week, and the wound must be kept very clean.
2. Sexual intercourse should be avoided for at least 4 weeks. At the end of this period, the necessary controls will be conducted by the surgeon, and sexual contact will be allowed.
3. In cases of fever, prolonged pain, discharge from the wound, swelling and redness of the penis, and inability to urinate or difficulty urinating, it is extremely important to consult the operating physician without delay.

Infection is one of the most important complications of compensatory surgeries. Efforts are made to prevent it by cleaning the surgical area and using effective broad-spectrum antibiotics. Antibiotics should continue for at least two additional days post-surgery. However, despite all precautions, infection of the implants can occur in 1-10% of cases. The risk of infection is higher in diabetic patients and those with spinal cord injuries. When an infection occurs, antibiotics are restarted, and the implant is removed. Permanently rigid implants make future urological interventions difficult, especially for those with urinary issues such as prostate disease. For these individuals, inflatable implants should be preferred, allowing for diagnostic or therapeutic access to the urinary tract when deflated.

Advantages of penile prosthesis

By applying this treatment, patients will enjoy benefits such as the ability to engage in sexual activity whenever they wish and to maintain adequate intercourse. This treatment option is primarily considered one of the most satisfying among other treatments for both partners.

What is patient and partner satisfaction with the penile prosthesis?

The satisfaction rate among those who have started using it after getting the “happy stick” is over 90%. Partner satisfaction is the same. In my clinical experience, many patients express that they are happy with the procedure.

What is the duration of the hospital stay, and when can the implant be used?

The operation time is about one to one and a half hours. After spending one night in the hospital, the patient is discharged the next morning. A follow-up is conducted after a week. Then, after six weeks, a final examination is performed, and if everything is satisfactory, usage is allowed.

What is the success rate of penile prosthesis implantation, and what are the complications?

Usage is permitted 1.5 months after the penile prosthesis is placed. The success rate is about 98%. The most significant complications are infections. In cases of severe pain in the penis and area, fever, chills, and swelling of the penis, infection of the prosthesis should be considered, and the implant should be removed in this scenario. The infection rate is approximately 2%. In the long term, complications such as the implant protruding through the skin, passing into the external urethra, which we refer to as the urethra, fracture, and mechanical failure are very rare.

Cost of penile prosthesis implantation in Istanbul, Turkey

The cost of penile prosthesis implantation in Istanbul typically ranges from $5,000 to $15,000, depending on the type of implant and the hospital or clinic.