Penile implants for erectile dysfunction in UAE and Europe
Penile implants
for erectile dysfunction
in UAE and Europe
Dr. Knigavko is one of the best penile implant surgeons in the UAE and Europe.
Сontent
Penile implant surgery in Dubai and Europe
Penile implant prosthesis is a surgical method of restoring an erection by introducing a prosthesis made of a special material into the cavernous bodies of the penis. Penile prosthesis is the most reliable, but usually used last method of treating erectile dysfunction.
Surgical treatment of erectile dysfunction is most often recommended when all other treatment methods with proven effectiveness, such as taking Viagra tablets, generic sildenafil, Cialis or Levitra, intracavernous Caverject or Trimex and intraurethral pharmacotherapy, vacuum erectile therapy, have proven to be ineffective or unacceptable for patient for any reason.
Modern methods of implant surgery for erectile dysfunction and penile prosthetics represent the most advanced solutions available today
All surgical methods for treating erectile dysfunction are based either on restoring the normal blood supply to the cavernous bodies of the penis, which ensure erection function, or on replacing the patient’s non-functioning cavernous bodies with penile implants which fully ensure their normal function.
The first group of operations includes:
“Arterialization” of the penis or connection to the cavernous bodies of a new artery, usually the inferior epigastric, increasing blood flow to them; this operation is performed extremely rarely when there is insufficient arterial blood flow in men after injuries to the penile arteries.
- Restriction of venous outflow from the cavernous bodies of the penis by ligation or embolization of the veins draining the cavernous bodies. This operation is performed when there is excessive venous outflow of blood.
The second group of operations includes:
The second group of operations is the implantation of various types of penile implants. Most often, penile prosthesis is used when erectile dysfunction is caused by irreversible causes. These include:
- Condition after radical prostatectomy;
- Diabetes;
- Severe pathology of the vessels of the penis (atherosclerosis of the arteries) or cavernous bodies;
- Congenital or acquired cavernous fibrosis or scarring of the cavernous bodies;
- Pathology of the tunica albuginea of the cavernous bodies — Peyronie’s disease;
- Complications of injuries and operations on the penis or pelvic organs, leading to persistent erectile dysfunction.
The effectiveness of penile implant surgery for erectile dysfunction
Installation of penile implants, today, is the most effective treatment for erectile dysfunction, not only among surgical methods, but also among all existing methods. The proportion of patients satisfied with the quality of sexual life after penile prosthesis reaches 90%, and their partners remain satisfied in more than 95% of cases. Sometimes, when implanting prostheses, partners do not even notice the difference if they do not know about the operation. Current non-surgical treatments for erectile dysfunction have similar patient satisfaction rates of only 60–70% and sexual partner satisfaction rates of up to 60%.
Unfortunately, vascular operations on the penis turned out to be less effective (up to 60%). New arteries connected to the cavernous bodies also undergo atherosclerosis after a few years, and instead of the veins blocked during the operation, new venous ones are involved in the process of pathological venous outflow from the cavernous bodies highways. Thus, after 2-3 years, the effectiveness of vascular operations does not exceed 15% on arteries and up to 50% on veins. In this regard, they are currently used by a rather narrow range of patients for special indications, such as isolated post-traumatic sclerosis of the cavernous arteries, the main type of excessive venous outflow in young patients. Moderate increases in efficacy are achieved with the addition of PRP and stem cells.
Benefits of penile prosthetics
If there is long-term and permanent erectile dysfunction caused by the above organic reasons, usually irreversible, there are currently no treatment methods that can get rid of it forever. In other words, all known conservative methods of treating organic erectile dysfunction consist of using either a pill, a vacuum erector, or an injection into the penis before each sexual intercourse. Thus, they are not curative, but auxiliary in nature and require constant lifelong use.
Unlike all existing methods of conservative and surgical treatment of erectile dysfunction, the installation of penile implants solves this problem forever. 1.5-2 months after the operation, the patient resumes normal sex life and no longer needs to use any medications.
Penil implant types
One-component plastic penile implants can be of two types:
- “Elastic” — American, Italian, Russian, Indian “Shah” polyurethane or penile prostheses made of special vinyl or silicone;
“Contour memory” semi-rigid penile implants – brands “Promedone Tube”, “Rigicon Rigi 10”, Coloplast Genesis, Boston Scientific Spectra. During the operation, one elastic cylinder (two in total) is installed in each cavernous body. Rigid dentures have the lowest cost, about $500. In this case, the penis is constantly in a working — erect position; the rest of the time, flexible prostheses can be pressed to the body with underpants. This disadvantage is the main reason, so if patients can choose a more advanced prosthesis — a memory circuit or a multi-component one, they choose them.
Inflatable vs Malleable penile prosthetics
| Implant Type | Description | How It Works | Type | Advantages |
|---|---|---|---|---|
| Three-piece inflatable | Cylinders in the penis, pump in the scrotum, fluid reservoir in the abdomen | Squeeze the pump to transfer fluid into cylinders for erection | Hydraulic (inflatable) | Most natural erection and flaccidity, better concealment |
| Two-piece inflatable | Cylinders and a pump with an integrated fluid reservoir | Fluid moves from reservoir to cylinders via pump | Hydraulic (inflatable) | Easier to implant, fewer components |
| Malleable (semi-rigid) | Bendable rods that stay semi-rigid | Manually positioned up for use, down to conceal | Non-inflatable | Simple use, minimal failure risk, least expensive |
| Specialized/custom implants | Advanced models like Peniflex, AMS 700, Coloplast Titan, Rigicon Infla10/AX etc. | Usually inflatable, may include girth expansion or anatomical enhancements | Mostly hydraulic | Personalized fit, advanced features, suited for complex cases |
The “Promedone Tube” or “Rigicon Rigi” penile prosthesis
is a multilayer silicone cylinder, in the middle of which a special multi-strand wire harness is installed, which ensures the necessary positioning of the penile prosthesis and holds it in the desired position. If you need to have sexual intercourse, the penis, with the implant installed in it, is raised up by hand. At rest it goes down. A definite disadvantage is the permanent hardness of the penis after surgery and possible cosmetic discomfort. The advantages of this model are the speed and simplicity of the operation, mechanical reliability and low risk of breakdowns, relatively low price, 700-900 US dollars, rationality in prosthetics for patients with Peyronie.
Two-piece inflatable penile prosthesis. How does a penile implant work?
This is a hydraulic model of a penile prosthesis, consisting of rigidity cylinders installed during surgery in the cavernous bodies with reservoirs built into their bases and a pressure pump, which is installed in the scrotum. The pump and cylinders are connected by tubes. The hardness of the penis during erection is ensured by the flow of fluid — sterile water, from the reservoirs of the penile prosthesis into the rigidity chamber of the cylinders.
To get an erection, it is enough to squeeze the pump installed in the scrotum several times. To relieve an erection, you need to bend the penis and hold it in a bent position for several seconds until a state of maximum relaxation is achieved.
The advantage of the two-component AMS Ambicor penile prosthesis compared to single-component semi-rigid ones is a more natural erection and a more natural state of rest of the penis. The disadvantage of a two-component prosthesis is a large pump — the size of the third testicle in the scrotum and a smaller working volume of fluid than in a three-component prosthesis. In terms of these qualities, two-component systems are inferior to three-component ones; their cost is about 4.5-5.000 USD which is cheaper than three-component ones. This prosthesis is installed by beginner implanters, or in patients with many previous operations, or with neurological diseases with tremor (Parkinson’s disease).
Three-piece inflatable penile prosthesis. Penile prosthesis inflation and deflation?
These penile prostheses are the most common and most cosmetically perfect currently available, both in terms of the naturalness of the erection and the state of rest, softness, and penis.
Three-piece penile implants consist of hollow silicone cylinders of variable stiffness that are inserted into the corpora cavernosa during surgery, a reservoir that is placed in the space behind the pubis, and a pressure pump with a valve that is placed in the scrotum. All three components are connected by tubes.
To get an erection, it is enough to squeeze the pump installed in the scrotum 5-8 times. To relieve an erection, you need to press a valve elsewhere on the pump.
The undoubted advantage of these penile prostheses is their ability to provide the best functional and cosmetic results.
Penile prostheses Rigicon infla 10, Coloplast Titan, AMS 700 and Zephyr ZSI 475 are the most advanced three-component penile prostheses with an antibacterial coating. Their use significantly reduces the incidence of infectious complications of penile prosthesis and non-engraftment of the prosthesis. The design of these systems also has a lot of new and progressive features, which has significantly increased their reliability. The new AMS700 LGX and Rigicon infla 10 AX prostheses expand not only in thickness, but also in length. When prosthesis filled it allows you to increase the overall length of the penis during implantation.
The cost prosthesis and operation to install inflatable penile prostheses is a little more expensive, they also have the highest price: 15-25 thousand USD, or 55-85,000 AE dirhams; however, they have the highest efficiency and ease of use.
In the USA, where the operation of installing penile implants is often paid for mostly by the insurance company, and where the largest number of penile prosthesis installations are carried out, interesting statistics were noted:
- 97% of patients who have a prosthesis installed are satisfied with their sex life and only regret that they did not have a prosthesis installed earlier.
- Men who installed a prosthesis by 1.8 times (80%) on average increase their annual income the next year after installation of the implant, because they are not distracted by depressive thoughts about their erection, they know that they will have an erection at the right time and are focused on work.
- 46% of men found a new partner or spouse within 2 years after installation of the prosthesis.
- 22% of men had children within 5 years after installation of the prosthesis.
Features of penile prosthesis surgery and the surgery recovery time
The operation of penile prosthesis is a rather complex technological process. To prevent complications, especially infectious ones, it is necessary to strictly adhere to the generally accepted implantation protocol throughout the world. To install the cylinders of the penile prosthesis, the cavernous bodies of the penis are destroyed during surgery by bougienage. During the operation, an individual selection of the length of the penile prosthesis occurs. To install the reservoir and pressure pump of the inflatable penile implants, spaces are created in the retropubic space and in the scrotum.
The patient spends the first day after surgery in the clinic. Sometimes, especially in the first week after surgery, there is minor pain and swelling of the penis.
In almost all cases, antibiotics are prescribed to prevent infection in the postoperative period. Approximately 3-4 days after the operation you can return to work, and after 1.5-2 months you can begin sexual activity. Sexual life after surgery is absolutely normal. The penile prosthesis does not significantly impair the sensitivity of the penis and does not in any way affect the quality of orgasm or ejaculation. Since the erection does not automatically fall after ejaculation, the prosthesis gives a great advantage to patients with premature ejaculation, now they will be able to satisfy the girl as much as they want until she orgasms. If the sexual partner is not warned, she may not even notice that the patient has a penile implant.
How is penile prosthesis surgery performed? Penil implat procedure
Before prosthetic surgery, the patient is thoroughly prepared and preoperatively examined to identify contraindications to surgery. Before penile prosthetic surgery, the therapy that was provided earlier is clarified in detail. In our clinic, prosthetic operations are usually performed under spinal anesthesia, that is, the patient may be conscious, breathing on his own, but not feeling anything below the navel.
Surgical intervention for penile replacement lasts from 40 minutes to 1.5 hours, depending on the type of implants installed. The prostheses used are supplied in factory sterile packaging, which minimizes the risk of postoperative complications.
Today, almost all forms of erectile dysfunction are amenable to conservative therapy or surgical treatment. To restore your sexual life, you should take the first step by contacting an andrologist and together with him choose the most suitable treatment method.
Penile implant brands. Best penile implant.
Penogrande — an innovative extracorporeal penile implant that differs from traditional intracavernosal devices. It is placed between Buck’s fascia and the subcutaneous tissue, allowing preservation of the cavernous bodies. Penogrande provides significant penile enlargement and enhanced rigidity without penetrating erectile tissue. The system includes a crescent-shaped silicone expander, stabilizer, pump, and reservoir. It supports tissue expansion for reconstructive purposes and assists in cases of venous leakage or fibrosis. The implant is modular, minimally invasive, and well tolerated by patients, with all reported cases to date showing high satisfaction and positive outcomes. Reed more
AMS (American Medical System) or Boston Scientific. Pioneers in the field of prostheses for penile surgery since the 80s. Thus, we often reinstalled non-functioning AMS prostheses installed 10-15 years ago. The company was the first to coat dentures with an antibiotic solution (Inhibisone). They have in their line the LGX model, which increases in length and thickness as it is pumped up. At the same time, the company is quite conservative, slowly introduces progressive new products, has the shortest warranty period for three-component prostheses — only 2 years, and has the highest price in the Arab market.
Coloplast Titan — appeared on the market more than 10 years ago, they have a very dense silicone frame, which is good for prosthetics for patients with Peyronie’s. Coloplast Titan Touch implants have a convenient pump with a valve and many sizes of models, but do not have an increasing length model. Their warranty period is usually 5 years.
Rigicon Infla — created by engineers from AMS and Coloplast, the medical director is Stephen Wilson — the father of modern penile surgery. The prosthesis embodies many technological innovations: multilayer silicone, which lasts a long time, a hydrophilic shell that accumulates antibiotics, a convenient pump for inflation, many models, including the extending model Rigicon Infla AX (Anatomical eXpansion), which is preferred by patients and penile surgeons because it gives the greatest length. In addition, Rigicon is the only company that provides a lifetime warranty on prostheses in any country in the world where it has a representative office. The company is currently developing a prosthesis that works with an electronic pump controlled by an application on the phone. It is believed that such prostheses will enter the market in 2030.
Zephyr is a “local” Swiss company that produces the ZSI 100 and ZSI 475 prostheses. The prostheses are not so popular because they do not have regional offices. The company is unique in the release of the ZSI 100 FTM and ZSI 475 FTM (Female to Male) models for transgender people, women becoming men. Such prostheses have a special plate for attaching the prosthesis to the pubic bones, which facilitates their stability and implantation.
How much does a penile implant cost in Dubai and Europe?
The penile prosthesis cost depends on the type of penile prosthesis, the city in which the operation is performed (Dubai, Kyiv, Wroclaw), as well as the length of hospital stay.
The current cost can be viewed on the >>> Price page
Penil implant before and after photos
More «Before/After» photos on our Telegram channel
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Answers to the most frequently asked questions:
Will the penis have a natural appearance?
Three-component hydraulic penile prostheses (for example Coloplast Titan Touch or Rigicon Infla AX) provide the greatest naturalness. Semi-rigid prostheses have a constant length and rigidity, Rigicon Rigi 10 or Coloplast Genesis, which makes them slightly different from a regular penis.
Will my girlfriend understand that I have a prosthesis installed?
Externally, the prosthesis corresponds to a normal penis; only a small pump in the scrotum during palpation can “tell” about the prosthesis. At the same time, most men said that their new partners had no idea about the prosthesis, but were only delighted with the quality and time of their persistent erection.
Can there be problems with urination?
When installed correctly, penile prostheses do not cause problems with urination, but in older people who often have prostheses installed, prostate adenoma often occurs when urination worsens. But these are not related processes. 3-component prostheses do not in any way affect the treatment of adenoma using enucleation or transurethral resection of the prostate (TURP). Semi-rigid prostheses can complicate the TURP procedure; sometimes we even temporarily remove the prostheses, perform a TURP and immediately install them back.
Will the penis become smaller with prosthetics and how can this be avoided?
When installing conventional implants, the penis is reduced by at least 1-2 cm from what it was during an erection. To avoid this, there are a number of methods that allow you to avoid reduction or even enlarge the penis during prosthetics:
- A) Use of expanding inflatable prostheses AMS LGX and Rigicon Infla AX. When rocking, they increase by 2-4 cm from the set size. (Watch a video)
- B) Skin plasty of the penopubical angle or penoscrotal angle – allows you to gain 1-2-3 cm on the upper or lower side.
- C) Oversize – installation of an implant 1-2 cm larger than the size of the cavernous bodies. More often used in younger patients with Coloplast dentures (who do not have an extension model). It is fraught in patients with diabetes and trophic disorders.
- D) Previous ligamentotomy and traction. A technique in which the patient first undergoes a ligamentotomy (sometimes with lipectomy), which gives 2-3 cm, after which the patient stretches the penis for 3-6 months using an extender, which gives another 3-4 cm (total 4-7 cm). So in our practice there were cases when, from the initial 10 cm, after ligamentotomy, traction and installation of the Rigicon Infla AX prosthesis, the patient received 16.5 cm during inflation!!!
How to determine the preliminary size (length) of the penis after penile replacement surgery with a 3-component Coloplast Titan implant?
The length of the extended penis after implantation with such a prosthesis will be equal to the length of the maximally extended penis (usually 12-13 cm).
Is it possible to conceive a child after installing a prosthesis?
Yes, this is possible, since the installation of a penile prosthesis does not affect fertility in any way. If a man produces sperm in his testicles and exits through the vas deferens, he will be able to impregnate his woman after surgery. Of course, if a prosthesis is installed in a man after a radical prostatectomy (removal of the prostate and seminal vesicles), fertilization is only possible through IVF-ICSI.
Is it possible to install penile implants after radical prostatectomy?
Yes, it’s possible. Radical prostatectomy is one of the most common pathologies, after which a prosthesis should be installed to restore erectile function. The optimal period for installing a prosthesis is 4-6 months after prostatectomy, since by this time all the anastomoses have healed, but the penis has not yet become smaller and sexual behavior has not changed (the man still wants sex).