Over the past few years, there have been many scientific and technological advances that are helping urologists like Dr Katelaris make life-changing differences to patients suffering from Erectile Dysfunction (ED).
ED is the inability to attain and/or sustain an erection long enough to engage in sexual intercourse. 1 in 5 men over 40 suffer from ED, and this risk increases with age.
Causes of ED can be psychological, including stress, or physical, such as any condition that affects the blood vessels (cardiovascular disease, diabetes, high blood pressure, prostate surgery, trauma or injury, kidney or liver failure).
ED can be stressful and embarrassing and may cause inconveniences to your life, including affecting your sex life. The good news is that there are a number of treatment options that may help you reclaim your spontaneity and confidence. When ED is mild or intermittent, a non-surgical treatment option, such as oral medications, may be the best approach. However, if the condition is ongoing, a penile implant may be the best option to regaining your sex life and overall wellbeing!
Dr Katelaris has 25 years of experience as a urologist and describes the condition as “sometimes a taboo subject for men and couples, however it is important to find out the treatment options available to restore intimacy and self-esteem.” Dr Katelairs personally recommends penile prosthetic surgery as a preferred treatment option, due to it essentially being a permanent solution, with 90% patient satisfaction rate. The penile prosthesis is an effective and permanent means of restoring sexual function that allows spontaneous sexual interaction and eliminates performance anxiety.
How do prosthetic implants work?
Prosthetic implants are made from biocompatible silica with an antibiotic coating to reduce infection risk. This option includes 24 hours hospital admission, a surgical incision in the scrotum, 6 weeks post-operative recovery and mild discomfort as patients learn how to inflate and deflate the device. Ultimately this option allows for spontaneity, intimacy and romance to return, with removed performance anxiety.
So how does a penile prosthesis work? There are two main types of penile implant: malleable/semi-rigid and inflatable. The malleable implants remain rigid at all times, however are flexible so can be concealed. The inflatable implants can appear both flaccid and rigid like a normal penis, so are often the preferred choice. The different options for inflatable implant are outlined below:
- One-piece implants consist of a pair of cylinders that are inserted into the penis. In this treatment option, the penis remains semi-rigid at all times and can be placed in an upwards position for sexual intercourse, and a downward direction for other activities.
- Two piece implants are hydraulic systems that consist of a fluid pump system (located at the base of the groin), and cylinders which are filled with fluid through manipulation of the pump. This external penile prosthesis creates an erection on demand, and a deflation valve can be pressed after intercourse to ease the erection.
- Three-piece implants function in the same way as two-piece implants, except that the reservoir of fluid is located separately in the abdomen. The advantage of this option is that a longer lasting erection can be achieved due to the larger pool of fluid, however one disadvantage is that it requires more extensive surgery.
Advantages of penile prosthesis:
- Penile implants are very durable, and can last over 15 years.
- The mechanical nature of the implant means that you can produce an erection whenever you wish to, almost instantly.
- The penile implant is discreetly enclosed inside your body so no one needs to know that you have one.
- Implants do not interfere with the ability to orgasm and ejaculate, and produce an erection that feels natural.
- Implants do not interfere with sexual spontaneity, as some other treatments might.
- Patients and their partners report high satisfaction rates.
Disadvantages of penile prosthesis:
- As with any operation, the penile prosthetic surgery option may involve some risk of infection of failure.
How do implants compare to other treatments?
As penile implants are a surgical procedure, they are considered a permanent treatment for erectile dysfunction. However, this may not be the most appropriate solution for everyone. Other treatment options include:
- Medications: These can include oral drugs such as Viagra, and injections of medications directly into the penis. These function by increasing the flow of blood to the penis and are considered safe to use unless the patient is on nitrate medications. While safe, these medications have a lower success rate in producing erections than implants.
- Vacuum pump: An external pump device that is used to draw blood into the penis. While an effective form of treatment, some users reported that it can interfere with romance and spontaneity.
A conversation with David and Pam about Penile implants:
David and Pam Sandoe have led the Prostate Cancer Support Group Network at the San Cancer Support Center for over 13 years and were both actively involved with the Prostate Cancer Foundation of Australia, which David retired from as National Chairman in 2015. They are both recipients of the Medal of the Order of Australia and have been happily married for 49 years.
However, in 1996, they both received a shock when David was diagnosed with prostate cancer at age 51 and underwent a radical prostatectomy. While this surgery was a success, a side effect of the operation was Erectile Dysfunction, which took a toll on the couples intimacy.
We sat down with David and Pam to answer any questions you may have about penile implant surgery. The couple commented:
“We knew about the possible side effects and were challenged by the implications, but as best friends, we were determined to find the right solution for us. In the long term, that turned out to be a penile implant, and we want to share our experience at every opportunity to assist couples whose quality of life may be suffering because of ED.”
In this conversation, David and Pam talk about what a penile implant before and after feels like, what it looks like on the outside and the differences between having a penile implant compared to sex before experiencing Erectile Dysfunction.
How does it feel to live with a penile implant?
David: “I think apart from the spontaneous aspects of having a penile prosthesis, I think a lot of people really do need to understand that it’s very natural, it feels very natural. I don’t feel as though I’ve got anything mechanical in me really, I just feel normal. I mean the apparatus is in the scrotum, I can have a shower in the golf club locker room and no-one knows that I’ve got a penile prosthesis. In fact, I just look normal.”
Pam : “Definitely, it just feels like it did beforehand, there are no issues about mechanical parts that I’m aware of at any time. It just works well doesn’t it? And it’s a very simple process, there’s a tube up either side of the penis. The little button is in the scrotum and there is a little bag of Saline that’s in the tummy area and you just pump the saline into the penis with the little button and voila, it’s there, it’s ready to go. It’s all about spontaneity and not having to get out of bed to do something and being disruptive, then with another touch the penis goes down so that’s it. You’re right for the night.”
What do you like most about the penile implant?
David: I describe erectile dysfunction as not being able to have an erect penis for penetration. That was the case with me after I had a radical prostatectomy. After I had the treatment for the prostate cancer, I realized that, and we had very good advice from our medical specialists, that the erectile dysfunction possibility may be there and for us to stimulate the penis as early as possible. So, we went through the oral medication, and that really didn’t work. Then we went to the penile injection. That did work, and I was surprised that I was able to do it so freely in the end, but it was tedious. It works for a lot of people, but, I mean, to get the solution right and to inject yourself, it’s sort of disruptive in the lovemaking process.
Pam: Frequently the spontaneity goes out of the romantic side of making love.
David: That’s right. Then we progressed to the vacuum device. And again, that worked, didn’t it?
Pam: Yes, that was very good.
David: It worked, but there’s a tediousness about that, also. You’ve also got to carry your equipment around. So, going through that process made our decision really pretty easy, that an implant was the ultimate solution. Now that we have it, well, I’m convinced.
Pam: I’m convinced.
David: You know, it’s very good, lifelong solution and our sex life now is as good as it’s ever been. That’s really important for our relationship. There’s no hesitation in encouraging other men and their partners to have the penile implant without putting it off. Just get on with it, after the appropriate time has been spent in looking at the benefits of penile prosthesis and talking to people. Just don’t put it off.
Pam: Yes. I think they just have to go through, step by step, through all the things that are out there that can be useful and used after their treatment. It’s just a matter of putting in some hard yards and then deciding no, none of these are working satisfactorily. I’ll go for the penile implant.
Do you think you made the right decision in getting a penile implant, and do you have any regrets?
David: In summary, I suppose you could say that our experience with erectile dysfunction was that we should’ve had the penile prosthesis a lot earlier. Because we tried the oral medication, it was not good for us. We tried the penile injections and that had its shortcomings. While it worked, the vacuum device, as you say, worked but it had its shortcomings as well. So I think we both agree that the penile prosthesis, given the benefit of hindsight, we should’ve had done a lot earlier.
Pam: Yeah. I think it’s also important to understand that it’s a matter of getting the blood flowing into the penis too. So with all the options that we chose to partake of, it was all beneficial in the long run, but it was just with the vacuum device, the penis is what they call in the ‘hinge position’ because there’s just as much of the penis inside the body as there is out. So it sort of flaps around a bit so it needs more guidance to be placed in the vagina than now having the penile implant, which is just very natural and it’s warm.
If you want a confidential and open discussion about erectile dysfunction, penile implant surgery, penile implant results, penile prosthesis cost and to decide whether it is the right choice for you, contact Katelaris Urology today.
References:
- Rodriguez KM, Kohn TP, Davis AB, Hakky TS. Penile implants: a look into the future. Transl Androl Urol. 2017 Nov;6(Suppl 5):S860-S866. doi: 10.21037/tau.2017.05.28. PMID: 29238665; PMCID: PMC5715181.
- Mayoclinic.org. 2022. Penile implants – Mayo Clinic. [online] Available at: https://www.mayoclinic.org/tests-procedures/penile-implants/about/pac-20384916#:~:text=Three%2Dpiece%20inflatable%20implants%20use,the%20reservoir%20into%20the%20cylinders. [Accessed 21 September 2022].
- Besturologyclinic.com. 2022. How Does a Penile Implant Work? : Urology Specialist Group: Urologists. [online] Available at: https://www.besturologyclinic.com/blog/how-does-a-penile-implant-work [Accessed 21 September 2022].
- Chung E. Penile prosthesis implant: scientific advances and technological innovations over the last four decades. Transl Androl Urol. 2017 Feb;6(1):37-45. doi: 10.21037/tau.2016.12.06. PMID: 28217449; PMCID: PMC5313299.
- Dr. Richard Natale. 2022. What Are the Different Types of Penile Implants?. [online] Available at: https://www.charlottemenshealth.com/2018/10/19/what-are-the-different-types-of-penile-implants/ [Accessed 21 September 2022].
- Sadeghi-Nejad, H., 2007. Penile prosthesis surgery: a review of prosthetic devices and associated complications. The journal of sexual medicine, 4(2), pp.296-309.
