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Fifty-nine-year-old Stanley comes to The Doctors sharing his struggle with impotence. He says he has tried many treatments, both oral and injections, and nothing has worked for him. He was told the last resort is a penile implant yet his insurance doesn’t cover it and it’s expensive. He wants to know if he has any other options that may help his problem or lower his out-of-pocket costs. The Doctors call on urologist Dr. Aaron Spitz to answer his question.
Dr. Spitz says the traditional standby therapy of an implant may very well be Stanley’s best option. He questions if Stanley has had any medical conditions like high blood pressure or diabetes that may be affecting his penis. Stanley shares that he had those conditions in the past when he was overweight, but for the past two years since he lost 70 pounds, he has been normal and is not being treated medically for any of these issues.
Dr. Spitz explains long-term damage to the penis may not be fully reversible. The blood vessels in the penis which are needed to be able to carry blood and expand with the help of medications may not react at all if they are damaged. For this reason, if pills and shots don’t worry a penile implant may be the very best treatment.
Dr. Spitz uses a sponge with three chambers to illustrate the chambers of the penis. Two of them normally will fill up with blood like a sponge and expand and swell with blood during an erection. The three channels surround the urethra. With issues like diabetes and high blood pressure, that sponge gets hard and fibrotic and it can no longer swell up and expand to make an erection.
An implant can take over for the blood flow and it contains chambers that will fill with water and be inserted into the space where the spongy tissue is. These chambers are connected to a special tube that goes into a pump in the scrotum and a reservoir behind the abdominal wall so it is all completely self-contained. The Coloplast Titan implant allows the man to reach through the skin of the scrotum and activate the pump which will release the water sending it to the chambers to fill up and make an erection.
ER physician Dr. Travis Stork asks about sensation and the ability to achieve orgasm and Dr. Spitz says this implant doesn’t affect any of that, meaning that patients will implants are good to go! He explains the penis has nerves that run along the top of it so that area is not affected and neither is the urethra channel, so ejaculation is kept intact.
The procedure can be done as outpatient or overnight and while men are typically pretty sore initially it goes away within 4-6 weeks. He says typically no sex for about the same amount of time and after, it may be uncomfortable at first. Over time everything will work easily and there will be no pain and the penis will react like a normal functioning one!
Dr. Spitz says this is not an appropriate first line of treatment but it is an appropriate last line, which is where Stanley is at. The cost of the implant is expensive. It is about $8-10,000 and hospitalization costs will make the entire procedure closer to $15-20,000. The Doctors reached out to urologist Dr. Tariq Hakky and if Stanley is, in fact, a good candidate they are going to give him an implant at no cost! Stanley is getting married soon so consider this a wedding gift from The Doctors!