Penile prosthesis: the new minimally invasive technique to rediscover one’s sexuality after overcoming prostate cancer
An active and fulfilling sexual life is possible, even if you have undergone a prostate operation that has left a functional deficit. The definitive solution is the penile prosthesis, or endocavernous device, which today can be implanted with a mini non-invasive operation. The details of this innovative technique were explained to us by Gabriele Antonini, the first and only one in Italy to carry it out, urologist andrologist of the “U. Bracci” Urology department of the Policlinico Umberto I in Rome.
Erectile dysfunction after prostate cancer surgery: when is it necessary to resort to a penile prosthesis?
Erectile dysfunction problems mainly concern those who have undergone prostate cancer surgery, but also those who have undergone colorectal surgery and patients suffering from diabetes. The erectile deficit can be more or less important, depending on the vascular microlesions reported. Post-surgical rehabilitation involves the use of oral medicines such as sildenafil and tadalafil, which however do not guarantee a total resumption of sexual activity. Indeed, most of the time they prove ineffective. In these cases, the only therapeutic solution is therefore the implantation of an intracavernous device that brings the sexual organ back to perfect functioning.
How does a penile prosthesis work?
The blood no longer circulates so this lack must be made up for the organ to function. The hydraulic prostheses I use are called three-component. They are made up of two inflatable cylinders, an activator device and a spherical reservoir. The activation mechanism is started manually, which is hidden inside the scrotum between the two testicles, and which causes the liquid, a physiological solution, to arrive from the reservoir inside the cylinders located in the two corpora cavernosa which thus swell and stiffen.
What are the characteristics of the technique you use and what are the advantages compared to others?
The technique I used, defined as Minimally invasive penile prosthesis implant, has the characteristic of being minimally invasive and therefore revolutionary: I learned and developed it after a long period of training in the United States, where I collaborated with one of the most important American andrological surgeons, Professor Paul Perito of the Coral Gables Hospital in Florida. I use it especially in patients operated on for prostate cancer and in those suffering from penile deformity due to plastic induratio penis.
The innovation lies entirely in the technique used to position the implant: an infrapubic incision of just 2.5 cm is made at the base of the penis for the implantation of the hydraulic penile prosthesis. The operation lasts twenty minutes, compared to 50 minutes for the traditional one. For the benefit of post-operative pain, which is almost non-existent, and the risk of infections which decreases considerably and is close to zero percent. Previously, the surgical incision was made between the penis and the scrotum, resulting in far greater post-operative discomfort and the patient’s ability to activate the system only after a month. Now with this new approach the times have been significantly shortened and the system can be activated just 7 days after the operation, and the resumption of sexual activity begins a month later.
How important is the psychological aspect of accepting the prosthesis?
Once the oncological aspect has been overcome, we must focus on the psychological aspect and the patient’s sexual life. Generally speaking, those operated on for prostate cancer are over the age of 60, although early diagnosis thanks to the introduction of PSA allows the tumor to be detected even around the age of 50. However, all this does not mean that once the disease has been overcome, one must give up an active and satisfying sexual life, which also gives psycho-physical well-being and energy to manage the disease.
We need to accept the problem. Many patients give up an active sexual life because the thought of implanting a penile prosthesis is experienced as a deficit and an impairment. In the common imagination, it is believed that the endocavernous device is something external to the organism, with the famous pump visible to the naked eye. On the contrary, this type of implant is inside the body and completely invisible and allows you to have a penis turgidity equal to that of a 20 year old boy. For this reason it should be compared in terms of its usefulness on quality of life to a hip prosthesis or a heart valve.
How important is the doctor-patient relationship in these cases?
Oncological pathology rightly takes up time from the specialist who in the vast majority of cases, after having brilliantly resolved the basic problem, neglects the quality of sexual life, creating a deep state of depression and frustration in the patient. In my opinion, the urologist must be completely dedicated to andrology, to be able to establish a relationship of friendship and confidence with the patient, creating empathy between the parties and to allow him to open up and face both the surgical phase and the subsequent follow-up phase with serenity.
© Antoniniurology