When are penile implants used?
If you want your quality of life back.
Modern hydraulic penile implants are always used once an existing case of impotence can no longer be corrected through pills or injections to treat erectile dysfunction or if these means are not tolerable to the patient.
This type of serious impotence typically follows radical prostatectomy.
The urinary incontinence that these patients are often experiencing at the same time can be corrected through the use of an artificial urethral sphincter.
The double-cylinder hydraulic penile implants used by us perfectly imitate a natural erection and contribute significantly to increasing/recovering the patient’s quality of life.
Basic information on our work / results
- We are a competence centre for penile implant surgery.
- There is only a very short recovery period due to the surgical technique that is gentle on the tissue.
- It can often be performed as ambulatory surgery.
- It is a non-traumatic and highly sterile procedure.
- There is very little pain involved.
- No permanent catheter insertion is involved.
- There is a high level of patient satisfaction.
The types of penile implants that we use
There are various types of penile implants available to medical practitioners that can theoretically be used.
We use hydraulic penile implants exclusively because our experience has shown that they are the only type capable of optimally imitating the natural function of an erection while remaining externally invisible and thereby providing the highest amount of patient satisfaction.
A pleasant side effect is that penile implants usually result in an increase in penis size when flaccid (which is normally a welcome improvement for patients) that looks completely natural with hydraulic implants and not unusual or artificial such as may be the case with solid implants.
How they work:
Our hydraulic penile implants consist of two penile prosthesis cylinders, a pumping mechanism and a fluid reservoir.
The penile prosthesis cylinders are inserted into the existing penile corpora cavernosa and take over their function.
The pumping mechanism used to create an erection is located in an invisible position below and behind the scrotum.
The fluid reservoir is inserted into the lower abdomen through the primary incision below the penis so that no additional incision in the stomach is required with our technique!
When the patient wishes to have an erection he using the pumping mechanism to pump the liquid (isotonic water) into the penile prosthesis cylinders, making the penis larger and firmer.
We usually use implants from the 700 series manufactured by AMS. Our experience has shown that they provide the best results and can be considered the ‘gold standard’:
The AMS 700 series offers an erection that appears more natural and can return to a flaccid state more quickly than two-piece or flexible (solid) implants. These highly developed, three-piece prostheses are inflatable implants available in a variety of models and sizes, thereby guaranteeing a custom fit.
The entire system is concealed inside the body and is not externally visible.
The AMS 700 series also features InhibiZoneTM, an antibiotic surface treatment plus a special wear-reducing parylene micro-coating that increases the reliability and durability of the cylinders.
The AMS 700 series is ideal for men who desire a penis that looks natural when erect and when returning to a flaccid state.
(Photos used with the friendly permission of AMS)
How the surgery is performed
We usually perform this as ambulatory procedure using light general anaesthesia. All of the pieces of the pump are inserted through a small incision between the penis and scrotum using a special technique that is gentle on tissue.
No further incision is necessary.
The incision is then closed and heals with nearly no visible scarring, looking like another fold in the skin.
The patient must relax for 3-4 days following the surgery (sitting or lying down with little standing) and can then normally return to work. The patient must refrain from sport and sexual intercourse for 5 weeks.
The pump will be activated for the first time after about 4 weeks and the patient will once again be instructed in its use.
Things to keep in mind for penile implant surgery
In theory, hydraulic penile implants sound very simple: incision, insertion, positioning, stitching, finished.
In practise, however, penile implant surgery is a highly complex operation if it is to result in a functional penis that is very satisfying to the patient.
This already begins with the incision:
Before the surgery can even be allowed to begin, an extensive and clearly defined disinfection protocol (on and around the site of the surgery) must be followed. This is extremely important and goes far beyond the disinfection involved in other surgeries. A penile implant and its attachment are inserted across the entire length of the penis. If an infection agent survives and penetrates into this area due to insufficient preliminary disinfection, this can have very uncomfortable repercussions.
There are also significant differences in the actual incision. Our technique merely involves a single minor incision directly below the penis that normally heals very well and is no longer visible late. Even the fluid reservoir is inserted through this incision. No further incision in the groin is required using this technique, thereby eliminating the risk of damaging important structures.
This continues with the insertion:
For visually successful and long-term results, maximum preparation is absolutely necessary on the part of all of the staff involved so that the surgery can be performed rapidly according to routine.
The penile implants must be removed from their packaging according to a defined procedure so that there is no possibility of them coming into contact with pointed or unclean instruments. The internal pieces must not be contaminated with blood components either. Special penile implant instruments are to be used exclusively.
It is extremely important and a basic pre-requisite for lasting success that the cavities into which the implants are inserted are prepared very quickly, precisely and without trauma. If the surgery is performed too slowly, too traumatically or in unsterile conditions then there is a risk that the incorrect penile implant length will be selected and the distal damage from this will cause the penile implants to later penetrate through the glans penis.
Our experience has shown that inexperienced or unqualified surgeons often use penile implants that are too short due to fear of distal tissue damage. This leads to an unnatural visual appearance and a bend in the glans penis during erection. This makes sexual intercourse significantly more difficult or even impossible.
The positioning is also a critical moment:
The individual pieces of the implant, particularly the connecting tubes, the reservoir and the cylinders, absolutely must not be allowed to be damaged through the use of too much force and/or incorrect instruments.
Attention must also be paid to correctly permanently positioning the tubes and the pump in particular. The pump must absolutely not be positioned above or between the testicles. This will make it externally visible as well as painful and barely operable.
The tubes must be optimally position in order to remain invisible and not put pressure on the testicles.
The stitching is the simpler part of the procedure in comparison:
Despite this, again and again we encounter patients with extremely nasty scars who underwent surgery somewhere else. Working with care and expertise is therefore important in this area as well so that the scarring is invisible in the end.
As nice and relieving as it is to have normal function returned again after the insertion of the prosthesis, there can be many uncomfortable consequences if the quality of the performed surgery is poor and/or the wrong materials and instruments are used.
Personal note from the author:
Currently over half of our work with penile implants involves removing and correcting implants that were incorrectly inserted and/or were the wrong size. The fact is that there are only a few surgeons who have really mastered penile implant surgery. These surgeries are extremely rare procedures in most urology departments that are unfortunately performed by those with little expertise all too often.
The subsequent correction is then frustrating work for us. Due to our many years of experience we are indeed usually capable of achieving a good result, yet due to the internal scarring from the initial surgery this result is almost never the same as the result that we could have achieved (in terms of the length of the penis) if we had performed the initial surgery from the beginning.
Not every penile implant surgery goes wrong in public hospitals, of course, but the number of our patients and our experience clearly show that it is not a rare occurrence.
Please don’t misunderstand. You can have the surgery performed anywhere you like, as we already have plenty of patients, but if you have already heard about us before your initial surgery then please think a little more about coming straight to us for the initial surgery instead of coming later for corrective surgery. This would save you another surgical procedure and make the work significantly easier for us. It is much more fulfilling for our surgeons to achieve a good result than to have to correct another’s mistakes.
I am aware that I may be ‘stepping on the toes’ of some medical colleagues with these comments, but I feel that it is justified. We are very open and inviting to all of our medical colleagues of any type, but please be sure to remember that medical practise involves helping patients and not protecting colleagues who constantly provide unsatisfactory work.
It is not about decrying the fact that surgeries sometimes go wrong but rather working on persuading surgeons who constantly deliver poor work to cease performing this procedure in the future. This can only succeed if patients simply stop going there.
The costs of the insertion of modern hydraulic penile implants according to our medical and quality standards are comprised of:
|Chief surgeon, assistant, clinic services, care, anaesthesia, medications:||from about EUR||10.900,-|
|Total materials for the surgery:||about EUR||300,-|
|AMS 700 GLX prosthesis:||about EUR||6.700,-|
|from about EUR||17.900,-|
Preparation for an operation
Around 3 weeks prior to your appointment you will receive an unmarked envelope by post containing your confirmation documents.
- Once you have confirmed your appointment with us, please refrain from smoking and drinking alcohol for 14 days prior to the operation. This is not a general statement but rather has a decisive effect on your results. Smoking significantly worsens the healing process for wounds by constricting the blood-vessel walls, while alcohol has a negative effect on the body’s metabolism.
- 10 days before the operation you must cease taking any aspirin, ASS or other blood-thinning medications. These medications increase the risk of bruising (haematomas) and unpleasant swelling occurring.
- You will have a detailed consultation with one of our doctors, during which there will be ample time for all of your questions to be answered. However, you should also definitely read our description of the operation beforehand in preparation.
- You must refrain from drinking or eating anything for 6 hours before your surgery on the day of your appointment. This also applies for procedures using local anaesthesia.
- You will then be prepared for the operation, which includes receiving an mild tranquillizer and painkiller in advance.
- The operation itself is performed in a relaxed environment. There is no need to feel anxious, as you will not feel any pain, while the carefully selected medication you are given will ensure you will rapidly recover after the operation with no lingering unpleasant memories of it.
- Normally you may return home after around 1-2 hours (following ambulatory surgeries). However, because you are not permitted to drive a car for the next several hours due to the medication you have received and because many of our patients arrive from quite a distance, we would advise you to spend the night in a nearby hotel (which would be cheaper than staying in the clinic)..
- You absolutely must bring another person with you for ambulatory surgeries.
We will give you antibiotics and sufficient painkillers to take home.
- You must take the antibiotics no matter what but the painkillers are merely to be taken as needed.
- After 3-4 days you may begin your daily shower routine once more, but please only use normal hand soap, not a creaming shower product. After this period, apply a new plaster to the cut(s) or use a spray plaster agent, depending on the procedure, for 1 week.
- We usually use self-dissolving stitches so that there is no need for any to be removed. We will give you corresponding directions if we have used stitches that need to be removed in your case.
- You should refrain from participating in sports or having sexual intercourse for 2 - 5 weeks (depending on the type of procedure).
- You should refrain from smoking for five weeks, as this generally impairs the healing process.
- You should also refrain from intensive sunbathing affecting the operated are for at least 8 weeks, as this can lead to pigmentation disorders (uneven colouring).
- We will provide you with documents on the kind of post-op care you require.
For your own security and in full confidence of the outstanding results and quality we provide, as of 1 July 2008 all of our patients are protected by our treatment guarantee.
Any unplanned treatments and surgeries that may prove necessary will be performed by us at our location free of charge. This guarantee is valid for a period of one year after the final operation we performed.
(There is a restriction on this in Germany: As it is illegal in Germany to perform medical services at absolutely no cost, we are legally required to still charge you a minimal fee. It will approximately correspond to the actual costs for materials and medications.)
Additional benefits generally available to our patients:
- Our surgeries are performed exclusively by highly qualified specialist surgeons with many years experience, all of whom had their qualifications scrutinised in detail before being appointed/selected.
- A detailed consultation on the options, limitations and risks involved will take place in the pre-operative discussion.
- The treatments are naturally carried out using the most technically advanced equipment.
- The members of the medical staff in the operating theatre and for post-op care are highly qualified.
- We use modern, gentle anaesthesia procedures.
- The materials and medications used are of the highest quality.
All patients who have their initial surgery performed by us are welcome to obtain post-op examinations and advice from us at any one of our centres free of charge. This offer is valid for a period of one year after the final operation we performed.
Procedure & contact
You can relax knowing you have placed your query in the hands of our experienced secretarial staff. Their extensive training enables them to offer you optimal care and to coordinate all other details. Contacting us is the only thing you need to do yourself and the staff will take care of everything else for you.
Our staff will be happy to arrange an appointment for a private meeting including an examination for you. These pre-operative discussions are without obligation and are always conducted by our in-house specialist for your particular query. We offer you highly qualified medical consultation and treatment right from the start.