Erection has a
mechanism that relies on
pumping blood into the
corpus cavernosum of the penis, and closing the outlets so that
blood pressure increases inside the penis to the extent of rigidity.
This mechanism may fail due to many
reasons, including leakage from the outlets (venous
leak), occlusion of the inlets (arterial
occlusion) and otherwise.
If impotence is caused by
venous leak, the leaking veins can be
individually occluded (ligated) to repair the faulty mechanism of
This requires accurate
studying of the veins prior to surgery, in terms of site and number,
accomplished by cavernosography.
The best results with
venoligation surgery are obtained in cases where leakage is through
a one or two veins at most, rather than many veins, patients less
than 45 years age, non-smokers, with impotence dating since puberty.
The incision is 1-3 cm long
on the upper surface of the base of the penis. Surgery takes 30-45
minutes, and patients are discharged from the hospital on the same
The incision for
venoligation, showing the vein (blue) right in the middle,
surrounded on either side by an artery and a vein.
Success rate is within 60%.
Some of the cases that fail surgery respond better to medical
treatment contrary to the lack of response before surgery. Other
failed cases require implantation of a
Venous leak can be stopped
by an alternative surgical method where an artery obtained from the
anterior abdominal wall is connected to the vein to pump blood in a
direction against the leaking blood, stopping the leak.
The incision is much longer
than that of venous leak, and the results are not higher.
If medical treatment fails,
and the previously mentioned surgeries fail or do not have good
expectations, penile prosthesis can be implanted to replace the
normal mechanism of erection with one that error-proof, while not
interfering with natural shape and form of the penis, natural
feeling, natural pleasure, natural ejaculation, fertility and
urination, all of which are preserved. It only addresses rigidity
that is completely restored. When one desires erection, he induces
rigidity in the penis by manipulating it in a special way that
varies according to the type of prosthesis implanted. When the penis
is made rigid, it stays that way for any length of time required,
until one undoes rigidity by another manipulation. Even after
ejaculation, the penis can be left rigid and intercourse can proceed
for any length of time. Intercourse can thus be possible for any
number of sessions, every day, and for any desired length of time.
However, the penis will not turn rigid on its own. One must make it
rigid with the hand manipulation that varies from one type of
implant to the other. For example, the inflatable prosthesis
(see later) is made rigid by pressing a small sphere that is placed
next to the testis inside the scrotal skin. Needless say that the
penis retains the normal shape and form, that is, it is very
difficult to tell that there is a prosthesis implanted.
The prosthesis is a
silicon-made cylinder that is inserted into each
corpus cavernosum, to
grant complete rigidity whenever needed. This is performed through a
small incision that is concealed and does not usually appear.
After the skin incision,
the corpus cavernosum is incised for a length of 1cm, a metal rod is
inserted into the corpus cavernosum to dilate it, and the prosthesis
The corpus cavernosum is
closed, and so is the skin.
This usually takes an
average of 60 minutes of surgery, and does not usually require any
length of hospital stay.
Two types of prosthesis
exist, depending on the mechanism of rigidity: the inflatable, and
The inflatable prosthesis
is made of two soft, long cylinders that are connected to a small
fluid-filled pump. The two cylinders are placed inside the two
corpora cavernosa. The pump is placed inside the
scrotum next to the testis. When
the pump is pressed, fluid leaves the pump and fills the cylinders
expanding them and rendering them rigid. The cylinders occupy the
whole length of the corpora cavernosa, thus result in rigid erection
of the penis when filled.
When one desires to undo
erection in case an inflatable prosthesis is implanted, he presses
the top of the pump or the penis itself (according to the model of
the inflatable prosthesis). Fluid flows out of the cylinders making
them soft again, and the penis shrinks back to normal.
prosthesis allows for erection and shrinkage
The semirigid / malleable
is different. It is composed of a long silver wire that can be bent
and straightened. The silver wire is surrounded by a firm cylinder
of silicon that has the feeling of a rigid penis. The cylinder can
be bent or straightened as desired. When straightened, it stays
straight and rigid.
Two cylinders are inserted,
one in each corpus cavernosum, in the same way an inflatable
prosthesis is implanted (see before). When one has a semirigid /
malleable prosthesis implanted and he desires erection, he
straightens the penis with his hand, and it stays erect as long as
he needs. When he is done, he bends the penis downwards so that it
does not show underneath his pants, but it stays rigid (though
The semirigid /
malleable prosthesis can be straightened and bent as desired
To sum up, the major
difference between the inflatable and the semirigid / malleable
prosthesis is that the inflatable can erect and shrink back, while
the semirigid / malleable can be erect or bent. This has major
health implications. For example, men with diabetes mellitus should
preferably implant and inflatable prosthesis rather than a semirigid
/ malleable prosthesis because the inflatable is less likely to
press on the tissues since it is not always rigid. When one needs to
have endoscopy performed for prostatic problems, the inflatable
permits endoscopy while the semirigid / malleable prosthesis makes
it more difficult. On the other hand, when one has
fibrosis of the penis, a semirigid /
malleable prosthesis may sometimes be better as the firm fibrous
tissue cannot harm it, contrary to the inflatable prosthesis.
Possible complications of
this surgery include wound infection, which can be prevented by
strict sterilization, antibiotics and perfect surgical technique.
Other very unlikely complications are over-sizing and under-sizing
of the prosthesis, both of which result from poor surgical
technique. Over sizing can result in perforation and extrusion of
the prosthesis especially in diabetics.
Implanting a prosthesis in case
In cases of extreme
fibrosis of the penis,
insertion of a penile prosthesis in such conditions is very
difficult and risky since the rigid fibrous tissue occupies the
where the prosthesis should be inserted. The corpora cavernosa
are closed cylinders. Removal of fibrous tissue out of them is
usually done by excavation in blind fashion ( being closed
cylinders), unless a very long incision is performed spanning
the whole length of the penis. Blind excavation results in
severe injuries. Long incisions result in infections. Again, the
author of this website; Dr.Shaeer,
has designed an innovative surgical technique where an endoscope
is inserted into the corpora cavernosa, allowing easy excavation
under vision. This technique is internationally published under
the name of "Shaeer's Technique":
Corporoscopic Excavation of
the Fibrosed Corpora Cavernosa for Penile Prosethesis
Implantation: Optical Corporotomy and Trans-Corporeal Resection,
Shaeer’s Technique. Osama Shaeer and Ahmed Shaeer.
Intellectual Property Registration number 00320, Ministry of Communication,