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Prof. Dr. Tahir Karadeniz, Üroloji Uzmanı

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Penile Prothesis (Happiness Bar) Surgery

Erection Dysfunction (Impotence)

Erectile Dysfunction (ED) is known as impotence among people. Medical definition of impotence is the inability to get and keep erection firm enough for sex. It is hard for the penis to get firm enough to go inside vagina or even if it gets firm enough it can loose the erection suddenly, before sexual intercourse.

The ratio of people with ed is very high such as 25% of the population while the ratio of people with high level ed is 9.6 %

Erection dysfunction problems may occur due to an underlying health condition (that we call organic reasons) or due to psychological reasons such as depression. If the reason is organic, the ed problem starts slowly and increases.

If the reason is psychological,ed problem starts suddenly and recovers without any help.

I want to mention a very important point that if the reason is organic, the patient is a candidate for cardiovascular diseases in 5 years such as heart attack or paralysis or vein occlusion. For this reason the person with organic ed must be examined by a cardiologist.

The Possible Causes of Erectile Dysfunction:

  1. Smoking
  2. Hypertension
  3. Diabetes
  4. Excess weight
  5. Sleep disorders and sleep apnea
  6. Chronic renal failure and dialysis (even if the patient had kidney transplant,the ed problem can not be recovered)
  7. Thyroid disorder
  8. Usage of drug and high dose alcohol
  9. Medications: usage of anti depressants, antipsychotic and hypertension medicines
  10. Brain and Spinal cord diseases: tumors, damages after an accident, parkinson’s disease,multiple sclerosis
  11. Hip fracture after a traffic accident
  12. Having Prostatectomy Radical due to prostate cancer causes 65% loss of erection
  13. Having Radical Cystectomy –removal of bladder- causes 85% loss of erection
  14. Having Rectal Cancer Surgery (rectum is the last part of large intestine)
  15. Having prostate radiotherapy (rate is 65 %) having brachytherapy (it is a form of radiotherapy where the radioactive materials are placed inside the prostate gland (It is sometimes called internal radiation) the rate is 31% and in 5 years the ratio of ED increases to 57%).

What is Penile Prothesis?

İt is known as happiness bar among people.the surgery takes 1 to 2 hours if there is no extraordinary situation. The aim of this surgery is to place an implant in the corpus cavernosum part of the penis to enable erection (normally the corpus cavernosum contains spongy regions filled with blood to enable penis erection) after penile prothesis surgery,the rate of sexual satisfaction of the patient and his partner is 85%.

Erectile Dysfunction Treatment

There are three steps for te treatment:

  1. Medication: as the first option ed patients are treated with pills.but it is risky for the patients who are using cardiovascular medicine.
  2. Penile injection: patient make the injection to his penis by himself in the way the urologist stated.
  3. PRP and Shock waves:the studies are on going at present. These treatments are considered to be experimental and can be performed for mild ed problems.

The most permanant and satisfactory treatment is penile implantation.

Types of Penile Prothesis:

There are two main types of penile prothesis:

    1. Hydraulic (Inflatable) Penile Prosthesis: There are two types of inflatable prosthesis as Two –pieces and three-pieces. Three-pieces inflatable penile implant is the most common one. It consists of two inflatable cylinders (2 silicon implants) inside the shaft of the penis, a fluid reservoir under the abdominal wall near the bladder and a pump located inside the scrotum.

 

Before the intercourse, man has to run the pump located in his scrotum by pressing the button. After activation the fluid is pumped from the reservoir to the cylinders located in the penis.the prosthesis becomes longer and thicker like natural erection.

After the intercourse.man presses the button and unblocks the fluid flow and erection ends.that means, man can erect his penis and end erection whenever he wants. He has the control.

3 pieces happines  bar, 2 cylinders, 1 pump, 1 reservoir3 pieces happines bar, 2 cylinders, 1 pump, 1 reservoir

  1. One Piece Penile Implants:These devices are more simple implants. Two implants are placed in penis.patient can get into intercourse anytime. There are rigid and semirigid types.

    One Piece Penile Implants

Important Notes About Penile Implant:

  • Malfunction: 15% of three-pieces implants may be damaged or broken in 5 years. In this case surgery is needed to remove the damaged implant and replace a new one.
  • Infection: There is a risk of infection like any surgery the possibility is 3%
  • The length and width decreases after the penile prothesis surgery. Therefore, the patients who had a surgery due to rectum, prostate or bladder cancer, the longer the period before having penile implant surgey, the more loss in the lenth and width of penis.

 

Treatment of Erectile Problem (Penile Prosthesis) Following Prostate Cancer Surgery

Today we are placing Penile Implant (prosthetic device) inside the penis by Penile Prosthetic Surgery. This surgery is known as “happiness bar surgery” among people, which treats erectile disfunction completely and brings an end to the nightmares.

Why do we make this surgery?

7 years ago, this patient came to us with very advanced stage prostate cancer (tumor spread outside prostate) and had Radical Prostatectomy surgery.

During the radical prostatectomy surgery we did not keep the nerves which were enabling the erection. Why? Becuse if we kept those nerves we couldn’t have removed all the cells of cancer. We removed the prostat gland and tissues surrounding it like the nerves and the lymph nodes nearby, to get rid of all risks.

Our patient has no problem concerning his prostate cancer for 7 years. Now he decided to have Penile Prosthetic Surgery and we placed the penile into his penis to allow him to regain erectile functions again as before. I want to emphasize here that, keeping the nerves during Radical Prostatectomy Surgery is not suitable for every patient. Our practises showed us that when nerves are kept, the possibility of existence of tumor inside the section kept is very high.

Therefore we never keep the nerves in cases of high risky prostate cansers those with 7-8-9 and 10 scores. Instead, we help people to regain erectile functions and reach the level of 20s by means of Penile Implants.

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