Hydraulic penis prosthesis as an alternative in the treatment of erectile dysfunction in the 21st century

lek. Michał Piotrows­ki

Skamex Sp. z o.o. sp. k.

Hydraulic penis prosthesis

Hydraulic penis pros­the­ses are an effec­tive and mod­ern method for treat­ing erec­tile dys­func­tion and impo­tence, often con­sid­ered as a final resort in ther­a­py for patients who have not respond­ed to oth­er, less inva­sive meth­ods such as psy­chother­a­py, oral med­ica­tions (e.g., Via­gra), intrau­rethral med­ica­tions, vac­u­um pumps, or penile injec­tions.

Mod­ern implants are closed, flu­id-filled sys­tems con­sist­ing of three com­po­nents: a pair of cylin­ders, a reser­voir, and a pump for con­trol­ling the pros­the­sis. All com­po­nents of the hydraulic penile pros­the­sis are con­nect­ed dur­ing the pro­ce­dure using spe­cial tub­ing.

Achiev­ing an erec­tion suf­fi­cient for sat­is­fy­ing sex­u­al inter­course involves repeat­ed­ly squeez­ing the pump locat­ed in the scro­tum, which results in fill­ing the cylin­ders with flu­id and con­se­quent­ly stiff­en­ing the penis.

Return­ing to the flac­cid state with Colo­plast Porges pros­the­ses (catheters, stents) is extreme­ly sim­ple thanks to a spe­cial sys­tem called “one-touch release” (OTR) — just a sin­gle press of a but­ton caus­es the flu­id to move from the cylin­ders to the reser­voir, result­ing in penile flac­cid­i­ty.

The entire system is externally invisible

The goal of penile pros­the­sis implan­ta­tion is to restore sex­u­al activ­i­ty and improve qual­i­ty of life. Mod­ern implants offer the pos­si­bil­i­ty of achiev­ing excel­lent erec­tions while main­tain­ing a nat­ur­al appear­ance of the penis in its flac­cid state, ensur­ing high sat­is­fac­tion for both patients and their part­ners.

If you’re expe­ri­enc­ing poten­cy issues, you should seek help from your urol­o­gist.

The Skamex com­pa­ny offers hydraulic penile pros­the­ses, which are mod­ern solu­tions pro­duced by the glob­al leader, Colo­plast Porges.

W 2016 roku zor­ga­ni­zowal­iśmy warsz­taty na tem­at implan­tacji pro­tez prą­cia, na które zaprosil­iśmy grupę urologów z Pol­s­ki. W cza­sie warsz­tatów odbył się pier­wszy zabieg wszczepi­enia hydraulicznej pro­tezy prą­cia u 40-let­niego pac­jen­ta. Wskazaniem do implan­tacji była impo­tenc­ja będą­ca powikłaniem leczenia pri­apriz­mu (przetr­wałego wzwodu prą­cia) – pac­jent od 2 lat nie miał wzwodów. Dzię­ki uprze­j­moś­ci firmy Colo­plast Porges zaprosil­iśmy prof. Steve­na Wilsona ze Stanów Zjed­noc­zonych ( Pro­fes­sor of Urol­o­gy at the Uni­ver­si­ty of Arkansas for Med­ical Sci­ences, Lit­tle Rock Arkansas)– który ma jed­no z najwięk­szych doświad­czeń na świecie we wszczepi­a­niu pro­tez.

Hydraulic penile prostheses

• The first penile pros­the­sis was implant­ed as ear­ly as 1973
• To this day, he has per­son­al­ly per­formed over 11,000 implan­ta­tions.
• Poland was the 50th coun­try where he taught urol­o­gists the art of penile pros­the­sis implan­ta­tion.

If a patient suf­fers from erec­tile dys­func­tion, has dif­fi­cul­ty achiev­ing sat­is­fac­to­ry penile rigid­i­ty, or expe­ri­ences a com­plete lack of erec­tions (impo­tence), he should con­sult a urol­o­gist for treat­ment. If the treat­ment proves inef­fec­tive or unsat­is­fac­to­ry, he should revis­it the urol­o­gist and dis­cuss the pos­si­bil­i­ty of under­go­ing penile pros­the­sis implan­ta­tion, specif­i­cal­ly a hydraulic penile pros­the­sis.

The most common causes of erectile dysfunction, including impotence

• Emo­tion­al or psy­chogenic fac­tors — such as depres­sion or sub­con­scious aver­sion to the part­ner, and some­times to sex
• Hor­mon­al dis­or­ders, low lev­els of male sex hor­mones
• Neu­ro­log­i­cal caus­es (e.g., mul­ti­ple scle­ro­sis).
• Endocrino­log­i­cal caus­es (e.g., dia­betes).
• Com­pli­ca­tions after surgery (e.g., after prostate or blad­der removal).
• Anatom­i­cal issues (caused by injuries, e.g., after acci­dents).
• Prostate dis­eases – inflam­ma­tion or can­cer.
• Meta­bol­ic caus­es (ath­er­o­scle­ro­sis).
• Cig­a­rette smok­ing.

Indications for implantation of cavernous body prostheses, penile prostheses

• Inef­fec­tive attempts at con­ser­v­a­tive ther­a­py — oral med­ica­tions, intra­cav­er­nos­al med­ica­tions.
• In case of inef­fec­tive­ness of ther­a­py using injec­tions into the cor­po­ra cav­er­nosa of the penis or lack of accep­tance of this method by the patient.

It is of utmost impor­tance to note that penile pros­the­sis implan­ta­tion surgery (cor­po­ra cav­er­nosa pros­the­ses) is asso­ci­at­ed with a min­i­mal risk of infec­tious com­pli­ca­tions. Pro­fes­sor Wil­son pre­sent­ed at our work­shops the results of stud­ies where the risk of infec­tious com­pli­ca­tions (infec­tion) after penile pros­the­sis implan­ta­tion surgery was below 1%. Patients should not acti­vate the sys­tem for the first 4–6 weeks after the surgery; only after this peri­od does the first acti­va­tion of the pros­the­sis occur, and from that moment onwards, men can resume sex­u­al activ­i­ty.

Research con­duct­ed among patients after penile pros­the­sis implan­ta­tion indi­cates that the major­i­ty of them achieve full sat­is­fac­tion approx­i­mate­ly 6–9 months after the surgery. Sat­is­fac­tion lev­els were com­pa­ra­ble to the phys­i­o­log­i­cal state that exist­ed before the onset of erec­tile dys­func­tion or impo­tence.

Hydrauliczne protezy prącia w Polsce

In Poland, up to July 2017, 4 pro­ce­dures using Colo­plast Porges pros­the­ses were per­formed (indi­ca­tions includ­ed pri­apism in one patient, ath­er­o­scle­ro­sis in anoth­er, and dia­betes in the remain­ing two patients). The out­come was very good for all oper­at­ed men. Patients report sat­is­fac­tion com­pa­ra­ble to the phys­i­o­log­i­cal state before erec­tile dys­func­tion or impo­tence issues arose. Addi­tion­al­ly, the part­ners of the patients are very pleased.

Prepa­ra­tion for the pro­ce­dure involves the patient being qual­i­fied by a urol­o­gist after doc­u­ment­ing the inef­fec­tive­ness of tra­di­tion­al non-inva­sive treat­ment meth­ods or the patien­t’s lack of accep­tance of them.

Course of the pro­ce­dure — most com­mon­ly, the pro­ce­dure is per­formed under gen­er­al anes­the­sia.

The most com­mon­ly used access routes to the cor­po­ra cav­er­nosa world­wide are through the peno­scro­tal and infra­pu­bic approach­es.

The sur­geon makes the deci­sion regard­ing the choice of access based on anatom­i­cal con­di­tions and their own expe­ri­ence. Then, the cor­po­ra cav­er­nosa are opened, and a space is cre­at­ed with­in them for the cylin­ders, with their length indi­vid­u­al­ly tai­lored for each patient based on the mea­sured length of the cor­po­ra cav­er­nosa.

The components of penile prostheses

All com­po­nents of the penile pros­the­sis are pre­pared in a prop­er man­ner to ensure they are ful­ly pro­tect­ed dur­ing implan­ta­tion. The sur­geon selects an antibi­ot­ic solu­tion in which all ele­ments of the penile prosthesis—cylinders, reser­voir, pump, and connectors—are soaked before implan­ta­tion. This pre­cau­tion­ary mea­sure aims to min­i­mize the risk of infec­tion asso­ci­at­ed with penile pros­the­ses. Main­tain­ing the high­est stan­dards of asep­sis and anti­sep­sis dur­ing the pro­ce­dure of implant­i­ng hydraulic penile pros­the­ses is cru­cial. After plac­ing all appro­pri­ate­ly select­ed com­po­nents of the penile pros­the­sis:

• of cylin­ders in the cor­po­ra cav­er­nosa
• the reser­voir in one of two loca­tions: pre­vesi­cal (pre-blad­der), mean­ing in the Ret­z­ius space between the pubic sym­ph­ysis and the uri­nary blad­der, or increas­ing­ly used ectopic place­ment under the rec­tus abdo­min­is mus­cle
• the pump in the scro­tum

All com­po­nents are con­nect­ed with spe­cial tub­ing and appro­pri­ate con­nec­tors, and before clos­ing the inci­sions, the sys­tem is checked to con­firm its prop­er func­tion­ing. The inflat­ed sys­tem is then ban­daged in a spe­cial way, com­mon­ly referred to as a “mum­my wrap.” 24 hours after the penile pros­the­sis implan­ta­tion, the sys­tem is released using the “one-touch” but­ton locat­ed on the pump in the scro­tum, lead­ing to the defla­tion of the cylin­ders in the cor­po­ra cav­er­nosa. This state should be main­tained for 4–6 weeks. Sub­se­quent­ly, the patient, usu­al­ly in the pres­ence of the attend­ing physi­cian, per­forms the first infla­tion of the sys­tem, and from that moment on, can resume nor­mal sex­u­al activ­i­ty.

• Pro­ce­dure dura­tion – approx­i­mate­ly 2 hours
• Post­op­er­a­tive hos­pi­tal­iza­tion – on aver­age, 1–2 days

After the procedure

• Patients typ­i­cal­ly achieve full sex­u­al sat­is­fac­tion approx­i­mate­ly 6–9 months after the implan­ta­tion of a hydraulic penile pros­the­sis.
• The lev­el of sat­is­fac­tion report­ed by patients is com­pa­ra­ble to the phys­i­o­log­i­cal state before the onset of erec­tile dys­func­tion or impo­tence.

In Poland, issues relat­ed to erec­tile dys­func­tion and impo­tence remain a taboo top­ic. In most Euro­pean Union coun­tries, penile pros­the­sis implan­ta­tion pro­ce­dures are reim­bursed by nation­al health funds or health insur­ance, either ful­ly or par­tial­ly (80%). In Poland, how­ev­er, patients must pay for the penile pros­the­sis implan­ta­tion pro­ce­dure them­selves.

What is the situation worldwide?

For exam­ple, in Ger­many, approx­i­mate­ly 400 pro­ce­dures are per­formed annu­al­ly, in Bel­gium around 100 pro­ce­dures per year, and in the USA about 400 pro­ce­dures per month. In Poland, only about 5 pro­ce­dures are per­formed annu­al­ly.

Is the rea­son the lack of erec­tile dys­func­tion and impo­tence in Poland?

Cer­tain­ly not. It appears that the pri­ma­ry cause is a lack of aware­ness about the avail­able help when non-inva­sive treat­ments for erec­tile dys­func­tion and impo­tence are inef­fec­tive. A sig­nif­i­cant num­ber of patients with dia­betes expe­ri­ence poten­cy issues but often do not know where to seek help. Addi­tion­al­ly, prostate can­cer, despite con­tin­u­ous­ly improv­ing diag­nos­tic and treat­ment meth­ods (laparoscopy, robot­ics), often leads to loss of erec­tile func­tion, result­ing in impo­tence, par­tic­u­lar­ly in patients aged 50–65.

These indi­vid­u­als are deprived of a very impor­tant aspect of life, which can often lead to men­tal health issues (e.g., depres­sion). They feel as if they have been left to deal with this prob­lem on their own.

If you know any­one in your sur­round­ings who has dia­betes or oth­er con­di­tions lead­ing to erec­tile dys­func­tion or impo­tence, you can share with them the knowl­edge that there is a way to return to nor­mal sex­u­al activ­i­ty. This solu­tion is a penile pros­the­sis – specif­i­cal­ly, the Colo­plast Porges hydraulic penile pros­the­sis.

Skamex, in col­lab­o­ra­tion with Colo­plast Porges, orga­nizes cours­es and train­ing ses­sions for urol­o­gists who want to gain expe­ri­ence in penile pros­the­sis implan­ta­tion pro­ce­dures. This ensures that patients are in the hands of pro­fes­sion­als with exper­tise in these pro­ce­dures.

Please con­tact us if you are a patient seek­ing advice on where and how to under­go the pro­ce­dure. Get in touch with us, and we will guide you urologia@skamex.com.pl or call +48 608 632 365.

We are in reg­u­lar con­tact with doc­tors who already have expe­ri­ence and have attend­ed cours­es con­duct­ed by the world’s lead­ing spe­cial­ists in this field.