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 Men's Health

october 2012
Options Machined For Men
Modern advances in medicine, offer the scope of a varied and case-specific solution to majority of men with erectile dysfunction. Surgical techniques are here to stay and penile implants may well be cited as the most advanced solution currently available. So gentlemen, whatever you do - keep it up, writes Dr Ajit Saxena.

From what renowned psychologist Sigmund Freud said, we know that food and sex figure prominently in the basic needs of a human being. Indeed, sex is a very good exercise for the entire body and normal healthy sex is important for the maintenance and proper functioning of the human body. Issues and ailments surrounding the reproductive organs and sexual health of men and women deserve due attention. Erectile dysfunction in men is one such issue.

Up till the early nineties, the only treatment available for erectile dysfunction was the use of a drug called Papaverine which was injected into the base of the penis using big fat needles. This, as you can imagine, was torture to the unfortunate man. But it was the only viable option available at that time. With the advent of sildenafil (better known as Viagra), came the use of medicines to address ED. Perhaps the biggest contribution of this drug was that it drew out a problem long-confined to the bedroom, for discussion in the drawing room. Men became open and willing to discuss their problem with the doctor and a new sub-specialty of urologists, known as andrologists, was born!

Is Knife Your Option?
In spite of these medicines, there are a lot of patients who either don’t respond to medications or cannot take them because of the side effects. This group of patients now have hope in a host of surgical options.

Diagnosing Your Case
Erectile function, whether in humans or in animals, depends on the proper inflow and timed outflow of blood to the penis and the proper function of penile muscles. A defect in any of these mechanisms results in decrease in erection, which may vary depending on the extent of vascular/tissue damage. These three phases of erectile dysfunction can be delineated very nicely by the Penile Doppler Study, which is a dynamic ultrasound. The options of different surgical treatments are as below.

A Blood Vessel Substitute
Surgical procedure for problems relating to the inflow of blood to the penis has been attempted in the past. The idea was to increase blood flow to the penis by joining the blood vessel supplying the penis to a blood vessel supplying the lower abdominal area. The basis was that since the abdomen is supplied by many other blood vessels, the function of the diverted vessel can be taken over by the others without any loss of tissue. However, the calibre of these blood vessels proved a practical difficulty in the success of this procedure, despite the best available techniques.

Balloon Dilatation
Balloon dilatation of penile vessels is a recent development. In cases where there is cholesterol deposition on the walls of the blood vessels or narrowing of blood vessel due to other reasons, a procedure similar to angioplasty (of the heart) is done. Contrast medium is inserted through one of the bigger vessels, which then outlines the small blood vessels supplying the penis. Once the defect is identified, a balloon dilator is pushed in and the area is inflated to open up the space. Where indicated, the results are gratifying.

Surgery For Venous Leak
A good erection is achieved by not just a good inflow of blood to the penis; the out flow too should be reduced to zero, so that the blood can stay. In certain conditions known as venous leak, there is early outflow of blood preventing a firm erection. Depending on the outflow, a man may have varying degrees of erection - from moderate to none at all. Thanks to the Penile Doppler Test, it is now known that there are two types of venous leaks: anatomical and physiological. The latter is secondary to decreased inflow. It is the structural defect of the veins, for which surgery gives good results. In selected cases, the removal of these defective veins restores the balance of blood flow. This surgery is largely abandoned because of the failure to recognise the two defects, which are totally different. Indications are that this surgical procedure is set for resurgence in the years to come.

Penile Implants

When all other options fail, a patient of ED can look for hope in the form of penile prosthesis. In the last 30 years, implants with good results have become available. Implants that are currently in use are of two types - semi rigid and inflatable.

How does it work? The shaft of the penis has two hollow tubes (corpora cavernosa) on the upper surface and a single tube (corpora spongiosa) on the under surface. The urethra runs through the corpora spongiosa. The two hollow tubes, which are placed side by side, get filled with blood on sexual stimulation, resulting in a firm erection. As blood flows in, it squeezes the walls of these veins, thus entrapping the blood in the penis. Following ejaculation, the reverse process occurs and the penis loses its turgidity. Now, if instead of blood, rods made of a special material can be inserted, the same result can be obtained. These rods are inserted surgically by an incision at the base of the penis.

Semi Rigid Penile Prosthesis
Inflatable Penile Prosthesis

There are similar but separate rods for the
left and right side.

Once the rods are inserted, the penis always
remains in a ready position.

The front and rear parts of the rods are
rigid and are connected by a hinge to allow
movement of the penis.

Because of the hinge, the penis can easily
be folded inside the underwear.

There is no visible difference between a
normal and an implanted organ. Further,
the sensations remain the same as with a
normal penis.

It does not require any contraption to be
activated every time. So, it does not require
much by way of patient education.

When properly inserted, it can bear a lot of
wear and tear.

There are two hollow tubes (cylinder)
of a special material connected near
the rear end by tubing to a micro pump.

In a two-piece inflatable penile
prosthesis, the liquid (saline) lies in the
rear part of the cylinder. In a threepiece
penile prosthesis there is in
addition, a balloon reservoir which is
usually fitted behind the pelvic bone.
The entire contraption is connected to
each other.

The pump fits in the scrotum at a place
where the patient can easily access
it, usually between the two testes. By
pushing a button or by pressing the
pump it can be activated to allow the
fluid to flow from the rear to the front
end of the tube.

Comparison & Complications
  • The advantage of a semi rigid penile prosthesis is its simplicity of use. Not much by way of patient counselling is required as compared to the inflatable variety.
  • Extrusion of implant is a rare complication, which is more likely with a semi rigid implant.
  • Infection can be a worry mostly with the inflatable device, but meticulous surgical care can eliminate it. Failure of the pump is possible but thankfully it is extremely rare.
  • When persons fitted with implants require any other surgery in the area, they should clearly inform their doctor.
  • A needle prick or a sharp instrument may result in leakage and subsequent failure of the device.

Despite these, the complications can be rated as just a few. Once implanted, the device lasts for usually a lifetime.