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able. This device combines a long plastic cylinder under the groin muscles. A pump is also connected
or tube that slips over the penis, making a seal with to the system and sits under the loose skin of the
the skin of the body. A pump on the opposite end of scrotal sac, between the testicles.
the cylinder creates a low-pressure vacuum around
the erectile tissue, which results in an erection by To inflate the prosthesis, the man presses on the
drawing blood into the penile erection tissues. pump. The pump transfers fluid from the reservoir
To keep the erection, once the plastic cylinder is to the cylinders in the penis, inflating them and
removed, a rubber constriction band (ring) goes causing an erection. Pressing on a deflation valve at
around the base of the penis, which maintains the the base of the pump returns the fluid to the reser-
erection. With proper instruction 75 percent of men voir, deflating the penis and returning it to the nor-
can achieve a functional erection using a vacuum mal flaccid state.
erection device. A common complaint is that the
erect penis is cold and the ring is uncomfortable While men who have had the prosthesis surgery can
around the penis. see the small surgical scar where the bottom of the
penis meets the scrotal sac, other people probably
will be unable to tell that a man has an inflatable
penile prosthesis.

When the penis is inflated, the prosthesis makes the
penis stiff and thick, similar to a natural erection.
Most men rate the erection as shorter than their
normal erection; however, newer models have cyl-
inders that may increase the length, thickness, and
stiffness of the penis.
.
When the penis is inflated by pressing on the scro-
tal pump , the prosthesis makes the penis stiff and
thick, similar to a natural erection. Most men rate
the erection as shorter than their normal erection;
however, newer models have cylinders that may
Vascular Penile Surgery increase the length, thickness, and even stiffness of
the penis.
Vascular surgery, penile arterial revascularization,
venous ligation procedures are rarely performed to A penile prosthesis does not change sensation on
treat selected cases of ED. the skin of the penis or a man’s ability to reach or-
gasm. The sensations associated with ejaculation
are not affected either. Once a penile prosthesis is
Severe Cases of ED put in, however, it may destroy the natural erection
reflex. Men usually cannot get an erection without
inflating the implant by pressing on the pump. If the
There are some men who have severe degeneration
in the erectile tissues of the penis, which makes implant is removed, the man may never again have
them unable to respond to any of the treatments list- natural erections. That is the reason why the penile
ed above. While this is a small percentage of men prosthesis is used only in cases of irreversible ED.
with ED , they usually have the most severe forms Occasional complications related to infection or
of ED. Patients most likely to fall into this group malfunction of the prosthesis can occur.
are men with advanced diabetes, severe kidney dis-
ease, blockage of many blood vessels in the body Fortunately, approximately 90%-95% of inflatable
. Furthermore, men who suffered from ED before prosthesis implants produce erections suitable for
undergoing surgical or radiation treatment for pros- intercourse. Satisfaction rates with the prosthesis
tate or bladder cancer are difficult to treat. are extremely high, and typically 80%-90% of men
are satisfied with the results and say they would
Penile Prosthesis: choose the surgery again.
Insurance plans are likely to pay for the penile pros-
The simplest type of prosthesis consists of a pair thesis , as long as a medical cause of ED is estab-
of malleable (bendable) plastic rods surgically im- lished. Medicare covers the surgery, but Medicaid
planted within both erection chambers of the penis. does not.
With this type of implant the penis also feels semi-
rigid and merely needs to be lifted or adjusted into
the erect position to initiate sexual activity. Many
men do find the malleable penile prosthesis natural
enough.
Currently, most men with ED choose a hydraulic,
inflatable penile prosthesis, which allows a man to
have an erection whenever he chooses and is much
easier to conceal when deflated. Many men feel that
the inflatable prosthesis is more natural.
Urologists should advise a penile prosthesis only
when there is a clear medical cause for ED and
when the problem is unlikely to resolve or improve
naturally or with other medical treatments. Rarely a
penile prosthesis is implanted during surgery to re-
construct the penis when scarring has caused erec-
tions to curve (Peyronie’s disease).

The inflatable penile prosthesis consists of two cyl-
inders -- a reservoir and a pump -- which are placed
surgically in the body. The two cylinders are insert-
ed in the penis and connected by tubing to a sepa-
rate reservoir of fluid. The reservoir is implanted
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