The different models of penile prosthesis


The different models of penile prosthesis

TIME flies. In the blink of an eye, we are now approaching the end of November. How exciting it has been for the platform of men's health. I am so pleased with the Movember movement that has generated interest and awareness on issues of men's mental health, prostate and testicular cancer. Of course, the release of the ultimate male escapism movie, Spectre, has also been linked with subjects related to men.

It has been absolute delight writing about my favourite topic - James Bond - from gadget and cell phone-induced infertility to the questions of Ian Fleming's depression and its incidence in men. I guess the last remaining topic in relation to the British Spy would be his cars, and indeed, it would be criminal not talking about Aston Martin.

Richard Hammond, presenter of BBC's Top Gear, once said; "No action hero is more closely associated with cars than James Bond".

In fact, to be precise, no action hero is more closely associated with the Aston Martin.

I was a mere lad, when I watched "Goldfinger", the third film in the Bond franchise that introduced the DB5, a relationship that has spanned five decades.

Although the models featured included the DBS and DB9, the classic DB5 returned in spectacular fashion in Goldeneye, Skyfall and the last scene of the latest Spectre. The DB5 has left an indelible mark on popular culture, and continues to be celebrated as one of the most iconic cars ever produced.

From one iconic model introduced in 1964, we are focusing on another "model" in medicine that began its journey in the sixties, and trying to find its relevance in the 21st century.

This time, I will be addressing the different models of penile prosthesis and their impact on patients in the post "blue pill" era.

Dear Dr. G,

My name is Johan and I am a 66-year-old diabetic.

I have been suffering from erectile dysfunction for the last few years and was responding well to the blue pills (Viagra) initially.

I was rather disappointed when the medications stopped working.

My doctor said it was related to nerve and vessel damage, despite my relatively good control of sugar intake.

I was asked to attempt direct injections into the penis, but unfortunately was faced with the issue of tissue damage complication after too many injections were given.

I have now been offered penile prosthesis to overcome my erectile dysfunction.

I understand there are two models of prosthesis. Can you help me to understand the differences between the two?

Cheers

Johan

Penile prosthesis is an implant placed inside the penile tissue in order to achieve erection. It is one of the oldest interventions for the treatment of ED (erectile dysfunction) since the 1960s.

The use of penile implants has dropped significantly over the last two decades following the popularity of oral therapy, but the treatment is still important for patients with resistance to said drugs, diabetes, pelvic trauma, Peyronie's Disease or even prostate cancer. Less commonly, such devices are also utilised in gender reassignment surgery.

There are primarily two types of penile implants - non-inflatable semi-rigid rods and inflatable devices. Semi-rigid rods are essentially malleable metals placed inside the erectile tissue chamber and can be bent to the required position for penetration. With such a device, there is virtually no chance of mechanical failure, but some men may find the permanent state semi-erection rather embarrassing, peculiar and difficult to conceal.

In order the overcome this, Brantley Scott had introduced the hydraulic, inflatable prosthesis in 1973. Although various alterations and improvements have been made over the last four decades, the basic structure of the device is unchanged. The device consists of an inflatable cylinder positioned in the erectile chambers of the penis, connected to a pump placed in the scrotum, which is in turned fed by a fluid reservoir hidden in the lower abdomen. The patient will need to activate the pump in the scrotum in order to inflate or deflate the device. Such models make it easier for the patient to "dress", but the possibility of mechanical failure and difficult manipulation remain an issue.

Susan Sontag, described by the New York Review of Books as one of the most influential critics in her generation once said; "Existence is no more than the precarious attainment of relevance in an intensely mobile flux of past, present and future".

When it comes to inventions in medicine, the relevance of devices can only be sustained if clinicians continue to have inquisitive minds to innovate and adapt to the complexity of evolving diseases.

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