SATISFACTION FOLLOWING PENILE PROSTHESIS SURGERY

Although surgical success rates for some devices now approach 90 to 95 percent, patient satisfaction does not parallel this impressive figure. A major problem is disappointment with postoperative penile length and width. Some men never attempt intercourse after the prosthesis is implanted; others have intercourse for only a brief time and then abandon sexual activities. Additional areas of disaffection with prostheses have surfaced in response to specific questions.

The majority of urologists are men, and in the beginning, the male perspective distinctly colored the reported results of prosthesis surgery. Female health-care professionals saw things differently. They approached the issue of satisfaction after implantation by interviewing both partners. Some couples were not having intercourse at all. Of those who were having intercourse, 25 percent reported restriction in positions because of the decreased penis size. Fifteen percent of the men experienced diminution of orgasmic intensity. Still, 79 percent of men said that they would, if given the opportunity, undergo the operation again. Only 59 percent of their partners had no hesitation.

Some urologists claim that satisfaction depends on the type of prosthesis, with IPP recipients being generally more satisfied than those who receive other prostheses. Because they are easily concealed and readily activated, one would have anticipated that the multicomponent IPP would have emerged by now as the dominant, if not the only, penile prosthetic device implanted.

This has not turned out to be the case, for two reasons. Significant problems with the internal hydraulics of IPPs remain, and mechanical failures are common. Perhaps more troublesome is the fact that a certain amount of manual dexterity is required to inflate the IPP.Originally, in an effort to mimic the genital caressing that is a natural component of sexual foreplay, the man’s sexual partner was encouraged to play an active role in pumping the scrotal bulb so that fluid could be transferred from the abdominal reservoir to the prosthesis, a maneuver intended to mimic a stimulated erection. This has not been as warmly embraced as expected.Sexual partners are often unwilling to participate in the pumping procedure. Some are simply not deft at manipulating the scrotal bulb. As a result, inadequate amounts of fluid are transferred from the reservoir to the prosthesis shaft, and a suboptimal erection ensues. In such cases, failure of the device has been ascribed not to mechanical problems of the unit itself but to the inadequate level of participation of sexual partners. Those who have been unwilling to become involved as vigorous squeezers of the scrotal bulb have been decried as “timid pumpers.” Other factors may also have a significant impact on postoperative sexual satisfaction. Any of the following put the couple’s satisfaction at risk:

• Extreme obesity
• Psychogenic impotence
• Impotence not the only sexual problem
• Sexual dysfunction in woman
• Severe marital conflict
• Unreasonable expectations
• Partner opposed to surgery
• Woman pressuring man to have surgery
• Couple ceased all sexual touching

Obese patients are often displeased following penile prosthesis surgery because the length of the unit protruding beneath their lower abdominal fat pad is limited. Most prostheses are approximately eight inches in length. If there is an extensive overhanging fat pad, then perhaps only an additional four inches of rigid penile tissue will protrude for purposes of sexual intercourse. If the patient’s partner is also obese, it will be very difficult for the couple to find a position in which penile-vaginal penetration and adequate vaginal containment is possible. For obese couples, postoperative sexual gratification may be limited.

Inappropriate expectations are high on the list of reasons for postoperative patient-partner dissatisfaction. The prosthesis provides only the penile rigidity necessary to achieve vaginal penetration. Patients who anticipate

that the equipment will allow them to recapture the real, or imagined, sexual prowess of their youth are likely to be displeased.

Patients whose impotence is attributed to psychogenic factors do not derive as much long-term benefit from prosthetic surgery as those whose impotence is caused by either neurogenic or vasculogenic factors.

On occasion, impotent men have sexual problems other than erectile dysfunction. Lack of spontaneous arousal, limited libido, and ejaculatory disorders are not corrected by penile prosthesis implantation.

The level of preoperative patient-partner interaction is a critical determinant in evaluating postoperative satisfaction. If, for example, the female partner has her own sexual dysfunction, such as pain during intercourse, then she may be fearful of experiencing vaginal penetration again. A man may choose to have a penile prosthetic implant without notifying his partner. Such a decision is commonly interpreted as a rejection of the partner. In addition, some women are fearful that their previously impotent partners, now outfitted with penile prostheses, will seek other lovers. Limited studies exploring this question have indicated that penile prosthesis recipients are no more susceptible to seduction than other comparably aged potent men, nor do they routinely seek out new sexual opportunities more often than their potent peers.

On the other hand, some female partners of impotent men, frustrated after long periods of sexual abstinence, may pressure the men into surgery. Any discordance in patient-partner desires for penile prosthesis surgery is considered a major risk factor for postoperative dissatisfaction.

Couples who have distanced themselves sexually from each other and have ceased hugging, touching, and all sensual and erotic contact may not be able to retrieve all aspects of normal sexual function merely by placing a prosthetic rod in the penis. Clearly, satisfaction is maximal only when both partners are involved in all discussions and decisions from the beginning.

4 Responses to “SATISFACTION FOLLOWING PENILE PROSTHESIS SURGERY”

  1. T M says:

    I have just had my 3rd AMS 700 prostheses implant as the doctor has informed me that there have been pin holes found in the first 2procedures.I feel that American Medical Systems are putting out bad product and should be reported to FDA.How can I do this.Your feedback on this matter will be appreciated.

    Thanking you in advance,

  2. ranjit says:

    In India which are best hospitals for penile implant surgery?

  3. mk says:

    i want do penile prosthesis implant
    which hospital i have to go and what will be the cost.

  4. Den says:

    I have a need and would want to come to India for Curature and Prosthesis surgery around the 5th of July 2012. Please give me your cost quotation for the surgery and tell me thenumbers of those I need to stay in hospital and hotel for the surgery/

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