Dear Dr. G,

I am a 64-year-old man who went for a body check-up two years ago.

I was diagnosed with prostate cancer, after the detection of an elevated tumour marker.

The doctor was initially optimistic my cancer was curable by surgery, however despite the best effort I was faced with the challenges of cancer recurrence.

My oncologist was still hopeful the cancer was still manageable, and I was treated with a course of external beam radiotherapy.

Although I am absolutely thrilled with my recent blood tests suggesting eradication of the cancer, however the price I pay is the worsening of my sexual function.

I first experienced erectile dysfunction after the radical prostatectomy, and I was so pleased the problem was solved with the magical blue pills.

I started noticing the medicine losing its effect following the radiotherapy and hormonal treatment.

As I have a young wife who is 15 years younger than me, my doctor asked me to use injections into the penis to restore the erection.

Truthfully, I simply find the thought of injecting into the penis impossible!

Don’t get me wrong. I am not scared of needles. After all, I have been through two major interventions for my cancer. However, there is just something I cannot do!

I have heard about penile prosthesis, but always assume this is an urban myth.

I simply cannot imagine how the implants work and would like to put Dr. G on the spot for some clarification.

What exactly is penile prosthesis?

How does the artificial penis work? Can they be plug-and-play?

What are the complications of penile prostheses?

In the spirit of Movemeber November Prostate Cancer Month, I really hope the Prosthetic Penis can solve my problems of wilting Manhood!

Prosthetic Paul

Penile prosthesis is one of the oldest and most effective treatments for erectile dysfunction introduced in the 1970s. The implant is incorporated into the erectile tissues of the body of the penis (corpora cavernosa) and is still commonly performed for men suffering from pelvic trauma, diabetes and prostate cancer. Various devices have been implanted with the goal of improving sexual function in men affected by erectile dysfunction (ED). As the worldwide prevalence of ED is expected to increase to over 322 million by 2025, the demand for implantable penile prosthesis should continue to rise.

There are essentially two types of implants, namely inflatable and non-inflatable implants. This hydraulic expandable device was invented in 1973, by Brantley Scott, which is filled with saline. It consists of inflatable double cylinders filling up both chambers of the erectile tissues of the penis. The other components of the device are the reservoir filled with saline and a pump to activate the fluid delivery. Prosthesis activation started with squeezing the pump to transfer fluid from reservoir into the erectile chambers. The pump is usually concealed in the man’s scrotum and the reservoir in the pelvis. Naturally, after intercourse, the device is deactivated, and the deflated chambers will ensure a flaccid penis. Scott was truly ahead of his time as inflatable penile prosthesis is still widely used fifty years after his invention. Significant developments in technology have also allowed for improved outcomes, functionality, and cosmesis. Future research into optimal materials and surgical approaches should provide continued benefits to patients.

The non-inflatable implants are fundamentally two malleable metallic rods, surgically inserted into both chambers of erectile tissues. This device can be bent into required position as needed for penetrative intercourse. Such simple prosthesis may not feel natural as the penis is constantly erected; however, this avoids the potential mechanical failures of inflatable devices.

Although penile prosthesis has provided many men with happy sexual relationships, the devices may not be the answer for all patients suffering from Erectile Dysfunction. The devices are not off-the-shelf purchases to be plugged and play. Some men complain of altered sensation and displeasure of a permanently semi-rigid penis. Others find the activation and deactivations cumbersome. Like any other device, Inflatable penis prosthesis may also have device malfunctions at some point. Penile prosthesis implantation is a procedure that can have a profound impact on a patient’s quality of life. However, serious complications such as implant infection, erosion, or injury to surrounding anatomic structures can occur. Therefore, it is always important to identify risk factors preoperatively.

Aimee Mullins, a 38-year-old American athlete, actress and fashion model born with missing fibula bones resulted in the amputation of both her lower limbs at the age of one. Despite her shortcomings, she has modelling career on the runway for Alexander McQueen, by opening his London show on a pair of wooden lower limb prosthesis. Mullins was the first person in the world on the iconic carbon-fibre cheetah and is regarded around the world as a sports pioneer. Mullins once said: “At some point in every person’s life, you will need an assisted medical device. Whether it is your glasses, your contacts. Or as you age, and you have a hip replacement or a pacemaker. The prosthetic generation is all around us.” Mullins is correct as the world is very much heading to a vision of Lee Major’s “Six-Million-Dollar Man” in the 1970s. Many men who are fed up with failing pills and threats of penile injections to relight the fire between the sheets are putting Dr. G on the spot for his views on penile prosthesis. His opinion is when we are accepting synthetic replacement to enhance our ability or to rectify our defective limbs, there is no difference in accepting the prosthesis of the “third limb”, if risks and benefits are well considered!

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