Penile prosthesis (happiness rod) is currently the most popular and widely accepted surgical procedure among the surgical treatments for erectile dysfunction.
The happiness rod is the most commonly performed surgery for erectile problems in our country and worldwide due to its high satisfaction rate among both patients and their spouses/partners.
What Is a Penile Prosthesis?
The penile prosthesis (penis prosthesis), commonly known as the happiness rod, is the name given to biocompatible medical devices that are externally placed in the penis to provide erection. It has been named the happiness rod due to its positive effect on erection.
Who Gets a Penile Prosthesis (Happiness Rod)?
The happiness rod is implanted in patients who experience erectile problems and do not benefit from other medical treatment methods despite using them. Before the happiness rod can be implanted, patients must have previously used other treatment methods and not benefited from them.
The primary treatments include:
- Oral medications
- Medications administered through the urinary canal
- Medications injected directly into the penis
- Vacuum therapy devices
- Treatments such as shock wave therapy.
This surgery is recommended for patients who do not respond to all these treatments.
Who Cannot Have Happiness Rod Surgery?
- Those with severe neurological disorders
- Those whose systemic diseases cannot be controlled (such as heart, diabetes, kidney, and liver diseases)
- Those unable to use their hands for two-piece or three-piece prostheses
- Those with active urinary tract infection
- Those without spouse or partner consent (relative)
Types of Penile Prosthesis (Happiness Rod)
Penile prostheses are broadly evaluated under three categories:
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One-Piece Penile Prostheses (Rigid and Semi-Rigid):
One-piece prostheses contain only cylinders. Two rigid or semi-rigid cylindrical prostheses are placed on opposite sides, right and left, of the penis.
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2-Piece Inflatable Penile Prostheses
Inflatable two-piece prostheses contain two prosthetic components placed inside the patient. The first is the cylinders placed inside the penis that can inflate and deflate; the second is the pump placed inside the scrotum between the testicles. There is a channel connecting the cylinders and the pump.
When the patient wants to have sexual intercourse, they find the pump inside the scrotum with their hand and press the pump several times. With this action, the fluid in the pump moves toward the cylinders inside the penis, and the penis becomes erect.
After intercourse, pressing a button on the pump causes the fluid to flow back into the pump, ending the erection.
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3-Piece Inflatable Penile Prostheses
Like the two-piece prostheses, the first component is the cylinders placed inside the penis, and the second component is the pump. In addition, the third component is the reservoir, a fluid-filled chamber. This third component is placed inside the abdomen.
When the patient presses the pump several times before sexual intercourse, the fluid in the abdominal reservoir moves toward the penis, creating an erection. After intercourse, pressing the button on the pump causes the fluid in the penis to move back toward the reservoir, and the erection subsides.
How Should a Penile Prosthesis Be Selected?
There are some key points to consider when selecting a penile prosthesis. The goal of happiness rod implantation is to achieve an erection that closely mimics a normal healthy penis. The patient should be able to easily achieve an erection whenever desired before sexual intercourse and should be able to end the erection smoothly after intercourse.
Today, the most commonly used penile prostheses are one-piece or three-piece. Two-piece prostheses are preferred in more specific situations and selected patient groups.
The patient’s general health conditions are the primary determinant in prosthesis selection. In addition to other factors, the most suitable model is generally recommended based on the patient’s health conditions. This recommendation should mostly be made by the surgeon who will perform the prosthesis surgery. Some key points that help decide which prosthesis to implant in which patient are listed below.
Advantages of Penile Prosthesis
Penile prosthesis surgery, an important surgical procedure that will make the patient and partner happy, has several advantages for both the patient and the female partner:
- Whenever sexual intercourse is requested by the man or his partner, the penis always has sufficient rigidity to meet this demand for an extended period.
- One of the significant problems commonly seen in men and causing concern during sexual intercourse is premature ejaculation.
Points to Consider When Choosing a Happiness Rod Penile Prosthesis
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Patient’s Ability to Use Their Hands
In some stroke patients, the inability to use the active hand is important in prosthesis selection. One-piece penile prostheses are frequently recommended for stroke patients.
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Accompanying Systemic Diseases
One-piece prostheses may be preferred in disease conditions affecting all body systems that cannot be controlled with treatment, primarily diabetes mellitus, to reduce the risk of possible complications.
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Certain Special Conditions
In certain special conditions such as electric shock, traffic accidents, and penile injury, one-piece prostheses may be recommended because the existing penile tissue is severely damaged and reduced.
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Penile Curvature – Peyronie’s Disease
One-piece or three-piece happiness rods can be used in Peyronie’s disease, also known as penile curvature that develops later in life with age. The decision will be made by the urologist who will perform the surgery.
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Cost
Cost is one of the important criteria considered by patients in prosthesis selection. Since these products are generally imported from abroad, prosthesis costs may vary according to economic indicators. The costs of three-piece prostheses are higher than one-piece penile prostheses.
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Patient Preference
Even though all conditions have been evaluated together, the final decision is made jointly by the surgeon and patient. Patient preference must be taken into account in prosthesis selection. Unless there is a contrary medical necessity, the surgeon performing the operation makes recommendations taking the patient’s preference into consideration.
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Previous Surgeries
In patients who have undergone numerous abdominal surgeries for various diseases and conditions and where reservoir placement is thought to be difficult, one-piece or two-piece prostheses may be preferred.
Through Which Incisions Is Penile Prosthesis Implantation Performed?
One of the topics patients are particularly curious about is the incision site. The choice of surgical incision site may vary depending on the patient’s specific conditions and the incision site with which the surgeon is experienced.
Common incision sites in happiness rod surgeries, known as penile prosthesis surgeries:
- Infrapubic incision site: An incision made between the penis and navel, close to the penis
- Penoscrotal incision site: An incision made from the midline of the penis downward to the scrotum, with part on the penis and part on the scrotum
- Periscrotal incision site: An incision made close to the penis but mainly on the scrotal skin
- Coronal incision site: An incision made over the circumcision line
How Is the Happiness Rod Penile Prosthesis Implanted Through Surgery?
- The patient is prepared with certain preoperative preparations. The patient is previously informed by the anesthesiologist about which type of anesthesia will be applied. Following anesthesia, the patient is positioned supine on the operating table.
- Appropriate antiseptic painting and surgical field cleaning is performed. A surgical incision appropriate for the patient and with which the surgeon is experienced is made on the skin.
- Then the structures called corpus cavernosum on both sides are found. Separate stay sutures are passed through these structures, incisions are made, and the cavernous structures (spongy tissue) are dilated through these incisions with dilating instruments.
- The dilated areas are thoroughly washed with previously prepared antibiotic solutions, and the length of the prosthesis to be implanted is measured. The prosthesis of the required size is properly placed inside the dilated cavernous structures. Subsequently, appropriate sutures are placed, and the procedure is completed.
For three-piece inflatable prostheses, in addition to these steps, a reservoir is placed in the groin and a pump is placed inside the scrotum. Then the connections between the reservoir, pump, and cylinders are made, completing the surgery.
How Is the Happiness Rod Used?
The operating systems of happiness rods differ from each other. When the prosthesis to be implanted is a one-piece, its use is much easier. No special effort is required for its operation because the penis is constantly rigid.
However, for two-piece or three-piece penile prostheses, patients should be informed about postoperative use. Patients should be adequately and clearly informed by the doctor before using the device.
The implanted device should be used in light of this information. Otherwise, the mechanical components of the device may be damaged, causing failure. This is an undesirable situation. It can lead to a difficult and undesirable situation, primarily financially and in terms of general health.
The general principle for inflatable prostheses, whether two-piece or three-piece, is that before sexual intercourse, to bring the penis to erection, the pump is first found in the scrotum with the hand. The pump is pressed several times with the hand.
The fluid in the pump or reservoir is transferred to the cylinders inside the penis, making the penis rigid. After intercourse, the erection is ended by pressing the button on the pump inside the scrotum.
Undesirable Situations After Penile Prosthesis Surgery
Although rare, some undesirable situations may occur after prosthesis surgeries. Some of these complications are listed below:
- Infection
- Bleeding
- Hematoma
- Mechanical failure
- Cylinder displacement
- Reservoir displacement
- Penile numbness
- Feeling of decreased penis length
Satisfaction Rates After Penile Prosthesis Surgery
Patient and partner satisfaction rates after penile prosthesis surgeries have been reported in the literature at high rates between 70-95%.
Low satisfaction rates are thought to be mostly related to the use of early prostheses from older years. Very high satisfaction rates have been reported for both male and female factors after surgeries performed with new generation technological products.
Happiness Rod Penile Prosthesis Prices
Happiness rod surgery is performed at different centers within Ankara. While there are price differences between these centers, the rough price ranges are similar to each other.
How Long Does Happiness Rod Surgery Take on Average?
The duration of happiness rod surgery varies depending on the patient’s characteristics and the type of prosthesis to be implanted. This duration is approximately 1-3 hours on average. Additional conditions such as pre-existing curvatures, plaques, and Peyronie’s disease in the penis contribute to prolonging this duration.
Do Reviews from Penile Prosthesis Users Cause Anxiety?
Reviews from happiness rod users may vary. Therefore, excessive online searching before the procedure may cause anxiety in patients.
In general, despite the high treatment success and patient satisfaction rates, existing negative experiences in some patients may negatively affect new patients as well.
The fundamental determining factor here is that patients who have had the surgery and have high satisfaction rates do not make any comments in digital media due to privacy concerns.
Patients satisfied with the surgery mostly prefer that this situation remains confidential and not heard about, so they do not write reviews in digital media.
When only patients with problems write reviews, unnecessary anxiety about the surgery may develop.
In this case, you can get the most accurate information from your own doctor because there is as much harmful information on the internet as there is useful. To avoid information pollution, please share all your curiosities about the surgery with your doctor.
Is Happiness Rod Surgery Difficult?
Happiness rod surgery is ultimately a surgery. Every surgery has its own set of difficulties. The surgery has its own set of challenges. However, when compared to other surgeries that pose vital risks, we can say it is a relatively more comfortable surgery.
It can be said to be a comfortable surgery for patients especially due to its ease factors such as no pain and early return to daily life in the postoperative period.
Does Bleeding Occur During Penile Prosthesis Surgery?
Bleeding occurs during penile prosthesis surgery. This bleeding is no different from bleeding in other surgeries. Additional and unexpected bleeding specific to prosthesis surgery usually does not occur.
Bleeding does not pose a serious problem during surgery, but if proper bleeding control is not performed, there is a possibility of some problems occurring after surgery.
Additionally, small amounts of bleeding into the scrotum or subcutaneous tissue may occur after surgery in patients using blood thinners, those with impaired wound healing, or with systemic diseases such as diabetes mellitus.
Is the Happiness Rod Satisfying for Women?
The happiness rod is quite satisfying for women. There are numerous studies in the literature on this subject. When satisfaction rates are evaluated for both partners (both female and male), they exceed 90%.
Therefore, happiness rod surgery is not only satisfying for men but is also quite satisfying and gratifying for the female partner.
When Can Those Who Have a Happiness Rod Implanted Have Intercourse?
Sexual intercourse is not permitted in the early period after happiness rod surgeries. This is important for preventing wound infection and allowing tissues to heal.
Generally, sexual intercourse is permitted 4 or 6 weeks after surgery. This varies from patient to patient. Therefore, it would be appropriate to get the most accurate information from the doctor who performed your surgery.
Is It Necessary to Use Medication After Happiness Rod Surgery?
After happiness rod surgery, antibiotics and anti-inflammatory medications are generally used as recommended by your doctor. Medications should absolutely not be used after surgery without a doctor’s recommendation.
You can also request detailed information from the surgeon who operated on you about when to resume previously used medications and how to use them.
For the timing of resuming blood-thinning medications after surgery, be sure to consult your doctor. Medications used for blood thinning differ significantly from each other. Therefore, the timelines for resuming these medications also differ. Request the most accurate information from your doctor.
If you accidentally start using blood-thinning medications early, you may increase postoperative bleeding.
If blood-thinning medications are started late, coagulation factor disorders may develop in the body, leading to fatal damage in the relevant organs. Therefore, blood-thinning medications should be resumed at a time deemed appropriate by the surgeon who performed your operation.
Is There Difficulty Urinating After Happiness Rod Surgery?
A catheter is generally placed in the urinary tract during happiness rod surgery. This catheter is removed the day after surgery, and there are usually no urination-related problems after surgery.
However, patients who had difficulty urinating before surgery due to prostate problems or urethral stricture should inform their doctor of this condition. When necessary, precautions can be taken in advance to reduce the likelihood of problems.
Does Penile Curvature Occur After Happiness Rod Surgery?
Penile curvature does not occur after happiness rod surgery. In most cases, pre-existing penile curvature is corrected after this surgery and reaches a level that allows normal sexual intercourse. The surgery’s benefit in improving curvature as well as its positive effect on erection is undeniable.
What Should Be Done If Bleeding Occurs After Happiness Rod Surgery?
After surgery, there may be slight bleeding in the form of blood oozing from the incision site. Beyond this, intense, serious, or life-threatening significant bleeding does not occur.
If you see bleeding at the wound site or if there is serious bleeding to the extent of soaking the dressing, notify your doctor. Early-stage bleeding is not serious bleeding. After the postoperative period, no bleeding occurs.
Caution should be exercised regarding bleeding in patients with bleeding disorders or those who used blood thinners before surgery. The pre-operative and post-operative medications of these patients should be carefully adjusted.
Post-operative dressing is usually opened and changed after 24 hours, followed by daily dressing for approximately 1-2 weeks, which is sufficient. Any additional dressing requirements should be carried out according to your doctor’s recommendations.
Prosthesis Usage Training After Happiness Rod Surgery
Training before using the device after surgery is absolutely essential. Otherwise, damage to the device may be inevitable. We definitely provide training at our clinic to patients whose surgery we have performed before they start using it. We only allow our patients to use the prosthesis after we are sure they can fully operate it.
Bathing After Penile Prosthesis Surgery
After penile prosthesis surgeries, closure of the wound on the skin is generally expected before bathing and showering. Generally, a period of 1-2 weeks is sufficient for bathing. It would be appropriate to consult your doctor about the most suitable timeframe for you.
What Should Be Done If There Is Redness or Bruising on the Penis After Happiness Rod Surgery?
If there is persistent redness on the penis and discharge from the wound site after surgery, you must definitely notify your doctor. Swelling, redness, increased warmth, pain, and accompanying purulent discharge may be harbingers of infection development at the prosthesis site.
Early detection and starting appropriate antibiotics is extremely important. Therefore, please notify your doctor in advance when you encounter the complaints described above.
Mild bruising and swelling on the penis may occur in the early postoperative period; these are completely normal. Over time, these symptoms will gradually decrease with each passing day. There is no need to worry.
When Is Discharge After Happiness Rod Surgery?
Patients are mostly discharged 24-48 hours after penile prosthesis surgery. However, this period may be extended depending on the patient’s characteristics. Especially in:
- those with systemic rheumatic disease
- diabetic patients
- cardiac patients
- those with chronic liver failure
- patients with chronic kidney failure, hospital stay may be prolonged as greater caution is needed regarding infection.
Getting up after surgery occurs very quickly. Although it varies depending on the type of anesthesia to be applied and the patient’s characteristics, patients can generally stand up and walk 6 hours after surgery.
Lifespan of the Penile Prosthesis
A specific lifespan has not been defined for penile prostheses, but the warranty periods from manufacturers for these devices vary. A single recent scientific study has indicated that it can exceed 20 years.
However, with the use of today’s prostheses, which are new technology products, this duration is expected to be much longer in most patients.
What Should Be Done to Extend the Life of the Penile Prosthesis?
First and foremost, having received training before using the device is very important. Being gentle and careful with the device during use in accordance with this training, being very delicate when achieving and ending erection before and after intercourse, and not exceeding the usage instructions are important for preserving the device’s lifespan.
Can the Penile Prosthesis Burst or Break Down?
This is one of the frequently asked questions by patients with inflatable penile prostheses. There is no need to worry because when sufficient fullness is achieved and the penis reaches maximum erection, further inflation is automatically prevented. Therefore, bursting does not occur with manual inflation.
How Is the Prosthesis Size Determined During Penile Prosthesis Implantation?
During penile implantation, while the structures related to erection called corpus cavernosum are being dilated, penis length is evaluated with special measuring devices and the most appropriate sized prosthesis is implanted in the patient.
Can Happiness Rod Surgery Be Performed on Those with Prostate Enlargement and Cancer?
Happiness rod surgery is an operation performed on men with erectile problems. Therefore, it has no relation to prostate size. It can be easily implanted in patients with prostate enlargement as well.
Happiness rod surgery is generally an operation applied to patients who experience erectile problems after prostate cancer surgery. Surgery is generally performed on patients due to prostate cancer. During this surgery, the nerves stimulating the penis are cut, leading to erectile problems.
Men who did not have erectile problems before prostate cancer surgery may experience erection-related problems after surgery. Particularly in this group of patients, penile prosthesis is much more successful and gratifying results are obtained.
Is There an Age Limit for Surgery?
There is no age limit for happiness rod surgery. More important than age, the person’s daily performance status, whether they have a neurological disease, their other existing systemic diseases, and whether they use medication for these are the determining features in the surgical decision.
Can the Happiness Rod Be Noticed from Outside?
Unfortunately, one-piece malleable prostheses that remain constantly rigid can be noticed from outside. Other than that, it is nearly impossible to notice inflatable prostheses, whether 2-piece or 3-piece, from outside.
In fact, even during sexual intercourse, it is difficult for the partner to notice unless touched. Therefore, male patients can use the prosthesis with confidence.
Happiness Rod for Diabetic Patients
Diabetes mellitus is a systemic disease. All organs in the body are negatively affected by this disease. Just like other organs, the penis is also negatively affected by diabetes. Erectile problems are among the common problems in diabetic patients.
In these patients, sometimes oral medication therapies or other treatment methods do not provide a response, and the need for happiness rod implantation arises.
Prostheses can be successfully implanted in all patients in this group whose blood sugar is under control. However, the most important risk awaiting these patients is delayed wound healing and infection.
Which Anesthesia Is Applied During Happiness Rod Surgery?
The anesthesiologist and the patient together decide which anesthesia will be applied during surgery. While numbing the lower body is mostly sufficient, general anesthesia can also be applied for patients who require or request it. This decision belongs to the anesthesiologist.
Does the Happiness Rod Enlarge the Penis?
Happiness rod surgery is not a penis enlargement surgery. However, since various curvatures and deformities can be corrected during surgery, some lengthening of the penis may be noticeable from outside after penile prosthesis surgery.
Additionally, some recently developed technological prostheses not only lengthen but also expand laterally, creating some increase in penile thickness and diameter.
Can One Have Children After Happiness Rod Surgery?
Happiness rod surgery is performed on patients with erectile problems. Due to its success in enabling sexual intercourse, it also facilitates the ability to have children. In other words, the surgery does not prevent having children.
Can Happiness Rod Surgery Be Performed After ESWT Treatment?
Happiness rod surgery can be easily performed on patients who do not respond to ESWT treatment, also known as shock wave therapy.
There is no drawback to receiving shock wave therapy known as ESWT before surgery.
Can a Two-Piece Be Upgraded to a Three-Piece Penile Prosthesis?
When a patient who previously had a two-piece prosthesis implanted needs to have it removed for any reason, a 3-piece prosthesis can be implanted in its place.
Is There a Limit to Using the Happiness Rod?
This is one of the frequently asked questions by patients who have had a happiness rod implanted. Patients are curious about how frequently they can have sexual intercourse after this surgery.
There is no restriction for this. What determines this frequency is the man’s desire for sexual intercourse and the female partner’s attitude toward this situation.
Can a Person with a Happiness Rod Ejaculate?
Ejaculation occurs normally in patients who have undergone the surgery. Problems such as lack of pleasure or enjoyment before ejaculation are generally not seen, and the feeling of orgasm (relief) during ejaculation is experienced normally.
Conclusion
- It is the last-resort treatment method applied to patients with erectile problems.
- One-piece, 2-piece, or 3-piece forms are available.
- 2 and 3-piece prostheses are also known as inflatable prostheses.
- One-piece prostheses are known as malleable prostheses.
- Pre-operative anesthesia preparation is performed.
- During surgery, the component placed inside the cavernous tissue, the pump, and the reservoir are implanted in different body areas for 3-piece prostheses.
- Pre-existing curvatures in the penis can be corrected during surgery.
- Post-operative patient and female partner satisfaction rates can exceed 90%.
References:
- PenileProsthesis Surgery: Current Recommendations From the International Consultation on Sexual Medicine. Levine LA, Becher EF, Bella AJ, Brant WO, Kohler TS, Martinez-Salamanca JI, Trost L, Morey AF. J Sex Med. 2016 Apr;13(4):489-518.
- Penileprosthesis implant: scientific advances and technological innovations over the last four decades. Chung E. Transl Androl Urol. 2017 Feb;6(1):37-45.
- Inflatable PenileProsthesis: Considerations in Revision Surgery. Wintner A, Lentz AC. Curr Urol Rep. 2019 Mar 20;20(4):18.
- Ambicor Two-Piece Inflatable PenileProsthesis: Background and Contemporary Outcomes. Ko OS, Bennett NE Jr. Sex Med Rev. 2018 Apr;6(2):319-327.
- Biomechanical Studies of the Inflatable PenileProsthesis: A Review. Madiraju SK, Wallen JJ, Rydelek SP, Carrion RE, Perito PE, Hakky TS. Sex Med Rev. 2019 Apr;7(2):369-375.
- Penileprosthesis in the management of erectile dysfunction following cancer therapy. Dadhich P, Hockenberry M, Kirby EW, Lipshultz L. Transl Androl Urol. 2017 Nov;6(Suppl 5):S883-S889.
- PenileProsthesis Infections-A Review of Risk Factors, Prevention, and Treatment. Pineda M, Burnett AL. Sex Med Rev. 2016 Oct;4(4):389-398.