Explantation and re-implantation of hydraulic penile prosthesis

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The penile prosthesis is a medical device which is surgically implanted into patients with organic erectile dysfunction of various causes, which does not respond to pharmacological therapy. Prosthetics can also be used to correct congenital or acquired abnormalities of the penis, such as deviation or Peyronie’s disease.

The implant does not modify the degree of turgidity of the glans, penile sensitivity or orgasm.

When is a penile prosthesis indicated?

  1. in cases where erectile dysfunction does not respond to oral therapy or where oral therapy is contraindicated or unsatisfactory; in cases where intracavernous pharmaco-prosthetics (with intracavernous prostaglandin injections) are ineffective or difficult to use for the patient;
  2. in cases of penile malformations such as curvature due to Peyronie’s disease or Induratio Penis Plastica associated with erectile dysfunction

(with a single procedure, penile prosthesis implantation allows the penis to be straightened, guaranteeing the necessary rigidity for penetration and satisfactory sexual relations).

  1. in cases of diffuse fibrosis of the corpus cavernosum secondary to infections, priapism, prolonged use of intracavernous injections;
  2. after destructive pelvic surgery such as radical prostatectomy, radical cystectomy, colorectal surgery, surgery for abdominal aortic aneurysm in which erectile dysfunction is an inevitable consequence which almost never responds to oral or intracavernous pharmacological therapy;
  3. after radiotherapy for prostate cancer or other pelvic pathologies;
  4. in patients with spinal cord lesions unresponsive to oral therapy or for whom intracavernous injection or vacuum device therapy is inconvenient.

The principal complications are prosthesis infections and mechanical wear and tear. The explantation and re-implantation of a penile prosthetic requires a great deal of experience and cannot be managed by an inexpert surgeon.