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Penile prosthetic surgery

A penile prosthesis is a medical device which is surgically implanted into those who are suffering from organic erectile dysfunction of different origins that cannot be cured or treated by medication. In rare, selected cases such surgery might exceptionally be performed in patients who suffer from certain psychological problems (ie non-organic cases) on the specific recommendations by psychiatrists or sexologists. The prostheses can correct congenital or acquired anomalies of the penis, cases of severe deformities or curvature, like in Peyronie disease, or can be employed as an adjuvant procedure to sex-change operations. The operation does not alter the turgidity of the glans, the sensibility of the penis, nor does it affect orgasm, which remain unaltered by any surgical intervention.

The erectile dysfunction devices can be divided based on constructional and functional parameters into two major categories: semi-rigid and inflatable ones. The semi-rigid or non-hydraulic prostheses contain soft implants, malleable and mechanical devices (the latter are rarely used today). The inflatable or hydraulic prostheses can be further subdivided whether they are mono-component or multi-component types, the latter may have two or more components. The bicomponent models are composed of two inflatable cylinders which are inserted in the two corpora cavernosa as well as an additional reservoir and a pump unit placed in the scrotum. The three component models have an additional larger reservoir which is placed in the abdomen in the pre-bladder space. The latter is preferable as they offer the best functional and aesthetic results and a perfect imitation of both erect and flaccid penis, as a result of embedding of the implant via a perfectly disguised small incision in the scrotum or suprapubic area. In the hydraulic prosthesis mechanical erection occurs due to the activation of a pump positioned in the scrotum, which conducts liquid (saline solution) from the reservoir to the cylinders in the corpora cavernosa. The latter stiffens and stays stiff until its detumescence is activated by a micro valve positioned in the same pump.

The surgical procedure is not a technically demanding one and could be performed either by spinal or by general anaesthesia. I do this in a Day-case basis by admitting the patients in the morning and discharging them in the afternoon. Next morning the urinary catheter will be removed and any drug treatment will be instituted. Those patients who are coming from a distance are invited to stay overnight in Florence. After three or four days rest it is possible for the patients to resume the daily activities though avoiding any kind of exertions for at least three weeks. Postoperative pain is controlled by analgesics and anti-inflammatory drugs. In my cases the current postoperative infection rate is around 2%, therefore on discharge I tend to prescribe oral or intramuscular antibiotic regime for ten days. The prosthesis is activated after four weeks.

Since 2013 I do the operation on a day case basis.

In June 2013 I performed the world’s first penile prosthetic surgery with robotic laparoscopic prostatectomy simultaneously.

I am member of the Board of Italian Society of Andrology that deals with the Italian Register of Prostheses. http://androprotesi.it/portfolio-items/nicola-mondaini/


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