Erosion and Migration
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Erosion (destruction of a tissue surface) and migration (spontaneous change of place) of the prosthesis occur more commonly with placement of rigid prostheses and in men with indwelling catheters or on clean intermittent catheterization. These complications may also occur when the prosthesis is too long or the patient has an unsuspected urethral injury.
In the case of urethral erosion, there may be some splaying of the urine stream and the tip of the prosthesis may protrude into the urethra. In such cases, the affected cylinder is removed, and the corpora are irrigated with an antibiotic solution and closed. A catheter is placed into the bladder for about 1 week to promote urethral healing. A new cylinder can be placed 6 months later.
The tubing may also erode through the skin. Such tubing erosion is often a sign of a smoldering infection, in which case the best thing to do is to remove the prosthesis. The surgeon can also attempt the salvage technique described earlier.
Lastly, the cylinders may migrate proximally toward the base of the penis, a condition that shows up as a new droop in the glans. When this happens, the cylinder must be removed, the defect in the corpus cavernosum corrected, and the cylinder replaced.
If the cylinders to be implanted are too short, they will not provide adequate support to the tip of the penis, causing the glans to droop. This drooping of the glans may make it difficult for the man to achieve vaginal penetration. A glans droop can be corrected by a simple surgical procedure and often does not require replacement of the prosthesis.
Penile Ischemia and Necrosis
These complications, which are extremely rare, occur when there is an injury to the blood supply to the corpora cavernosa or to the glans. Men with severe diabetes, those with extensive vascular disease, and those who require an extensive dissection for placement of the prosthesis are at increased risk of developing penile ischemia or necrosis. If the postoperative dressing is too tight, it may also cause ischemia.
Patients often experience some discomfort during the first 2 months or so after placement of a penile prosthesis. If the pain persists for a longer period, your physician may evaluate whether you have an infection or whether the prosthesis is too large. Some men may experience penile discomfort with the initial inflation of the prosthesis that is related to stretching of the tunica (the thick white membrane wrapped around the corpora cavernosa), but this usually resolves with time as the tunica stretches.
Residual Penile Curvature
In patients with Peyronie's disease, placement of the prosthesis and maneuvering of the prosthesis when it is erect in the operating room are usually all that is needed to correct the penile curvature that can occur with this condition. In rare cases, residual curvature may persist after placement of the prosthesis. If this condition does not improve with use of the prosthesis, then another procedure may be performed to excise the plaque.
The incidence of mechanical problems with prostheses is approximately 5%—quite a low rate. Such problems may potentially include leaks, aneurysms, and rupture of the cylinders.
Leaks typically occur at connection sites and where the cylinder tubing enters the cylinder. Leaking prostheses either will not work or will not provide adequate rigidity. Connection site leaks may be easily repaired. A leaking cylinder can be replaced, but it is recommended that the entire prosthesis be replaced if the prosthesis has been implanted for a few years.
Aneurysms (i.e., dilations of a part of the cylinder) are very uncommon with the current prosthesis models. If they occur, the affected cylinder must be removed and replaced with a new device.
The cylinders can also rupture, usually as a result of unrecognized damage during the closure of the corpora. This problem is often detected when the device is inflated 4 to 6 weeks after surgery.
Autoinflation is the phenomenon whereby the device inflates on its own without you manipulating the pump. It is the result of increased pressure around the reservoir. The newer penile prostheses have "lockout valves" which prevent autoinflation.
Is there a role for sex therapy in the treatment of ED?
Yes, there is often a role for sex therapy in the treatment of ED. You do not have to have psychogenic ED to potentially benefit from sex therapy. Sexual problems do not occur in isolation, nor are their effects limited only to the sexual arena. Sexual problems can be associated with relationship difficulties, decreased self-esteem, anxiety, and depression.
Sex therapy is very effective in helping people understand both the physiologic and the psychological aspects of ED. It also helps people identify and deal with unrealistic expectations and negative self-images, understand their partner's sexual needs and requirements, and dispel any myths about sexuality and sexual function that the patient and his partner may have. It also allows for help with relationship issues, such as intimacy conflicts, power and control struggles, and trust issues, which may be just as important as treatment of the ED in the restoration of a healthy sexual relationship.
Your doctor can help you locate a sex therapist in your area. A sex therapist may be a psychologist or psychiatrist who has a special interest in sexual dysfunction.