Tag Archives: prosthetic

Should my husband have a penile implant?

Posted on by Dr.Herazy

My husbands penis curves 90º upward when erect because of Peyronie’s disease and has painful intercourse. We believe it’s from an injury he sustained during intercourse about a year or so ago. We have seen a urologist several times and have been told our only real option is a prosthesis. Do you think your program could help us?

Greetings,

It is not my intention or desire to interfere between your husband and his urologist concerning any aspect of his treatment or his relationship with his doctor.  I will not answer your question directly if your husband should or should not consider having a penile prosthesis surgically implanted to resolve his current sexual problem – I have no direct opinion or advice for your question.  That is a subject for discussion between the two of you and your husband’s treating doctor.  My only interest and purpose in making this reply is to offer general ideas, and pose questions to you, to broaden your discussion with the urologist about the progression of your husband’s care.

My general opinion on this subject and ideas for you to consider, as you make up your own minds about his treatment, are these:

    1.  The penile prosthesis is a mechanical device that induces an artificial state of erection – either temporary or permanent –  so that intercourse can take place.  It is usually thought of a surgical treatment for Erectile Dysfunction, and less so for Peyronie’s disease. Regardless of the type of penile prosthesis that is used it is necessary to surgically remove all or part of the corpora cavernosa (the bulk of the internal tissue that gives body to the penis) to make room for the prosthesis.  Once this is done the penis can never be returned to normal.  If there is some reason (massive infection, his body rejects the foreign material of the prosthesis, failure of the device) to remove the prosthesis, his penis will be just a small shell of what it once was.

    2.  There are several basic types of prosthetic devices, and each has its advantages and disadvantages.  Which one is suitable for a patient is often determined during the actual operation when internal measurements can be made. Sometimes it happens that the patient wants one thing, but the surgeon is not able to provide that option because of anatomical problems.  The type of prosthesis to use is a huge subject and one that is very important for you to consider ahead of time.  I suggest that you go to several websites to research what your actual options are for each type of prosthesis, and what are the pros and cons of each.  Some sites you can visit are http://www.urologicalcare.com/advanced-ed-treatments/types-penile-implants/    and   http://www.mayoclinic.com/health/penile-implants/MY00358

    3.  While it is stated that 90%-95% of inflatable prosthesis implants produce erections suitable for intercourse, it is important to note that this must mean that 5-10% of  inflatable prosthesis implants produce erections that are not suitable for intercourse.  In my opinion for 5-10% of men to wind up having a non-functional erection after going through a gruesome surgery so they would have a functional erection, is a huge failure number.  The medical profession is proud to tell patient that the rate of patient satisfaction is very high with penile prosthesis use, and state that somewhere in the range of  80%-90% of men are satisfied with their results.  Again, I look at it from other direction and think about the 10-20% of men who are not satisfied with their device after going through the surgery.  Many people I communicate with are disappointed because of the lack of natural feel and natural appearance of the penis after surgery, the partial or total loss of sensation, the occasional or constant pain they experience, and/or the feel of something foreign in their groin area.  They must either continue to let it remain inside their body or remove it and be left with a flap of skin. 

    4.  Very few of the websites that discuss penile prosthetic surgery provide much detail about surgical failures and adverse surgical reactions. No surgery is totally free of possible direct complications, and penile implants have their own unique list of  possible complications:

  • Infection, and even recurrent infections that return long after the surgery is over
  • Uncontrolled bleeding after surgery, possibly leading to re-operation
  • Scar tissue formation, especially important in someone who already has Peyronie’s disease
  • Tissue erosion and breakdown internally where the implant touches tissue, leading to eventual removal
  • Accidentally cut nerves, arteries or veins that lead to unintended consequences like pain, numbness, coldness, and/or chronic edema 
  • Mechanical failure of the prosthetic implant, leading to re-operation and removal

I have communicated with hundreds of men whose penile implant surgeries have gone bad.  Some doctors might mention post-operative infections, and even severe post-operative infections, but they do not elaborate what that really means in terms of possible long-term consequences to the patient and his partner. As a result of infections that occur, scar formation and unintentional cutting of nerves, arteries and veins the patient is left with more problems than before his penile implant surgery.  A man can be left with partial or total loss of sensation – that means partial or total numbness of the penis – no sexual stimulation or pleasure is felt.  He can be left with temporary or permanent pain, of a mild to severe nature, that is made worse by anything contacting the penis.  I have communicated with men whose only option after several failed penile surgeries was amputation.    

    5.  Most people who write to me about surgical options for  Peyronie’s disease are considering an operation that will correct the curvature, not install a foreign device. What is the reason you were given to not do a Nesbit procedure or a skin graft?   Most often, after the Nesbit or skin graft fails only then, as a last option, is a penile implant suggested.  I am curious why in your husband’s case the implant was suggested to start.  While I am not a big fan of the Nesbit and skin grafting options, they are still more conservative than a penile implant.

    6.  It makes sense to me to first attempt more conservative options; options that do not have permanent and irreversible consequences. If this makes sense to you, you could consider spending a little time on the PDI website learning about the conservative options available to you.  

   7.  There is no way for me to tell you in advance if the Alternative Medicine methods of PDI will help your husband.  It is something that has to be worked on over time to determine if he is capable of supporting and enhancing his immune response to eliminate the Peyronie’s plaque that is causing his penile curvature. 

In college a wise professor repeated frequently to our class, “There is never a perfect situation.”   As I grow older I understand the importance of keeping this in mind.  When it comes to the often imperfect nature of surgery of any kind, it is better to be conservative at the onset and gradually play out to more aggressive and potentially risky options as your conservative choices are used up – not the other way around.    

Good luck in discussing this subject with your urologist.   TRH