IMPOTENCE SURGERY: Semirigid Malleable Prosthesis
▲ GENERAL INFORMATION
Impotence is a condition in which a man usually cannot
get an erection of the penis that is rigid enough and
lasts long enough to complete sexual intercourse. It is
a common and treatable problem. Men with erection
problems often still have other sexual functions; they
may still have sexual desire and may still be able to have
orgasm and ejaculate semen.
It may help if first you understand how an erection
occurs:
The shaft of the penis has a corpus cavernosum on
each side. These are spongy tissues filled with arteries
that bring blood to the penis and veins that drain the
blood. Usually, the vessels in the corpus cavernosa are
collapsed, so the penis is soft.
When a man is sexually aroused, the brain sends
nerve signals to the penis that make all the arteries open
up, allowing blood to rush in. As the penis swells it
tends to squeeze the veins, preventing the blood from
easily leaving the penis. This causes the penis to become
rigid and ready for intercourse.
Erection is the result of physical as well as psychologic factors and usually takes place differently in
younger, middle-aged, and older men. Conditions that
can interfere with the mechanism of erection include
the following:
• Diseases that cause hardening of the arteries or
otherwise affect arteries.
• Diseases that affect the nervous system.
• Diabetes (it affects both the vessels and the nervous
system).
• Heavy smoking and heavy drinking.
• A number of drugs, including those given to treat
high blood pressure.
• Psychologic causes that can include stress and anxiety
due to marital, financial, or other external problems.
Anxiety about the ability to perform well during
intercourse can in itself be a common cause of
impotence.
DIAGNOSIS
• Essential to making a diagnosis is a medical, detailed
psychologic, and sexual history.
• There will be a thorough examination of the genitalia.
• You will have an examination of your blood, urine,
heart (EKG), and lungs (chest x-ray).
• Ultrasound: Harmless sound waves are aimed at the
area of your penis. The sound waves bouncing back
(the echoes) from this area are seen as a picture on a
screen. Ultrasound is a convenient and painless way
to examine tissues inside the penis. This test will be
done before and after medicine is given to you to
make the vessels in your penis enlarge to see if
anything might be wrong with this mechanism.
• Injecting a medicine into the penis that normally
stimulates an erection and then observing the
response.
• A test to determine whether you have an erection
when asleep. Performing this test during sleep
reduces the effect of psychologic factors.
q Copyright 1999 by WB Saunders Company. All rights reserved.
● TREATMENT
When having the conference with the urologist, it is
important that you discuss the following issues in a frank
and honest manner:
• The degree of motivation to correct the problem.
• The degree of the partner’s support and involvement
in this whole process.
• The willingness to learn the necessary techniques so
that they can be performed properly.
The following types of treatment are available:
• Substituting medicines you are taking that are known
to cause impotence.
• Taking hormones if they are in short supply in your
body.
• Proper counseling and therapy, which can have
excellent results.
• Repair of faulty blood vessels if this is found to be
the cause.
• Drug therapy. Some very promising medicines are
now available to treat impotence. Such treatment
should almost always be a first consideration. If you
try these medicines and they do not work, then other
treatments can be considered.
Vacuum Constriction Device (VCD): This consists
of a plastic cylinder, a vacuum pump, and an elastic
constriction band. The five steps are as follows:
• Lubricant is applied to the penis.
• The cylinder is placed over the penis.
• Air is pumped out of the cylinder to create a
vacuum, which causes an erection.
• The constriction band is transferred to the base of
the erect penis to maintain erection.
• The cylinder is removed. The constriction band can
safely be left on the penis for half an hour.
Penile Injection Therapy: Medicine is injected into
the penis that causes expansion of arteries and relaxation
Semirigid
rods
Scrotum
Rods bent
downward
Figure 1. The malleable rods within the penis need to be bent
to the desired shape as necessary.
IMPOTENCE SURGERY: Semirigid Malleable Prosthesis
347
of penile tissue. Blood flow then increases into the two
erection chambers, helping to cause the erection.
Penile Prosthesis: Two types of prostheses are (1) a
semirigid malleable rod that is placed in the shaft of the
penis and can be straightened to an erect position as
desired (Fig. 1) and (2) an inflatable soft prosthesis that
is placed in the shaft of the penis and can be inflated to
a rigid shape as desired.
After careful consideration of all the factors, the recommendation is that you have an operation in which a
semirigid prosthesis is placed in the shaft of your penis.
PREOPERATIVE PREPARATION
• You will have an examination of your blood, urine,
heart (EKG), and lungs (chest x-ray).
• Do not eat or drink anything for 8 hours before the
operation.
■ OPERATION
• You will be asleep for the operation.
• The incisions will be on the underside of the shaft of
the penis and the prostheses inserted.
• The operation takes about 2 hours.
POSTOPERATIVE CARE
• You will be taken to a recovery room and observed.
When your blood pressure, pulse, and breathing are
stable, you will be taken to a regular hospital room.
348 IMPOTENCE SURGERY: Semirigid Malleable Prosthesis
• You should be able to go home in a day or two.
• Arrangements will be made for your medicine,
follow-up office visit, and stitch removal.
• As with any operation, complications are always
possible. With this type of operation, complications
can include bleeding, infection, malfunctioning of the
prosthesis, and possibly others.
✚ HOME CARE
• Resume your usual activities, increasing them
gradually as tolerated over the next few weeks.
• Take medicines as prescribed.
• You may shower as usual, starting on the second day
after the operation.
• Do not engage in sexual activity for about 6 weeks
and then only if the incision is well healed.
• Do not drive a car if you are taking medicines that
reduce your alertness.
✆ CALL OUR OFFICE IF
• You develop any unusual signs or symptoms.
• Any of the incisions become red or swollen, or there
is drainage from them.
• You develop a temperature higher than 1007F.
• You have any questions.
q Copyright 1999 by WB Saunders Company. All rights reserved.