Before undergoing surgery to implant a prosthesis, there is an important point that the surgeon must clarify so that the patient knows what to expect from the result: it is the validity of the penile prosthesis.
A 2007 study by specialists at the University of Ankara that followed 2,384 patients for two decades evaluated the durability of the malleable penile implant and found that hydraulic failure of the system is rare.
However, it is worth clarifying that this does not mean that the malleable prosthesis, also known as semi-rigid, does not present hydraulic failures. Furthermore, this system has been improved over time and, in the experience of urologists, this version tends to last longer than the inflatable one.
Brazil x United States
There is another factor that favors the implantation of malleable prostheses: in Brazil, the Unified Health System (SUS) offers only this model. Health insurers are exempt, according to thelist of the National Supplementary Health Agency (ANS), to pay for the inflatable one.
In a quick comparison with the United States, the government program and most health plans for men over 65 years old cover not only the inflatable prosthesis, but the medical fees and the reoperation of the penile prosthesis in case of failure, with all the corresponding expenses paid.
In Brazil, the current regulation and the high cost (the inflatable one can cost 10 to 20 times more than the semi-rigid model) make the patient prefer the malleable one.
However, the evaluation of the most suitable prosthesis should always be carried out in the office together with the surgeon, as both models have advantages and disadvantages.
5 tips to increase the durability of the penile prosthesis
Today there are a wide range of prosthetic options on the market, of various brands and calibers.
Given the variety, the challenge is to find the most favorable for your reality, considering the individualities of fibrosis, penile reconstruction and the anatomy of each limb, so that it lasts longer.
Below, I will give 5 tips on how to increase the durability of the penile prosthesis:
1) Surgeon experience
The surgeon's experience is very important to predict the validity of the penile prosthesis.
There are some brands and models that the specialist usually uses more than others. Thus, he has the opportunity to accompany the patient and verify if the prosthesis lasts longer or if it lasts less. From there, the surgeon tends to recommend a more durable implant to minimize the need for lifelong replacement.
I have been dedicated to this area for 22 years and have already been able to follow up countless patients and the effective duration of the implant. I even stopped working with some models that had early failures, as it can be very frustrating for the patient.
2) Anatomy and penile prosthesis
To preserve penile prosthesis durability, we need to think about the anatomy of each patient's sexual organ and adopt strategies that make the implant last longer.
A longer penis requires a model/company that offers a larger prosthesis, for example.
The size x caliber ratio is very important.
3) Penile reconstruction
As I said before, a penis that is longer requires a wider implant to be strong. If it is very thin and does not support a more caliber prosthesis, we need to adopt penile reconstruction to recover the functionality of the limb.
If a thin cylinder is placed on a long penis, it will not have good firmness and may bend during intercourse, damaging the prosthesis.
A thinner implant is more likely to break and lose its durability.
It should be noted that the longer the implant is inside the penis, the more this tissue will tear. If there is a need to change the prosthesis, there may have been tissue expansion that allows for a larger and/or longer model to be implanted.
It's not just experience and penile anatomy that determine how long the prosthesis lasts.
The patient's lifestyle can interfere with durability, depending on how the patient accommodates the malleable denture, the force used to manipulate the inflatable denture, etc.
Penile implants have evolved a lot in recent years, especially the type of material used, which is essential to give the penis the vertical firmness it needs, in addition to allowing movement.
In the case of malleable prosthesis, for example, the metal composition can be silver, stainless steel with titanium or nitinol and the technology used in metal alloys also influences the choice.
I conclude by saying that there is no magic formula in relation to prostheses. Trust surgeons who perform this work frequently and know from their observations which choice will deliver the patient the best cost-effectiveness and implant duration.
If you have lost penile rigidity or your penile prosthesis has broken, please contact my team. We will analyze your case and offer an individualized indication for you to regain sexual health.
To learn more about the work developed at the clinic by Dr. Paulo, check out:
MD, PhD, Dedicado no Tratamento da Doença de Peyronie, Pênis Curvo e Implante de Próteses Penianas. Doutor em Urologia pela USP, CRM 67482, RQE 19514. - Vencedor do Debate do Sobrevivente da AUA em 2019.