Penile Prosthesis and Three-Piece Inflatable Systems: A Complete Guide

Penile Prosthesis and Three-Piece Inflatable Systems: A Complete Guide

Erectile dysfunction is a common condition that adversely affects male sexual health and the quality of life of couples. Where first- and second-line treatments such as oral medication, ESWT (shock wave therapy), the P-Shot or stem cell therapy produce no response, the most definitive and lasting solution offered by andrology, and the one with the highest patient satisfaction, is the penile prosthesis.

In this guide we examine in detail the penile prosthesis treatments performed by Op. Dr. Taylan Yanar at the Andrology Clinic in Mavisehir, Izmir, and the three-piece inflatable penile prosthesis systems that represent the current state of the technology.

What Is a Penile Prosthesis?

A penile prosthesis is a medical device placed surgically inside the penis to produce an erection.

Penile prostheses are medical devices placed surgically into the channels within the penile tissue (the corpora cavernosa) in men who have completely lost the ability to achieve an erection. They imitate the erection mechanism directly, without altering blood flow or nerve structure.

Who Is This Treatment Suitable For?

• Men with permanent loss of erection due to diabetes, hypertension or atherosclerosis,
• Those whose erectile tissue has been damaged following radical prostate or bladder cancer surgery,
• Those with Peyronie's disease (penile curvature) accompanied by advanced erectile dysfunction,
• Patients who gain no benefit at all from shock wave, injection or drug treatments.

Types of Penile Prosthesis and How They Compare

Penile prostheses fall into two main groups according to their basic mechanism:

1. One-piece (malleable) prosthesis
   • Mechanism: contains a bendable medical-grade metal rod.
   • Firmness and appearance: the penis remains permanently firm. It is straightened by hand for intercourse and bent afterwards to be concealed within underwear.
   • Naturalness: it provides standard firmness, but because the penis is permanently firm, concealing it under clothing requires a little more care.
   • Ease of use: because it contains no mechanical pump or button, it is extremely simple to use.
2. Three-piece (inflatable) prosthesis with pump
   • Mechanism: an intelligent mechanical system consisting of a pump, a fluid reservoir and flexible cylinders.
   • Firmness and appearance: it is made firm with the pump when required and fully deflated after intercourse at the press of a button.
   • Naturalness: it offers a completely natural appearance and sensation. From the outside, or under swimwear, it is impossible to tell that a prosthesis is present.
   • Ease of use: it is controlled easily and comfortably by means of a soft button concealed within the scrotum.

The Gold Standard: Three-Piece Inflatable Penile Prosthesis Systems

The most frequently chosen system in modern andrology, and the one with the highest patient and partner satisfaction (over 95 per cent), is the three-piece inflatable penile prosthesis.

The Anatomical Components of the Three-Piece Prosthesis

The system consists of three parts concealed entirely within the body:

1. Cylinders: flexible structures placed inside the erectile tubes of the penis.
2. Pump: a small, soft control mechanism placed inside the scrotum, beside the testicles.
3. Fluid reservoir: a chamber placed in the lower abdomen holding the special fluid required to inflate the prosthesis.

How Does the System Work?

• Achieving erection: before intercourse the patient presses the concealed pump in the scrotum several times, allowing fluid from the reservoir to fill the cylinders. The penis reaches its natural firmness and maximum size.
• Deflation: when intercourse is over the release button on the pump is pressed; the fluid returns to the reservoir and the penis returns to its completely natural, flaccid state.

The Operation and the Recovery Period

Penile prosthesis surgery is carried out in sterile operating theatre conditions under general or spinal anaesthesia.

• Surgical technique: it is performed through a small, concealed incision of approximately 3 to 4 cm at the junction of the penis and the scrotum (penoscrotal).
• Duration: the operation is completed in 60 to 90 minutes on average.
• Hospital stay: the patient generally spends one night in hospital and is discharged the following day.
• Return to sexual life: tissue healing is complete approximately four to six weeks after surgery. At Op. Dr. Taylan Yanar's clinic the patient is taught how to use the system in practice and can return to an active sexual life with confidence.

Frequently Asked Questions

Can a three-piece inflatable prosthesis be detected from the outside?

No. Because all the components are placed inside the body, it is impossible to tell that a prosthesis is present when viewed from the outside or when wearing swimwear or close-fitting clothing.

Does a penile prosthesis affect orgasm and ejaculation?

Certainly not. The prosthesis only provides firmness. It does not affect sensation, the nerves or the ejaculation mechanism. A patient who could reach orgasm before the operation continues to experience the same pleasure afterwards.

Does prosthesis surgery prevent a man from having children?

The prosthesis does not damage sperm production or the seminal ducts. The ability to father children naturally is preserved.