Three-Piece Inflatable Penile Prosthesis Surgery and Recovery

Three-Piece Inflatable Penile Prosthesis Surgery and Recovery

Erectile dysfunction is no longer an insoluble problem in modern medicine. For patients who have had no response to medication, injections or vacuum devices in particular, the three-piece inflatable penile prosthesis is the most advanced solution available and is regarded in the medical literature as the gold standard. At our clinic in Izmir we have applied this advanced surgical technology successfully for many years, with the aim of improving our patients' quality of life and giving them a natural sexual life. Thanks to its ease of use and the natural appearance it offers, this type of prosthesis is the most widely chosen penile implant model in the world.

Many of our patients are apprehensive at first about the idea of surgery, but the confidence and permanence the three-piece system offers place it ahead of every temporary method. As we observe in the many patients who come to us from across Turkey and from abroad, this treatment provides not only a physical improvement but a considerable increase in confidence. On the basis of our experience in andrology we can say that, with the right patient selection and careful surgical technique, these prostheses open the door to a satisfaction that lasts a lifetime. In this guide we cover the details of the system, the surgical process and all the technical questions patients ask.

What Is a Three-Piece Inflatable Penile Prosthesis and How Does It Work?

The three-piece inflatable penile prosthesis is a hydraulic system used in the surgical treatment of erectile dysfunction and concealed entirely within the body. It consists of three main components: two cylinders placed inside the penis, a pump placed in the scrotum and a fluid reservoir placed within the abdomen or beside the bladder. The basic principle of the system is to imitate the body's natural mechanism of erection. In a natural erection the penis fills with blood; in this system fluid passes from the reservoir into the cylinders, producing the same effect.

The mechanism is discreet: from the outside it is never apparent that there is a device in the body at all. When you squeeze the small pump in the scrotum, sterile saline fluid from the reservoir fills the cylinders in the penis and makes it firm. When intercourse is over, pressing the release button on the pump returns the fluid to the reservoir and the penis returns to its natural, flaccid state. In the operations we carry out at our clinic in Izmir we explain this mechanism to our patients down to the smallest detail, so that comfort in use is as high as possible.

The Main Components of the System

The three main parts at the heart of the system are connected to one another by highly durable tubing. The cylinders, the first component, are placed inside the cavernous bodies that produce an erection. They have special coatings compatible with the tissue that minimise the risk of infection, such as antibiotic-impregnated surfaces. The reservoir, the second component, generally holds between 60 and 100 ml of fluid and is concealed surgically where it cannot be seen. The pump, the third component, is positioned beside the testicles where the patient can easily reach it. This three-part structure allows the system to distribute hydraulic pressure in the best possible way.

Simulating a Natural Erection

Why is the three-piece system superior to the others? Because it produces not only firmness but expansion in girth as well. With malleable, one-piece prostheses the penis remains permanently rigid, whereas the three-piece model allows you to produce an erection whenever you wish and to return to a relaxed state whenever you wish. This gives our patients considerable comfort not only during intercourse but in everyday clothing and social life. In our experience the level of firmness this model provides is indistinguishable from the natural erection of a healthy man.

Why Choose the Three-Piece Inflatable Prosthesis?

Although a number of different solutions are available for men with erectile dysfunction, the reasons for choosing the three-piece inflatable prosthesis are compelling. The first is the lasting solution it provides. For patients who do not wish to deal with the side effects of medication or the inconvenience of injections, the prosthesis means recovering sexual function for life through a single procedure. The guidelines of the European Association of Urology (EAU) also describe this method as the option with the highest success rate in cases that have not responded to other treatment.

At our clinic, serving Izmir and the surrounding provinces, one of our patients' greatest concerns is naturalness. The three-piece system is the model that best meets this expectation. Its greatest advantage is that the penis hangs completely naturally when not inflated and presents no obstacle when urinating or exercising. The mechanical life of these prostheses is also very long; thanks to technological progress, current devices offer 15 to 20 years or more of trouble-free use.

Comparison with Other Types of Prosthesis

Compared with the two-piece or one-piece (malleable) prostheses on the market, three-piece models are technically superior. Malleable prostheses are cheaper and the surgery is simpler, but the penis remains permanently at a certain firmness and this can be noticeable through trousers. Expansion in girth is also not possible with malleable models. The three-piece inflatable prosthesis, by contrast, allows the penis to expand in both length and girth through its hydraulic system, creating a complete sensation of fullness. The great majority of specialist andrologists recommend this model provided the patient's general health allows.

Aesthetic and Functional Advantages

Because the system is invisible from the outside, the patient's privacy is preserved. We frequently encounter cases in which even the partner has not noticed that there is a prosthesis. Because the surgical scars are concealed among the folds of the scrotum or along the circumcision line, aesthetic concerns are reduced to a minimum. Functionally, these prostheses have a high pressure capacity, so there is no question of the penis bending or deflating during intercourse. This sense of confidence removes the patient's performance anxiety entirely.

Who Is Suitable? The Selection Process

The three-piece inflatable prosthesis is not suitable for every patient, which is why we carry out a very detailed assessment at our clinic. The primary candidates are men who have not responded to oral medication such as phosphodiesterase-5 inhibitors, or who cannot take that medication because of cardiovascular disease. In patients with systemic conditions that damage the vascular and nerve structures, such as diabetes, prosthesis surgery is generally the only definitive solution.

During the selection process we consider the patient's general surgical risks, his manual dexterity — needed to operate the pump — and his expectations. At the examinations we carry out at our centre in Izmir we assess the cavernous structures of the penis by ultrasound (penile Doppler) and physical examination. We also evaluate carefully any previous pelvic surgery, such as prostate cancer surgery, since this can affect the placement of the prosthesis.

Diabetes and Arterial Disease

Diabetes is one of the most common causes of erectile dysfunction. Prolonged high blood sugar leads to blockage in the blood vessels of the penis and to damage in the nerve endings (neuropathy). Medication is generally ineffective in this situation. The factor to which we pay most attention when fitting a three-piece prosthesis in diabetic patients is the risk of infection. Bringing HbA1c levels under control before surgery and using antibiotic solutions during the operation raises the chance of success above 98 per cent. In our experience diabetic patients are the group with the highest satisfaction rate after a prosthesis.

Recovery After Radical Prostatectomy

In patients who have undergone surgery for prostate cancer (radical prostatectomy), the nerves that produce an erection may be damaged. If erectile function has not returned within one to two years of surgery, prosthesis surgery becomes an option. Some shortening of the penis may be observed in such cases, but three-piece prostheses maximise the penis's existing capacity and allow sexual life to be recovered. At our clinic this method is a genuine lifeline for patients who are celebrating survival after cancer and wish to return to their sexual life.

The Prosthesis Operation

The surgical process is carefully planned from the patient's admission to hospital through to discharge. It is generally carried out under general anaesthetic or spinal anaesthetic. The operation takes on average between 60 and 90 minutes depending on the surgeon's experience and the patient's anatomy. At our clinic in Izmir we aim to shorten recovery time by using modern surgical techniques and minimally invasive approaches.

Our preferred surgical technique is generally the scrotal approach. In this method the whole system is accessed through a small incision of about 3 to 4 centimetres in the midline of the scrotum. Once healed, this incision becomes almost invisible. During the operation the spongy tissues inside the penis (the cavernous bodies) are dilated with special instruments and the prosthesis cylinders are placed in these spaces. The pump and reservoir are then positioned and the system is tested.

Preparation and Tests Before Surgery

Preparation is the key to a successful operation. Routine blood tests, a urine culture and an ECG are requested before surgery. The presence of a urinary tract infection in particular is an absolute contraindication; the infection must be treated first. The patient is advised to shower with special antibacterial soap the day before surgery and again on the morning of the operation. In accordance with health protocols in Turkey, the risk of infection is minimised with strong intravenous antibiotics given during and after the procedure.

Surgical Techniques: the Infrapubic and Scrotal Approaches

There are two main surgical approaches in andrology. The scrotal approach gives the best view for placing the pump and the procedure is completed through a single incision. In the infrapubic approach the incision is made in the pubic area just above the penis. At our clinic we mostly use the scrotal technique, because it reduces the risk of nerve damage further and allows us to position the pump more precisely. In both methods the fundamental aim is to bring the components of the prosthesis into their most natural form within the tissue.

Infection Control and Safety Protocols

Infection is the complication most feared in penile prosthesis surgery. The surfaces of the prostheses used today, however, are equipped with special technologies (such as InhibiZone or hydrophilic coatings) that release antibiotic from the moment the device is placed in the body. Thanks to the sterilisation standards of our operating theatre and the care taken by our surgical team, our infection rate is below 1 per cent. By using advanced methods such as the no-touch technique during surgery, we prevent any contact between the prosthesis and the skin flora entirely.

Recovery and Using the Prosthesis

Our patients are generally kept under observation in hospital for one night after surgery. A urinary catheter and a pressure dressing on the penis are in place for the first 24 hours. The following day the dressings are removed, the catheter is taken out and the patient is helped to walk. Mild swelling and bruising in the scrotum during the first few days are entirely normal. Ice packs and painkillers keep the patient comfortable during this period. Patients can return to their daily routine about a week after surgery.

The prosthesis is generally activated for the first time four to six weeks after the operation. This period allows the sutures to heal completely and a healthy capsule to form around the prosthesis. At our clinic we carry out the first activation ourselves and teach the patient in practical terms how to use the pump and how to inflate and deflate the system. Most of our patients are able to operate the system easily with one hand after a few attempts.

First Intercourse and the Activation Process

After the six-week waiting period, once the tissues have healed sufficiently, intercourse is permitted. We advise our patients to take care during the first few occasions and to use a lubricant if necessary. With a three-piece inflatable prosthesis the sensation of ejaculation, the experience of pleasure and the capacity for orgasm all remain as they were before surgery. The prosthesis provides only firmness; because it does no harm to the nerve endings or the urinary channel, there is no loss of sensation. On the contrary, we observe a marked improvement in the quality of pleasure, because anxiety about achieving an erection has gone.

Frequently Asked Questions

Is the Prosthesis Noticeable from the Outside?

No, definitely not. All the components of the system — cylinders, pump and reservoir — are placed inside the body beneath the skin. When the penis is flaccid it looks no different from a penis without a prosthesis. The pump in the scrotum can be felt beneath the skin but cannot be seen. Our patients therefore feel entirely comfortable at the gym, on the beach or in communal showers. This discretion is what patients treated at our clinic in Izmir are most pleased with.

Does the Prosthesis Affect Ejaculation or the Ability to Father Children?

This is a very important question. Prosthesis surgery does not interfere with the mechanisms of ejaculation or orgasm. If you were able to ejaculate before the operation, you will continue to do so afterwards. The prosthesis gives the penis mechanical firmness only. Because sperm production and quality are unaffected, there is no obstacle to fathering children. Indeed, in couples who have been unable to conceive because of severe erectile difficulty, natural conception may become possible thanks to the prosthesis.

How Long Does the Prosthesis Last, and What Happens If It Fails?

Prostheses produced with current technology are extremely durable. Mechanical failure rates are below 1 per cent a year. Studies show that more than 90 per cent are still working without difficulty after 10 to 15 years, and many of our patients use their prosthesis for life. In the rare event of a fault such as a leaking pump or a punctured cylinder, either the faulty component alone or the whole system can be replaced. Dr. Taylan Yanar is also experienced in revision surgery, which can be completed in less time than the original operation.

Is the Pain After Surgery Severe?

Thanks to modern anaesthetic techniques and the long-acting local anaesthetics used during the operation, patients do not experience severe pain. For the first three to five days there may be a feeling of fullness and an aching pain in the penis and testicular area. This is easily controlled with simple painkillers. Most of our patients report that they no longer need painkillers from the third day after surgery. At our centre in Izmir we provide a detailed pain management protocol so that patients come through this period as comfortably as possible.

Will My Partner Feel That There Is a Prosthesis?

Three-piece prostheses are designed to give a sensation as close as possible to the natural tissue of the penis. When full firmness is achieved with the pump, the penis is at body temperature and feels natural to the touch. Your partner will generally not notice any difference during intercourse. Many of our patients tell us that the situation goes unnoticed unless they mention it themselves. The firmness of the penis is uniform and it does not bend, which creates a natural sensation for the partner.

Does the Penis Become Shorter After Surgery?

No, the prosthesis does not shorten the penis.

The prosthesis itself does not shorten the penis; but in men who have had erectile difficulty for a long time, contraction and fibrosis in the tissue may mean that the penis has already shortened somewhat. During the operation the surgeon fits the largest prosthesis appropriate to the penis's existing anatomical capacity. When the prosthesis is inflated, the penis reaches the maximum firm length it reached before surgery. Some advanced models, which expand in both girth and length, can also create a degree of additional length where the tissue allows.

Treatment in Izmir and the Dr. Taylan Yanar Difference

The treatment of erectile dysfunction is not simply a surgical procedure but a process requiring sensitive communication between patient and doctor. At our clinic in Izmir, under the leadership of Dr. Taylan Yanar, we assess each patient's physical and psychological situation individually. The most important factor in the success of three-piece prosthesis surgery is the surgeon's specific experience of microsurgery and prosthesis placement in andrology. Although many centres carry out this operation, the modern hospital facilities Izmir offers and our specialist team allow us to provide our patients with the highest level of comfort.

We do not simply carry out the operation; we are at our patients' side at every stage, from the consultation beforehand through activation afterwards to long-term follow-up. Our aim is that our patients should feel safe and at ease while recovering their sexual health. If you too are looking for a lasting and natural solution to erectile dysfunction, you can contact our clinic in Izmir for detailed information and take a step towards a new life. Sexual health is an inseparable part of general health and happiness, and in the right hands it can be treated.

For appointments and further information: Dr. Taylan Yanar sees patients in Izmir, drawing on deep experience in andrology and urology. Our clinic is equipped with the latest technology, and your privacy and your health are our priority. Do not hesitate to seek professional support for a happy and healthy sexual life.

This content is for information only. Diagnostic and treatment methods vary from patient to patient. Please consult a specialist for a definitive diagnosis and treatment plan.