What Is a Penile Prosthesis? A Complete Guide

What Is a Penile Prosthesis? A Complete Guide

Sexual health is one of the most fundamental things affecting a man's quality of life, his confidence and his relationship with his partner. Modern medicine offers a number of treatment options for men with erectile dysfunction. Medication, injections and vacuum devices do not always produce the result hoped for, however. This is the point at which the penile prosthesis — known colloquially in Turkey as the "happiness stick" (mutluluk çubuğu) — comes into play. At our clinic in Izmir this lasting solution offers our patients not only a physical improvement but a psychological renewal as well. In this guide we look in detail at what penile prosthesis treatment is, how it is carried out and who it is suitable for.

Erectile dysfunction is the failure of sufficient blood to reach the penis, generally for vascular, neurological or hormonal reasons. It can become chronic in men with diabetes, high blood pressure or heart disease in particular. The penile prosthesis is regarded as the definitive solution where the condition has become chronic and has not responded to other treatment. Technological progress in andrology has raised the success rate of this surgery above 95 per cent. In our experience, with the right patient selection and careful surgical technique, our patients return fully to their previous sexual function after the operation.

What Is a Penile Prosthesis and When Is It Chosen?

A penile prosthesis is a medical device placed surgically inside the spongy tissue of the penis (the corpora cavernosa) that produces an erection. It allows a man to achieve the firmness needed for intercourse and to maintain it for as long as he wishes. One of the questions we are asked most often at the clinic is whether these devices are noticeable from the outside. Modern prostheses are designed to conform entirely to the body's anatomy and are impossible to detect by sight. In the andrology services we provide in Izmir, our patients' aesthetic concerns and their privacy come first.

Although it is generally described as a last-resort treatment, the penile prosthesis is in fact a method that offers lifelong comfort. According to the guidelines of the European Association of Urology (EAU), the penile prosthesis is the most effective option when oral medication (PDE5 inhibitors) or injection therapy has failed. Why has the device acquired the nickname "happiness stick" in Turkey? Chiefly because it gives the patient back the confidence he had lost and removes the fear of failure in his sexual life altogether. The greatest change we observe in our patients is the improvement in their relationship with their partner and in their general mood after surgery.

Types of Penile Prosthesis and the Differences Between Them

There is no single model of penile prosthesis. There are two main types: malleable (bendable) and inflatable. Malleable models keep the penis in a permanent state of firmness but can be bent in whichever direction is wanted. They are very simple to use and may be preferred for older patients with limited manual dexterity. For some patients, however, the fact that the penis remains permanently semi-rigid can be a drawback aesthetically.

Inflatable models have a more sophisticated structure. Consisting of two or three components, these systems work by means of a small pump placed in the scrotum. When the patient wishes to have intercourse he squeezes the pump, inflating the prosthesis and producing a natural erection. When intercourse is over he presses the release button and the penis returns to its normal, soft state. At our clinic in Izmir we decide together with the patient which model best suits his anatomy and his way of life. In our experience the three-piece inflatable models are the option that best imitates the sensation of a natural erection.

Why Is It Called the "Happiness Stick"?

The reason the term has become so widespread in Turkey is the dramatic result the treatment produces. A man with erectile dysfunction has to cope not only with a physical problem but with depression, anxiety and conflict with his partner. The penile prosthesis resolves that spiral of difficulty in a single day. Regaining sexual function after surgery increases a man's self-respect. Patients therefore see the device not simply as a prosthesis but as a source of happiness.

Fitting the device does not affect sensation in the penis or the function of ejaculation and orgasm. Our patients continue to feel the same pleasure and ejaculation occurs normally. Our assessments show that partner satisfaction rates among patients using a prosthesis are also very high — which explains why the treatment is known by this symbolic name.

What Causes Erectile Dysfunction Severe Enough to Require a Prosthesis?

Erectile dysfunction is not always psychological in origin; the great majority of cases have organic, physical causes. Diabetes, blocked blood vessels and obesity are the strongest triggers of erectile dysfunction. The vasodilating effect of medication may not be sufficient in a patient whose vascular structure has broken down completely. In cases such as these the prosthesis functions as a mechanical support system replacing the natural mechanism that has failed.

Erectile dysfunction developing after cancer surgery is another important reason for fitting a prosthesis. The nerves running to the penis may be damaged during radical prostatectomy (surgery for prostate cancer) or during surgery for bladder cancer. Damage to these nerves means that the signals the brain sends cannot reach the penis. In this situation even the strongest medication may be of no use. At our clinic we achieve excellent results with penile prostheses in patients who have beaten cancer but whose sexual life has suffered as a result.

The Effect of Diabetes and Arterial Disease

Diabetes damages the structure of the small blood vessels and the nerve endings throughout the body. Because the mechanism of erection depends entirely on the vessels filling with blood, erectile difficulty in diabetic patients both begins at an earlier age and follows a more severe course. In patients with long-standing diabetes, fibrosis — hardening of the tissue — may develop in the penis even when blood sugar is under control.

In such cases the prosthesis becomes the only option. Research in Turkey indicates that more than half of diabetic men encounter erectile difficulty at some point in their lives. In the prosthesis surgery we carry out on diabetic patients we choose special antibiotic-coated devices in order to minimise the risk of infection, keeping the healing risks that diabetes brings to the lowest possible level.

Loss of Erection After Prostate Surgery

Erectile difficulty after prostate cancer surgery remains a risk however carefully the surgeon works. Even when nerve-sparing techniques are used, recovery of the nerves can take 18 to 24 months — and in some cases that recovery never occurs. If the patient remains sexually inactive during this period, the tissue of the penis may shorten and atrophy.

Many patients who have undergone cancer surgery come to our clinic in Izmir to regain their sexual function. Where medication has not helped during penile rehabilitation, fitting a prosthesis one year after surgery is recommended. This is the most important step in allowing the patient to return to his former quality of life after beating cancer. In our experience these patients are able, thanks to the prosthesis, to make their sexual life even more stable than it was before the operation.

Assessment and Preparation Before Prosthesis Surgery

As with any surgical procedure, a detailed period of preparation is needed before a penile prosthesis is fitted. Our first priority is to be certain that the patient's erectile dysfunction is irreversible. When we assess a patient we examine not only his physical condition but his hormonal and metabolic profile as well. The patient's way of life, his expectations and any blood-thinning medication he takes all bear directly on the planning of the operation.

One of our most important diagnostic tools is the patient's own medical history. When the erectile difficulty began, whether it responded to medication and whether morning erections are present all give us valuable clues. At the first consultation with patients coming to us in Izmir and from surrounding provinces, we demonstrate how the prosthesis works using animations and models. This is critical in helping the patient to form realistic expectations of the outcome.

Penile Doppler Ultrasonography and Assessment

We use penile Doppler ultrasonography to measure the degree of erectile dysfunction objectively. In this procedure a substance that dilates the blood vessels is injected into the penis and the rate of blood flow is measured by ultrasound. If blood flow is insufficient, or if the blood cannot be retained in the penis and leaks back (venous leak), this confirms that surgery is required.

The Doppler test is the most concrete evidence available before a decision on a prosthesis is made. We explain the results of this test to our patients in detail and set out, with scientific data, why medication has proved insufficient. Accurate diagnosis is the first and most important step towards a successful operation.

Psychological Factors and Managing Expectations

Prosthesis surgery is not simply a technical procedure; the patient also needs to be mentally prepared for the process. Men who have had erectile difficulty for a long time may have developed performance anxiety, a settled fear of failure. Such patients may feel apprehensive in the early stages even after the prosthesis has been fitted. For this reason we also offer counselling as part of the treatment process at our clinic.

Involving the patient's wife or partner in the process increases the success rate. We explain that the prosthesis is not a magic wand but an excellent instrument that restores sexual function mechanically. Our experience in Izmir shows that patient satisfaction after surgery is far higher among those whose expectations are realistic. After the prosthesis has been fitted, the length of the penis will be similar to its length during a natural erection; patients sometimes expect a longer penis than they in fact had. Clarifying details of this kind before surgery is essential to our patients' satisfaction afterwards.

Types of Prosthesis: Malleable and Inflatable Models

Which model is chosen depends on the patient's age, his general health, his manual dexterity and, of course, his budget. At our clinic we use FDA-approved products from internationally recognised manufacturers (Boston Scientific, Coloplast and others). These devices are designed to remain in the body for life and are made from biocompatible materials. As an andrology specialist in Izmir, Dr. Taylan Yanar takes an individually tailored approach to every patient.

During the selection process we explain the advantages and disadvantages of both models in detail. Malleable prostheses are more economical and surgically easier to fit, while inflatable prostheses are superior in ease of use and in naturalness. In recent years, as the importance attached to quality of life has grown, demand for three-piece inflatable models has increased considerably.

One-Piece (Malleable) Bendable Prostheses

These prostheses consist of two rods with a stainless steel or silver core and a silicone coating. They are placed in the cylindrical spaces on either side of the penis. When the patient wishes to have intercourse he straightens the penis by hand; afterwards he bends it downwards or to the side to conceal it under clothing.

Their advantage is that the risk of mechanical failure is almost non-existent. Because they contain no pump or reservoir the surgery takes less time and the risk of infection is slightly lower. They are ideal for older patients with limited dexterity or who prefer not to use a complex system. Because the penis is always somewhat firm, however, the possibility of its being noticeable under close-fitting clothing may be seen as a disadvantage. At our clinic we assess the suitability of this model by discussing the patient's way of life with him.

Three-Piece Inflatable Prostheses

This model represents the current state of the art. The system consists of three components: two cylinders placed inside the penis, a pump placed in the scrotum and a fluid reservoir placed behind the abdominal wall. When the patient squeezes the pump, fluid from the reservoir fills the cylinders and the penis becomes erect.

The great advantage of this model is that it imitates a natural erection exactly. When not inflated the penis is completely soft and is never noticeable from the outside. It also produces expansion in girth, giving a more satisfying firmness. At our clinic in Izmir we generally recommend this model to patients with an active sexual life who care about appearance. In our experience the great majority of patients become accustomed to the system quickly, after a few attempts.

Which Prosthesis Is More Suitable for You?

The choice is made according to the patient's anatomy, any previous surgery and his financial circumstances. In a patient who has undergone major abdominal surgery, for instance, placing the reservoir may be difficult, so a two-piece model may be preferred. In a patient with very advanced diabetes a one-piece model may be recommended in order to keep the operating time short.

The guidelines of the European Association of Urology (EAU) emphasise that the preferences of the patient and his partner are the most important criterion. At our clinic we give patients the opportunity to handle and examine both models. Once they have seen the firmness of the devices and how they work, patients find it easier to decide which option will be most comfortable for them. It should not be forgotten that the best prosthesis is the one the patient feels most comfortable with.

Recovery and Sexual Life After Prosthesis Surgery

The operation generally takes an hour to an hour and a half and our patients usually stay in hospital for one night. Mild pain and swelling in the first few days afterwards are normal and can be controlled with simple painkillers. Thanks to the minimally invasive techniques we use, our patients are able to return quickly to daily life.

The most critical part of recovery is keeping the wound clean and taking the antibiotics prescribed regularly. Sexual intercourse is not permitted for the first four to six weeks. This period is needed for the prosthesis to settle into the surrounding tissue and for the sutures to heal completely. At our centre in Izmir we carry out routine checks in the second and fourth weeks after surgery so that we can follow recovery closely.

Aftercare and What to Watch For

We advise our patients to avoid heavy physical activity in the first weeks after surgery. Showering generally begins 48 hours afterwards. The first instruction in using the prosthesis is given at the clinic once the swelling has settled, that is after about four weeks. At this session the patient is shown in practical terms how to activate the pump and how to deflate it.

Infection is the complication most feared in prosthesis surgery. Thanks to modern antibiotic-coated devices and sterile surgical conditions, however, that risk has fallen to around 1 to 2 per cent. We advise our patients to pay the closest attention to hygiene afterwards and to contact us immediately in the event of any redness or discharge. Our specialist team in Izmir provides round-the-clock support so that patients can come through this period safely.

Frequently Asked Questions

Is a Penile Prosthesis Noticeable from the Outside?

No. The prosthesis is placed entirely inside the body and cannot be seen with the naked eye from outside. Three-piece inflatable models in particular give a completely natural appearance when the penis is not inflated. The pump in the scrotum lies beneath the skin and is not noticeable either. Our patients in Izmir who have had this surgery tell us that they have no hesitation about swimming in the sea or a pool, or about changing at the gym. Thanks to modern engineering, these devices conform perfectly to human anatomy.

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

The prosthesis affects only the erectile mechanism of the penis; it does no harm to the nerve structure, to ejaculation or to the sensation of orgasm. A man whose ejaculatory function was healthy before the operation will ejaculate in the same way afterwards and can father children. There is no change in the quality or quantity of sperm. As Dr. Taylan Yanar always explains to our patients, the prosthesis serves only as a support; sensation remains natural, as it was before. There is therefore no reduction in sexual pleasure.

How Long Does the Operation Take and How Many Days in Hospital Are Needed?

The operation generally takes between 60 and 90 minutes depending on the model used and the patient's anatomy. In our well-equipped hospital facilities in Izmir we usually keep patients under observation for one night after the procedure. The dressings are changed the following day and the patient is discharged with the necessary advice. Patients travelling from other cities or from abroad are advised to stay in the city for a further three to four days and to return home after their first check-up.

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

Modern prostheses are manufactured with lifelong use in mind. Studies show that more than 90 per cent are still working without difficulty after 10 to 15 years. Mechanical failure or fluid leakage can occur, though rarely. In such a case the faulty component, or the whole system, can be replaced in a straightforward revision operation. The devices we use at our clinic in Izmir carry a worldwide guarantee. Failure of the device poses no risk to the patient's health; erectile function simply stops and the device needs to be replaced.

Can Diabetic Patients Have Prosthesis Surgery?

Yes. Diabetic patients are the group most frequently considered for a penile prosthesis. Diabetes is the most common organic cause of erectile dysfunction, and in these patients medication generally becomes insufficient after a time. It is very important, however, that blood sugar levels (HbA1c) are under control before surgery. We monitor sugar levels carefully both before and after the operation in order to reduce the risk of infection. At our clinic in Izmir we use antibiotic-impregnated prostheses specifically for diabetic patients, keeping the risk of infection to a minimum.

Does a Penile Prosthesis Make the Penis Longer?

This is one of the questions our patients ask most often. A penile prosthesis is not a lengthening operation. The prosthesis allows the penis to reach the length it has at maximum firmness. Because the tissue of the penis loses its elasticity over time in men with erectile difficulty, some shortening may be felt; the prosthesis recovers that loss but does not extend the penis beyond its natural limits. At our clinic we measure the length of the penis before surgery and explain honestly what the patient should expect afterwards. What matters is not length but a stable, lasting firmness capable of restoring sexual function.

Penile Prosthesis Treatment in Izmir with Dr. Taylan Yanar

The treatment of erectile dysfunction is a sensitive field requiring expertise, experience and an understanding of the patient's psychology. At our clinic in Izmir, Dr. Taylan Yanar and our specialist team offer solutions to international standards for men struggling with erectile difficulty. In the prosthesis surgery we carry out using the best-equipped healthcare facilities in Izmir, our fundamental aim is that our patients should recover both physical and psychological health.

Every patient is unique and every case requires a different approach. Through the patient-centred approach we take at our clinic, we are at our patients' side at every stage, from the choice of prosthesis through to recovery. Using everything modern medicine offers, we are demonstrating that no one need live with erectile dysfunction any longer. If you too are looking to make a fresh start in your sexual life and to find a lasting solution, we shall be glad to welcome you to Dr. Taylan Yanar's clinic in Izmir and to plan your treatment with you.

Sexual health is too valuable to be put off. Take a step today towards improving your quality of life and regaining your confidence. With our specialist team in Izmir and years of surgical experience, we are here to offer you the prosthesis treatment that suits you best. Please contact us for an appointment and for further information.

Disclaimer: this content is for information only. Always consult a specialist doctor for diagnosis and treatment.