Titan penile implant surgery offers you the chance to regain a satisfying and fulfilling sex life. Your penile implant surgery also ensures a more spontaneous sex life. Expert penile implants can result in 17% more girth, three times more rigidity, and three times more durability. When you compare between inflatable vs. non-inflatable penile implants, your penis will look relaxed and normal when flaccid with the inflatable Titan implant. Surgical approaches Conducting true randomized, placebo-controlled trials in IPP surgery is difficult owing to ethical issues and patient recruitment; thus, more multi-institutional collaborative studies with longer-term follow-up should be undertaken with strict methodology and meaningful objective outcome measures. The increased understanding of IPP surgery and advances in prosthetic surgical techniques have resulted in higher quality products and better surgical outcomes. A multimodal analgesia protocol including intraoperative analgesia strategies can minimize postoperative pain and improve patient satisfaction rates (Grade C). In a study by Mulhall et al. 32 post-PPI patients reported a statistically significant improvement in satisfaction score when PPI is used in conjunction with sildenafil (24).Prevention remains the best approach to troubleshoot prosthetic-related complications such as corporal perforation, urethral injury and suboptimal placement of IPP components.If you’re thinking about or have had penile implant surgery, knowing what to do during recovery is essential.Increased durability and rigidity may enhance penetration performance during sexual intercourse, for greater confidence in a variety of sexual positions.3,4,5 Maximized girth may lead to increased partner stimulation and satisfaction.6Adverse events following penile protheses implantation may be new onset (de novo), persistent, worsening, transient, or permanent.The use of intracavernosal injections and vacuum erection devices are generally not used after PPI surgery as there is an inherent risk of prosthetic cylinder damage. In men with Peyronie’s disease (PD) and concomitant ED, a concurrent penile prosthesis implant is often advocated in men who require complex penile reconstructive surgery, or in those who have a high likelihood of postoperative ED11. Variability in patient care — in terms of postoperative antibiotic use, pain management, scrotal care, and cycling of the penile prosthesis implant — must be reduced to enable optimization and assessment of outcomes across patient groups. Besides traction therapies and surgeries to enhance perceived penile size, refinements in the surgical approach to allow greater conservation of cavernosal smooth muscle and optimal sizing of the implant cylinders are simple ways to optimize penile length. Although the implant is not visible, depending on the placement (submuscular) the reservoir may be palpable. Patients with spinal cord injury may have an increased risk of infection. The Titan implant is a 3-piece fluid-filled system manually operated to produce and sustain an erection for sexual intercourse. If you’d like to talk to someone who has the Titan implant, schedule time to meet with a Patient Educator. In the case of a unilateral perforation, a single-cylinder placement on the normal corporal chamber (contralateral side of urethral perforation) can be undertaken, although reported patient satisfaction is considerably lower in a single inflatable cylinder than with two-cylinder placement4. The proximal corporal measurement often determines the selection of cylinder size and selection of rear tip extender length to ensure that the proximal cylinder tip can be placed accurately4. The appropriate cylinder size is selected based on the maximum corporal length measurement with the aim of maximum cylinder size with minimum rear tip extenders (Table 2). The surgical incision involves a vertical or horizontal incision over the upper part of the scrotum (trans-scrotal) (Fig. 1a) or extending into the penile shaft (penoscrotal junction) (Fig. 1b), which can provide better corporal exposure (by extending the incision further along the penile shaft). Titan® Inflatable Penile Implant:Reignite performance In a study by Wang et al., the penile lengths of 11 patients who had full erections after intracavernous injections (ICI) done at the time of penile duplex ultrasonography before surgery was compared with measurements 1 year after PPI insertion (4). Deveci S et al. measured the stretched flaccid penile length (SPL) of 56 patients undergoing their first implant surgery pre-operatively and 6 months after (3). Loss of penile length as a result of penile prosthesis placement is the most common postoperative patient complaint shown to reduce overall satisfaction with the procedure. Loss of penile size is a common complaint that can negatively affect patient satisfaction rates following successful penile prosthetic implant surgery. Continued investment in research and development by device companies has resulted in the creation of a newer generation of penile prosthesis implants, whereas clinical governance by regulatory bodies ensures that these devices remain safe and reliable. If you’re thinking about or have had penile implant surgery, knowing what to do during recovery is essential. Welcome to BetterBody MD’s guide to penile implant recovery time. A penile implant can help many men restore their sexual confidence and enjoy the freedom from erectile unpredictability. Additionally, the ideal Titan penile implant candidate is an individual who may have curvature of the penis and wishes to improve this feature. You will no longer have to plan ahead or worry about timing, as Titan implants ensure a more spur-of-the-moment sex life.Lastly, a Titan penile implant provides versatility during sexual intercourse. Conserving cavernous tissue during PPI surgery can help to preserve residual sexual function and penile length. In fact, a new length measurement technique for IPP has allowed larger cylinders to be inserted in primary implants with no increased risk of distal erosion after 24 months. When choosing the size of cylinders to be used, inadequate sizing or intentional downsizing by surgeons will have a direct impact on the final erect penile length. In his study involving 50 patients managed with immediate PPI, overall treatment satisfaction rate was 96% with no complaint of penile shortening. Great Psychedelic Movies That Are Worth Your Time An IPP is thought to be better and safer than malleable implants in the neophallus because it enables a more physiologically normal erection process, without constant pressure against the distal neophallus flap. Great care should be taken to avoid damaging the existing device and a cutting current should be used wherever possible. In the salvage procedures, all components of the device should be removed, followed by vigorous mechanical lavage with solutions comprising a combination of diluted betadine, half-strength hydrogen peroxide and antibiotic agents, such as kanamycin and/or bacitracin antibiotic solution18. Strategies to correct residual penile curvature include manual penile modelling (with inflated cylinders), intracorporal plaque incision, extracorporal plaque-releasing incision and/or graft reconstruction11,62. A malleable implant can also be used to provide a cheaper and easier alternative and patients can then elect to have an IPP implanted at a later date58,59,60,61. However, ectopic reservoir placement might not be ideal in thin patients in whom the reservoir outline might be visible, and potential complications such as inadvertent vascular injury and reservoir migration or herniation54,55. Retropubic reservoir placement is achieved by blind puncture through the transversalis fascia in a penoscrotal approach, with a potential risk (1–2%) of inadvertent organ injury (vascular, bladder or bowel) especially following robotic surgery. Penile prosthesis surgery in the neophallus after gender-affirming surgery is often complex and should be performed by an expert surgeon owing to the anatomy of the neophallus and higher revision rates than for conventional IPP surgery (Grade C) (Box 1). Several advanced surgical techniques and adjuvant manoeuvres can be used to increase penile length during IPP insertion although these manoeuvres should be performed by an expert surgeon. The decision to perform a salvage implant procedure in suspected or confirmed infected IPP should always involve both the surgeon and patient and the patient’s partner, with due consideration of the various options and scenarios (Grade C). Thus, IPP placement in the neophallus risks subsequent prosthesis malposition and distal erosion in up to one-third of cases79. The neophallus and native phallus have pertinent anatomical differences, which can present surgical challenges, as the neophallus lacks proper corporal bodies and surrounding tunica albuginea79. Continence surgery should generally be performed before IPP surgery, any inadvertent urethral injury would require abandoning and would preclude preparation and implantation of both prostheses.Current practice has shifted towards improved perioperative local anaesthesia and postoperative analgesia cover89,90.The experts concluded that proper patient selection, informed consent and strict adherence to safe surgical principles are important to optimize clinical outcomes.If a Titan penile implant is right for you, a treatment plan is curated to fit your needs and budget.Management strategies for implanting prostheses in men with corporal fibrosis include sharp dissection with Metzenbaum scissors, serial corporal dilation with Hegar or Brooks dilators or the use of other specialized tools such as cavernotomes (Carrion-Rossello, Minneapolis, MN, USA) and Uramix (Lansdowne, PA, USA)4,18.Corporal cylinder complications — including crossover, proximal or distal corporal perforations — can occur in any patient owing to poor surgical technique and in men with corporal fibrosis4,11.Furthermore, anchoring the proximal end of the penile implant can be challenging owing to the lack of proximal crura and attachment to ischial rami. In the 16th century, men of the Topinama tribe of Brazil allowed poisonous snakes to bite their penises in order to enlarge them. The Sadhus holy men of India and males of the Cholomec tribe in Peru used weights to increase their penile lengths. Across different cultures, references to penile enhancement exist in various forms. Device malfunctions may result in the inability to inflate or deflate the device. For the same cylinder length, the Coloplast Titan provides a larger cylinder girth diameter (up to 21 mm each cylinder) than other IPPs and the Bioflex material is thought to be stronger and more fatigue resistant than silicone material in ex vivo and in vitro studies51. However, the insertion of the reservoir into the retropubic space is performed blindly in this approach4. IPP surgery can be performed through penoscrotal (or trans-scrotal), infra-pubic and sub-coronal approaches (Fig. 1 and Table 1). Thus, an appropriately trained and safe surgeon with high-volume expertise in penile prostheses will deliver high-quality outcomes, and potentially, increased economic value47. more girth than the competition2 Placed in the scrotum, the pump is used to activate and deflate the system. The cylinders remain full and allow you to be erect for as long as you want. Placed in the abdomen, the reservoir houses the fluid that is used throughout the system. Custom-fit to your natural length, the Titan implant has three parts. Titan penile prostheses are a safe and effective option for many men who struggle with erectile dysfunction. Their visible results demonstrate Titan’s effectiveness at improving the overall appearance of an erect penis. Furthermore, anchoring the proximal end of the penile implant can be challenging owing to the lack of proximal crura and attachment to ischial rami. Careful preoperative planning is required, including a review of the patient’s previous surgical records; and having pre-operative imaging with CT or MRI might be necessary at times to better delineate the anatomy. In AUS surgery, corporal dilatation during IPP surgery must be performed with caution in the proximal part of the corporal tissue near the AUS cuff, as both corporal bodies have already diverged; a single-step dilatation can sometimes be a better option than sequential dilatation to avoid injuring the urethra18. The Zephyr ZSI 475 was launched in the early 2010s and the company manufactures the ZSI 475FtM in 2016, specifically for female-to-male gender assignment surgery2,7. As an airline pilot, I would plan my trips around layovers where I knew I would have have access to a gym and time to train. However, it was not unusual to miss several months at a time for various reasons. Slower times in exchange for less pounding on my spine is a tradeoff I'm happy to make. Strategies to preserve and potentially increase penile size are of great importance to all implanters. Based on the results of our search, strategies were classified into 3 groups based on the timepoint in relation to the primary penile prosthetic insertion surgery, which included pre-insertion, intraoperative and post-insertion. Only English-language articles that were related to penile prosthetic surgery and penile size were sought. After several months of intracorporal stretching, the patients were reoperated and wider and often longer standard-sized prosthetic cylinders can be substituted. In a study of 37 such patients, where it was impossible to dilate the corporal to 12 mm for standard-sized cylinders, smaller downsized cylinders were inserted to act as tissue expanders. While this approach offers the advantages of an expedious restoration of sexual function and the avoidance of a potentially difficult implant surgery brought on by dense corporal fibrosis, one may have to contend with a possibly higher rate of infection, which was 6% in this study (11). In recent months, there has been interest in the use of VED pump 2-3 months prior to PPI surgery because preliminary studies suggest that preoperative stretching with a VED may allow longer cylinder placements at the time of the penile prosthetic surgery (9). Before the introduction of phosphodiesterase-5 inhibitors, vasoactive penile injection testing and colour penile Duplex ultrasonography were routinely obtained as part of the diagnostic algorithm12. This Asia Pacific Society of Sexual Medicine session was not sponsored by any IPP device company, and the clinical recommendations were made independently based on the professional experience and expertise of the panellists. This session was not sponsored by any IPP device company, and the clinical recommendations were made independent of the IPP device manufacturers. As only a few prospective and randomized controlled trials involving IPP surgery have been published, a full Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was not adopted for this article; instead, a narrative approach was taken. Given the lack of high-quality randomized controlled trials in IPP surgery, specific emphasis is placed on information from narrative review articles and published guidelines (Box 1). Most men with long-standing ED will develop loss of penile length owing to corporal hypoxia and fibrosis11,18.A Titan penile surgery is a great option to consider if you want to overcome your erectile dysfunction and achieve longer-lasting erections.The early and daily use of a vacuum erection device (VED) soon after radical prostatectomy may lower the likelihood of penile length loss.In cases of prolonged ischemic priapism or removal of a previously infected implant, severe corporal fibrosis may preclude the use of larger cylinders.The informed consent process provides legal documentation for the IPP surgery and is unique to each institution, although several organizations such as the British Association of Urological Surgeons15 or the Sexual Medicine Society of North America16 have published a standardized template that can be adapted to suit the individual surgeon.The increased frequency of infections in patients with diabetes is caused by an underlying hyperglycaemic environment that favours immune dysfunction.In a study by Wang et al., the penile lengths of 11 patients who had full erections after intracavernous injections (ICI) done at the time of penile duplex ultrasonography before surgery was compared with measurements 1 year after PPI insertion (4).The Coloplast Titan series, formerly the Mentor prosthesis, was introduced in 2002 and is available in Titan (standard), Narrow Base (NB) and extra-large (XL) cylinders6. Coated implants and bacterial contamination Penile implants are generally covered by most insurance plans, including Medicare.Loss of penile length as a result of penile prosthesis placement is the most common postoperative patient complaint shown to reduce overall satisfaction with the procedure.The AMS 700 series initially used a Tactile pump but has since switched to the current Momentary Squeeze pump, which is modified to be smaller and easier to handle, with better concealment and quicker pump deflation2,5.When the device is deflated, the fluid moves back into the reservoir.The circumferential technique has been largely abandoned, owing to the risk of prosthesis fracture from poor axial rigidity, whereas sliding techniques can be performed with or without grafting72.Their visible results demonstrate Titan’s effectiveness at improving the overall appearance of an erect penis.During this time, you should avoid any sexual activity to allow your tissues to heal completely. The subcoronal approach involves a subcoronal incision below the glans penis with degloving of the penis (Fig. 1d), enabling concurrent corporal reconstructive surgery at the time of IPP surgery, as nearly the entire corpora can be accessed through the same incision. Surgeons should have adequate knowledge of these surgical approaches; the preferred method is often based on surgeon experience, the patient’s specific anatomy and whether a concurrent penile reconstructive surgery is undertaken48,49,50. IPP surgery is an invasive surgery and potential complications in the perioperative and postoperative settings can add to the overall economic burden, patient dissatisfaction and future medicolegal risk17. Databases including MEDLINE, EMBASE and Cochrane CENTRAL trials register were searched for the following terms “inflatable penile prosthesis implant”, “clinical outcome”, “complication”, “urinary incontinence”, “transgender”, “priapism”, “augmentation” and “penile reconstruction”. Everyone is different and recovery times vary, but typically it’s between 4 – 6 weeks until you can resume sexual activity.1 Your physician will determine what you can and can’t do during this time. If it has been a long time since you’ve achieved a good erection, you may experience some atrophy and perceived penis shortening.9 Discuss this in greater detail with your physician. The penis appears relaxed and normal when in the flaccid state; it will not be obvious that an implant is there.1 In patients with a pre-existing AUS, the placement of IPP should be planned so that the pump and reservoir are on the contralateral side78. Candidates for synchronous surgery are usually patients in whom conservative management for both conditions has been unsuccessful and who wish to undergo a single surgical procedure. A lock-out valve was incorporated into the Momentary Squeeze pump to prevent auto-inflation of the penile cylinders against extensive force or sudden elevated pressure within the reservoir. IPP surgery is complex and should be performed by clinicians who have adequate experience in prosthetic surgery. Prevention remains the best approach to troubleshoot prosthetic-related complications such as corporal perforation, urethral injury and suboptimal placement of IPP components. Meticulous preoperative preparation, adherence to key surgical principles and safe surgical techniques are crucial to optimize clinical outcomes. Proper patient selection, counselling and informed consent are essential, coupled with optimization of existing medical conditions especially diabetes (Grade B). Continence surgery should generally be performed before IPP surgery, any inadvertent urethral injury would require abandoning and would preclude preparation and implantation of both prostheses. In a carefully selected group of patients who understand the implications of combined procedures, a single-incision approach such as trans-scrotal insertion of IPP and AUS75 or a single perineal incision for combined IPP and MS76 is feasible and potentially more cost-effective than having a staged procedure77. Technical considerations for the device placement will vary depending on the sequence of prosthetic surgery and the surgeon’s preferences. Other surgical techniques that can enhance the perception of increased length include ventral phalloplasty, suprapubic lipectomy, and suspensory ligament release, all of which have been used to provide a subjective penile length gain66. The circumferential technique has been largely abandoned, owing to the risk of prosthesis fracture from poor axial rigidity, whereas sliding techniques can be performed with or without grafting72. If I can push myself to my physical limit a couple of times a week and still have the energy to crawl around with my daughter, then I'm satisfied. Furthermore, “One-Armed Swordsman” introduced the concept of the anti-hero, which additionally entailed intense swordplay, heavy bloodletting, and a level of violence that was unprecedented for the time. Various solutions are available to help with this condition, including medications, devices, and lifestyle changes. It’s important to learn about the risks of untreated erectile dysfunction, so you recognize the importance of getting prompt treatment. As a man with a family size my wife and I are happy with, it all worked out great. The aim of this review is to describe the various strategies that have been used to maintain penile length or girth after the insertion of a penile prosthetic implant. Adverse events following penile protheses implantation may be new onset (de novo), persistent, worsening, transient, or permanent. Impact injuries to the pelvic or abdominal areas (e.g., sports injuries) can result in damage to the implant which may necessitate replacement of the device. Adverse events are known to occur with penile protheses procedures and implants; some may require revision surgery or removal of the implant. Removal of the device without timely reimplantation of a new implant may complicate subsequent reimplantation. The device may fail to deflate and/or deflation of the device may be slow or difficult for some patients. Pre-existing abdominal or penile scarring or contracture may make surgical implantation more complicated or impractical. As you explore ED solutions that may include a penile implant, there’s nothing like real stories from real guys who have been there. Dr. Tajkarimi is one of the top 20 surgeons in the world for performing penile implants. With your penile implant, you can control the duration and intensity of your erections. With the penile implant, you will achieve firm and lasting erections. To create an erect penis, you will easily locate the pump in your scrotum and gently squeeze it a few times until you reach full erection. Squeezing this pump transfers fluid from the reservoir to the cylinders, causing them to inflate. A Titan penile implant is a device made of silicone and Bioflex that helps men with erectile dysfunction achieve and maintain an erection. Patient’s perception of decreased penile size after PPI can negatively influence overall satisfaction and sexual quality of life measures. At the time of PPI revision, a prosthesis that was 20% longer in length was used which improved erect penile length by 4.4 cm. However, the relationship between patient outcomes and surgical volume is well documented for a variety of other surgeries and is also relevant for IPP surgery42. Early and continuous effective communication among patients, general practitioners, and specialists (including the surgeons, cardiologists, and haematologists) is pivotal in managing such high-risk patients who are taking blood thinners during the perioperative period. Generally, patients at a high risk of thromboembolism should be considered for a more aggressive perioperative management strategy with appropriate bridging therapy. The IPP surgery can be performed with a low risk of clinically significant haemorrhage and thromboembolic risk for a patient on aspirin alone39 whereas antiplatelets (for example, clopidogrel) and anticoagulants (for example, warfarin or ticagrelor) should be withheld4. In most instances, the postoperative scrotal haematoma can be managed expectantly without a need for further surgical intervention40,99,100, using a combination of bed rest, ice application, scrotal support, compression dressings and prophylactic antibiotic use40. Several strategies to minimize the risk of scrotal bleeding and haematoma formation have been described, including watertight closure for corporotomies, partial cylinder inflation, compressive dressing and closed drainage98. Furthermore, multimodal analgesia protocols adopted from other surgical fields and subspecialties have been implemented in IPP surgery with good outcomes96,97. Thus, postoperative antimicrobial prophylaxis should be recommended only when the potential benefits outweigh the risks and anticipated costs — including the expense of the agent and its administration, the risk of allergic reactions or other adverse effects, and the potential for induction of bacterial resistance. The use of prostheses with antibiotic coatings has reduced the rates of infection or revision surgery related to infection82,83,84. This includes the ability to have an orgasm and ejaculate if you were able to do so before the implant.8 If you had sensation in your penis before receiving the implant, you should have the similar sensation in your penis after the implant.9 Upon deflation, the fluid will move out of the cylinders and back into the reservoir, returning the shaft to a natural-looking flaccid state. Fluid moves from the reservoir into these cylinders to create an erection. Two inflatable cylinders are placed into the natural erectile space of the penis (the shaft). When the device is deflated, the fluid moves back into the reservoir. The strategies in this review target 3 stages of patient care; pre-insertion, intraoperative and post-insertion. The mechanical erections brought on by PPI are sometimes perceived as inadequate because of absent glans tumescence. Human autologous grafts are good options if longer operative time and donor site complications are not of major concerns. In augmentation corporoplasty, tissue grafts are used to elongate the penis during PPI insertion. Completely hidden inside the body, the Titan penile implant is designed to mimic the look and performance of a natural erection. Strict patient selection and counselling are essential, coupled with the use of evidence-based surgical principles and safe surgical techniques, as well as vigilant postoperative care, are paramount to ensuring the best clinical outcomes and patient satisfaction rates. Several strategies are aimed at minimizing the risk of scrotal bleeding and haematoma formation, and in most instances, the postoperative scrotal haematoma can be managed expectantly without a need for further surgical intervention (Grade B). Postoperative antibiotics use can be discontinued within 24 h unless justified for specific antimicrobial prophylactic regimens in specific groups of patients and postoperative antimicrobial prescription is often based on the surgeon’s own personal preference in consultation with a local institution’s antimicrobial guidelines (Grade C). Surgical intervention with clot evacuation is mandated if patients present with an enlarging scrotal haematoma, prolonged pain and impending skin infection40,98,100. Thirdly, an inflated PPI fills up only the corporal bodies of the penis and has no impact on glanular engorgement, which is a physiological phenomenon in normal erections. This could affect the accuracy of their recollection of what their penile sizes were prior to the onset of their condition. Secondly, many patients who underwent PPI insertion may have a history of ED lasting many months or years. Is a Titan Penile Implant Right for Me? Additionally, patients with more noticeable curvature of the penis achieve improved, rigid erections. Each transformation shows the amazing results possible with this penile implant procedure. Titan implant before and after images depict actual results from real patients who have undergone the Coloplast Titan placement. Read on to see real before and after results and learn more about Coloplast Titan penile implants to determine if this highly specialized and satisfying procedure suits you. Moreover, they reveal how a penile implant procedure preserves maximum girth and length for solid and natural-looking erections. By contrast, the present consensus statement builds on and expands the surgical aspects of the 4th International Consultation on Sexual Medicine guideline on penile prosthesis implant, which was endorsed by the International Society of Sexual Medicine and published in 2016 (ref.4). A successful penile implant surgery with Dr. Tajkarimi can boost your self-confidence in sexual encounters. Three to four weeks after your surgery, you can safely use your Titan penile implant during sexual intercourse. Device characteristics and placement Like any body part that goes unused for a long time, the muscles and fibers of that body part begin to break down. The Titan implant is completely hidden inside the body and is not visibly noticeable. Increased durability and rigidity may enhance penetration performance during sexual intercourse, for greater confidence in a variety of sexual positions.3,4,5 Maximized girth may lead to increased partner stimulation and satisfaction.6 It is important to note that a reputable professional treated the patients. During your consultation, Dr. Tajkarimi will decide which implant and size is best for you. The Coloplast Titan implant offers a wide variety of sizes since there is a wide variety in male anatomy. We are hopeful that advancements in stem cell technology may one day allow surgeons to pre-operatively increase cavernosal smooth muscle content and improve tunica albuginea elasticity, which are the bane of contemporary penile shortening after PPI. Box 1 Summary recommendations for inflatable penile prosthesis surgery Tajkarimi’s work was streamlined, not rushed, and the healing time that I was told to expect was spot on. Post-surgery, he has been readily available to respond to all my concerns and questions quickly. He made my surgery day effortless — bolstering my confidence with humor and encouragement. Dr. Tajkarimi will decide if this implant method suits your needs during your visit. Surgeons are increasingly likely to be faced with the dilemma of either continuing these agents and accepting potential serious bleeding or withholding therapy and risking fatal thromboembolic complications4,39. The prescription of antifungals should be done in consultation with an infectious disease physician and the clinical decision should be made to promptly explant the infected IPP if the patient fails to improve after 48 h or in the presence of pus or urosepsis. Although the use of postoperative antibiotics lacks strong scientific evidence, many surgeons will prescribe postoperative antibiotics to cover for common skin organisms (for example, Staphylococcus spp.)3,4. However, the choice of antibiotics is likely dependent on hospital prescribing guidelines, surgeon’s preference, patient’s drug allergy and/or sensitivity, antibiotic availability and local anti-microbiograms. A formal urine microscopy test should be obtained to ensure that there is no bacterial growth in the urine before surgery. Patients should be advised to avoid strenuous physical activity in the early postoperative period for the first 4 weeks. Current practice has shifted towards improved perioperative local anaesthesia and postoperative analgesia cover89,90. The proximal cylinder end can be anchored to the pubic bone to prevent proximal cylinder migration, either with direct placement of permanent sutures onto the proximal cylinder base or rear tip extender, or within a graft–cylinder complex (for example, the Dacron polyester vascular graft)80. The introduction of the modern inflatable penile prosthesis (IPP) in 1974 completely revolutionized the treatment for erectile dysfunction (ED)1. Furthermore, most intraoperative complications, if recognized, can be addressed intraoperatively to enable placement of the device at the time of initial surgery. We can’t wait to help you reclaim your sex life and fulfill your desires with the #1 penile implant procedure. Residents in Northern VA and Greater Washington DC who struggle with severe erectile dysfunction seek Titan penile implants at our state-of-the-art medical facility to help restore their sex life. If a Titan penile implant is right for you, a treatment plan is curated to fit your needs and budget. The ZSI 475FtM is a specifically designed prosthesis for use in a neophallus, which consists of a single-cylinder (12, 15 or 17 cm in length) with a large, more glans-like distal tip, large stainless steel and silicone proximal base for pubic bone fixation, and a pump that resembles a testicle81. A specialized IPP designed to meet the specific needs of transgender patients after phalloplasty is a great unmet need, as transgender patients experience higher revision rates than cisgender men owing to complications related to prosthetic infection (8 to 50%), erosion (4 to 10%), malposition (3 to 30%) and mechanical failure (9 to 20%)79,80. The decision on the implantation of one or two cylinders is often made based on the size and girth of the neophallus to ensure that the cylinder is aesthetically acceptable, symmetrical, and not too superficial to the overlying skin. Table 1. Causes for loss of penile size. Although the use of postoperative antibiotics lacks strong scientific evidence, many surgeons will prescribe postoperative antibiotics to cover for common skin organisms (for example, Staphylococcus spp.)3,4.When the device is inflated (or activated), fluid moves out of the reservoir into the cylinders.Penile prosthesis implantation is often considered the last option in men who are refractory to or unwilling to use phosphodiesterase-5 inhibitors, intraurethral or intracavernosal injections, and a vacuum erection device10.Surgeons are increasingly likely to be faced with the dilemma of either continuing these agents and accepting potential serious bleeding or withholding therapy and risking fatal thromboembolic complications4,39.The difference in patients reporting an increase in length compared to decreased length in both groups was statistically significant (P14).Careful preoperative planning is required, including a review of the patient’s previous surgical records; and having pre-operative imaging with CT or MRI might be necessary at times to better delineate the anatomy. This means you can engage in sexual activities without worrying about the quality or duration of your erection. Unlike other temporary methods, such as pills or injections, the inflatable implant is always ready to use. You will notice that your erections are more firm and long-lasting, allowing for satisfying sexual experiences. These techniques require mobilization of neurovascular bundles and urethra, incision and/or excision of coexisting penile plaque and complete transection of corpora to stretch the penis to the maximum corrected length. Several advanced surgical techniques and adjuvant manoeuvres to increase penile length during IPP insertion, including circumferential incision68, the sliding technique with a double dorsal-ventral approach69, the modified sliding technique70 and the multiple slice technique71. Proper informed consent should be obtained, as the risk of sensory loss, glans ischaemia and/or necrosis, prosthesis-related complications, and failure to gain any meaningful length are serious concerns and cannot be underestimated66. The Titan Inflatable Penile Prosthesis is a surgically implanted mechanical penile implant intended for the treatment of erectile dysfunction in men.Generally, patients at a high risk of thromboembolism should be considered for a more aggressive perioperative management strategy with appropriate bridging therapy.During your consultation, Dr. Tajkarimi will decide which implant and size is best for you.To improve patient satisfaction and the overall perception of greater penile length, several penile enhancement procedures have been described.Across different cultures, references to penile enhancement exist in various forms.Diabetic, as well as immunocompromised patients, may have an increased risk of infection which could result in permanent damage to tissue/organs.If the retropubic or ectopic placement of the reservoir is not feasible or might result in a suboptimal outcome, a separate transverse hypogastric incision can be made to enable direct placement of the reservoir into the retropubic space.Surgeons should have adequate knowledge of these surgical approaches; the preferred method is often based on surgeon experience, the patient’s specific anatomy and whether a concurrent penile reconstructive surgery is undertaken48,49,50.In a randomized study of 100 patients with PPI, half had corporeal dilation while the other half did not. In some instances, extended corporotomies with incision or excision of corporal fibrosis followed by the use of graft material might be necessary18,56. The IPP implantation should generally be aborted in the presence of urethral injury (Grade B) (Box 1). The tubing should be buried properly within the scrotal dartos layers for improved concealment and to avoid the tubes kinking and the pump migrating. Stay sutures can be placed at the edges of the scrotal fascia opening to prevent upward pump migration. In patients who have both ED and stress urinary incontinence, synchronous or sequential (delayed) IPP with male sling or artificial urinary sphincter (AUS) surgery can be performed effectively and safely18. At present, no published data are available regarding the Penuma cast in the setting of penile implants and it is not recognized as a standard of care. The presence of tissue necrosis and purulence in the corporal bodies, or exposed device component(s) are contraindications for salvage surgery18. For nearly 50 years, considerable advances have been made in IPP technology and, coupled with improved scientific knowledge in terms of perioperative management and innovative surgical techniques, IPP surgery has been accepted as an effective and safe treatment for ED in many men2. The experts concluded that proper patient selection, informed consent and strict adherence to safe surgical principles are important to optimize clinical outcomes. A Titan penile surgery is a great option to consider if you want to overcome your erectile dysfunction and achieve longer-lasting erections. In pediatrics, scrotoplasty has been used to improve the projection of an inconspicuous penis. A more intact spongy cavernosal tissue can become engorged and contribute to a more natural response during sexual stimulation. Surgeons trained in the insertion of semirigid prostheses are often taught to downsize the rods to avoid distal erosions. Before the arrival of IPP, synthetic intracavernosal semirigid rod penile prostheses were used extensively. The choice of surgeon is likely to have an impact on eventual penile length after PPI. In a separate case report, a patient with post-PPI penile shortening underwent vacuum erection device therapy twice daily for 10 minutes per session for approximately 1 year as well as 8 hours of penile traction therapy daily for 8 months. For patients with previous infected explants, the substituted cylinders may be 2-4 cm longer (26). In cases of prolonged ischemic priapism or removal of a previously infected implant, severe corporal fibrosis may preclude the use of larger cylinders. This was compared to the response from 37 patients who did not have ventral phalloplasty during PPI, where 31/37 (83.8%) patients complained of penile shortening and only 1 (2.7%) reporting an increase in penile length. In a study by Miranda-Sousa et al., 36/43 (83.7%) patients who had ventral phalloplasty during PPI reported an increase in their perception of penile length while 2/43 (4.6%) patients reporting a decrease. Some of the best evidence for penile implants is Coloplast Titan before and after images. If not yet done at the time of PPI insertion, ventral phalloplasty, suprapubic lipectomy and penile suspensory ligament release procedures can be contemplated as part of an overall post-insertion strategy to recover perceptual penile length. In a study by Mulhall et al. 32 post-PPI patients reported a statistically significant improvement in satisfaction score when PPI is used in conjunction with sildenafil (24).