الفهرس 
ANATOMY OF THE PENISOnly 14 pages are availabe for public view
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Abstract
P
enile prostheses have been introduced as the first effective organic treatment for erectile dysfunction (ED) over three decades ago and still play an important role in the treatment of ED in patients that don’t respond to medical therapy. Although they are the most invasive treatment option, penile prostheses guarantee the highest satisfaction rate among all available ED options and provide a predictable and reliable result.
Patients are offered penile prosthesis implantation when less invasive treatments for ED are unavailable, unsuccessful, contraindicated, provide an inadequate erectile function, or are considered unacceptable by the patient.
The indications for penile implant surgery include Organic impotence, Patients unwilling to consider, failing to respond or unable to continue with intracavernosal drugs and external devices, Post-injection penile fibrosis, Peyronie’s disease with impotence, ED after Priapism, after phalloplasty and Psychological impotence after all treatments and counseling exhausted.
Penile prosthesis used after non nerve-sparing pelvic surgery performed on the bladder, prostate and rectum which causes ED due to interruption of the neurovascular bundles involved in erectile mechanisms.
Also penile prosthesis used after radical surgery for penile cancer and for treatment of congenital or acquired missing penis.
Penile prosthesis implantation can be safely performed in men who have had radical prostatectomy and external radiation therapy.
The first step in the implantation of a penile prosthesis is correct informed consent, to be discussed with the patient and his partner in order to understand their expectations of this treatment, and dispel any unrealistic ones.
The informed consent discussion should describe the prosthesis and how it works. The type of anesthesia (usually spinal or general) is discussed. Because patients are discharged in less than 24 hours, the procedure is considered outpatient surgery.
The type of approach may differ according to the type of implant used, the surgeon’s preference, anatomy and previous surgical history of the patient.
There are different surgical approaches to implanting a penile prosthesis and they depend on the device to be positioned and the surgeon’s experience. Sub-coronal approach is suitable when a malleable or a mechanical prosthesis is implanted, while infrapubic or penoscrotal approaches are chosen for inflatable devices.
Regardless of the type of prosthesis used, a meticulous surgical technique and surgeon’s experience are the most important factors determining the outcome of the procedure.
The advent of new surgical tools and new infection-resistant materials has significantly reduced the risk of intra- and postoperative complications and the need for revision surgery. Various companies have also improved their mechanical systems in order to reduce the risk of failures.
In summary, selection of the appropriate device for the individual patient is very important. Considerations include patient’s preference and underlying medical condition, surgeon’s preference, and cost of the device.