Hydraulic penis prosthesis as an alternative in the treatment of erectile dysfunction in the 21st century

lek. Michał Piotrowski

Skamex Sp. z o.o. sp. k.

Hydraulic penis prosthesis

Hydraulic penis prostheses are an effective and modern method for treating erectile dysfunction and impotence, often considered as a final resort in therapy for patients who have not responded to other, less invasive methods such as psychotherapy, oral medications (e.g., Viagra), intraurethral medications, vacuum pumps, or penile injections.

Modern implants are closed, fluid-filled systems consisting of three components: a pair of cylinders, a reservoir, and a pump for controlling the prosthesis. All components of the hydraulic penile prosthesis are connected during the procedure using special tubing.

Achieving an erection sufficient for satisfying sexual intercourse involves repeatedly squeezing the pump located in the scrotum, which results in filling the cylinders with fluid and consequently stiffening the penis.

Returning to the flaccid state with Coloplast Porges prostheses (catheters, stents) is extremely simple thanks to a special system called "one-touch release" (OTR) - just a single press of a button causes the fluid to move from the cylinders to the reservoir, resulting in penile flaccidity.

The entire system is externally invisible

The goal of penile prosthesis implantation is to restore sexual activity and improve quality of life. Modern implants offer the possibility of achieving excellent erections while maintaining a natural appearance of the penis in its flaccid state, ensuring high satisfaction for both patients and their partners.

If you're experiencing potency issues, you should seek help from your urologist.

The Skamex company offers hydraulic penile prostheses, which are modern solutions produced by the global leader, Coloplast Porges.

In 2016, we organized workshops on penile prosthesis implantation, inviting a group of urologists from Poland. During the workshops, the first surgery to implant the Coloplast Porges hydraulic penile prosthesis was performed on a 40-year-old patient. The indication for implantation was impotence as a complication of priapism treatment—the patient had not had erections for 2 years. Thanks to the courtesy of Coloplast Porges, we invited Prof. Steven Wilson from the United States (Professor of Urology at the University of Arkansas for Medical Sciences, Little Rock, Arkansas)—who has one of the largest experiences worldwide in penile prosthesis implantation.

Hydraulic penile prostheses

  • The first penile prosthesis was implanted as early as 1973
  • To this day, he has personally performed over 11,000 implantations.
  • Poland was the 50th country where he taught urologists the art of penile prosthesis implantation.

If a patient suffers from erectile dysfunction, has difficulty achieving satisfactory penile rigidity, or experiences a complete lack of erections (impotence), he should consult a urologist for treatment. If the treatment proves ineffective or unsatisfactory, he should revisit the urologist and discuss the possibility of undergoing penile prosthesis implantation, specifically a hydraulic penile prosthesis.

The most common causes of erectile dysfunction, including impotence

  • Emotional or psychogenic factors - such as depression or subconscious aversion to the partner, and sometimes to sex
  • Hormonal disorders, low levels of male sex hormones
  • Neurological causes (e.g., multiple sclerosis).
  • Endocrinological causes (e.g., diabetes).
  • Complications after surgery (e.g., after prostate or bladder removal).
  • Anatomical issues (caused by injuries, e.g., after accidents).
  • Prostate diseases – inflammation or cancer.
  • Metabolic causes (atherosclerosis).
  • Cigarette smoking.

Indications for implantation of cavernous body prostheses, penile prostheses

  • Ineffective attempts at conservative therapy - oral medications, intracavernosal medications.
  • In case of ineffectiveness of therapy using injections into the corpora cavernosa of the penis or lack of acceptance of this method by the patient.

It is of utmost importance to note that penile prosthesis implantation surgery (corpora cavernosa prostheses) is associated with a minimal risk of infectious complications. Professor Wilson presented at our workshops the results of studies where the risk of infectious complications (infection) after penile prosthesis implantation surgery was below 1%. Patients should not activate the system for the first 4-6 weeks after the surgery; only after this period does the first activation of the prosthesis occur, and from that moment onwards, men can resume sexual activity.

Research conducted among patients after penile prosthesis implantation indicates that the majority of them achieve full satisfaction approximately 6-9 months after the surgery. Satisfaction levels were comparable to the physiological state that existed before the onset of erectile dysfunction or impotence.

Hydraulic penile prostheses in Poland

In Poland, up to July 2017, 4 procedures using Coloplast Porges prostheses were performed (indications included priapism in one patient, atherosclerosis in another, and diabetes in the remaining two patients). The outcome was very good for all operated men. Patients report satisfaction comparable to the physiological state before erectile dysfunction or impotence issues arose. Additionally, the partners of the patients are very pleased.

Preparation for the procedure involves the patient being qualified by a urologist after documenting the ineffectiveness of traditional non-invasive treatment methods or the patient's lack of acceptance of them.

Course of the procedure - most commonly, the procedure is performed under general anesthesia.

The most commonly used access routes to the corpora cavernosa worldwide are through the penoscrotal and infrapubic approaches.

The surgeon makes the decision regarding the choice of access based on anatomical conditions and their own experience. Then, the corpora cavernosa are opened, and a space is created within them for the cylinders, with their length individually tailored for each patient based on the measured length of the corpora cavernosa.

The components of penile prostheses

All components of the penile prosthesis are prepared in a proper manner to ensure they are fully protected during implantation. The surgeon selects an antibiotic solution in which all elements of the penile prosthesis—cylinders, reservoir, pump, and connectors—are soaked before implantation. This precautionary measure aims to minimize the risk of infection associated with penile prostheses. Maintaining the highest standards of asepsis and antisepsis during the procedure of implanting hydraulic penile prostheses is crucial. After placing all appropriately selected components of the penile prosthesis:

  • of cylinders in the corpora cavernosa
  • the reservoir in one of two locations: prevesical (pre-bladder), meaning in the Retzius space between the pubic symphysis and the urinary bladder, or increasingly used ectopic placement under the rectus abdominis muscle
  • the pump in the scrotum

All components are connected with special tubing and appropriate connectors, and before closing the incisions, the system is checked to confirm its proper functioning. The inflated system is then bandaged in a special way, commonly referred to as a "mummy wrap." 24 hours after the penile prosthesis implantation, the system is released using the "one-touch" button located on the pump in the scrotum, leading to the deflation of the cylinders in the corpora cavernosa. This state should be maintained for 4-6 weeks. Subsequently, the patient, usually in the presence of the attending physician, performs the first inflation of the system, and from that moment on, can resume normal sexual activity.

  • Procedure duration – approximately 2 hours
  • Postoperative hospitalization – on average, 1-2 days

After the procedure

  • Patients typically achieve full sexual satisfaction approximately 6-9 months after the implantation of a hydraulic penile prosthesis.
  • The level of satisfaction reported by patients is comparable to the physiological state before the onset of erectile dysfunction or impotence.

In Poland, issues related to erectile dysfunction and impotence remain a taboo topic. In most European Union countries, penile prosthesis implantation procedures are reimbursed by national health funds or health insurance, either fully or partially (80%). In Poland, however, patients must pay for the penile prosthesis implantation procedure themselves.

What is the situation worldwide?

For example, in Germany, approximately 400 procedures are performed annually, in Belgium around 100 procedures per year, and in the USA about 400 procedures per month. In Poland, only about 5 procedures are performed annually.

Is the reason the lack of erectile dysfunction and impotence in Poland?

Certainly not. It appears that the primary cause is a lack of awareness about the available help when non-invasive treatments for erectile dysfunction and impotence are ineffective. A significant number of patients with diabetes experience potency issues but often do not know where to seek help. Additionally, prostate cancer, despite continuously improving diagnostic and treatment methods (laparoscopy, robotics), often leads to loss of erectile function, resulting in impotence, particularly in patients aged 50-65.

These individuals are deprived of a very important aspect of life, which can often lead to mental health issues (e.g., depression). They feel as if they have been left to deal with this problem on their own.

If you know anyone in your surroundings who has diabetes or other conditions leading to erectile dysfunction or impotence, you can share with them the knowledge that there is a way to return to normal sexual activity. This solution is a penile prosthesis – specifically, the Coloplast Porges hydraulic penile prosthesis.

Skamex, in collaboration with Coloplast Porges, organizes courses and training sessions for urologists who want to gain experience in penile prosthesis implantation procedures. This ensures that patients are in the hands of professionals with expertise in these procedures.

Please contact us if you are a patient seeking advice on where and how to undergo the procedure. Get in touch with us, and we will guide you urologia@skamex.com.pl or call +48 608 632 365.

We are in regular contact with doctors who already have experience and have attended courses conducted by the world's leading specialists in this field.