Half a century ago a team of surgeons in Texas had the intuition to create the first penile prosthesis that replaces the hydraulic system of the penis damaged by prostate cancer. Since then techniques and materials have improved, and for the future a new generation of ‘touchless’ prostheses is being studied, easier to use, which instead of the ‘pump’ have a modular neurotransmitter which perceives the excitatory stimulus from the central nervous system to trigger an erection. The Italian Society of Andrology (SIA) made the point during the national congress underway in Rome until 25 June. The experts draw the attention of the institutions to the fact that in Italy “just one patient out of 10 accesses the system through a public or contracted service”.
From the wooden prostheses created in the 16th century in France by Ambroise Paré, to the insertion of bones in the 30s, to the acrylic splints of the 50s, up to the insertion of polyethylene implants in the 60s, we will have to wait until July of 1973 for the implantation of the first hydraulic penile prosthesis described in the journal ‘Urology’ by Scott, Bradley and Timm. The surgery, successfully performed by the authors without problems of rejection or infections at the Urology division of the Baylor College of Medicine Texas Medical Center in Houston, USA, was performed with two pumps instead of one, placed in the scrotal area, and the submuscular insertion into the abdomen of a flat tank, which will later become cylindrical with a change of shape dictated above all to facilitate the surgeon’s work.
“From the first implant, the prostheses have evolved with the advent of new technologies, new materials, and with the improvement of the surgical technique they have become a safe, minimally invasive and effective procedure. The prosthetic positioning takes about an hour and is completely hidden because there are no external components – explains Alessandro Palmieri, SIA president and professor of Urology at the Federico II University of Naples – The convalescence is very short and the overall recovery times are rapid: within about a month and a half one can regain active sexual life with an erection restored to 100%. The main risk is that of infection of the prosthesis, which requires its immediate removal. However, this complication is very low and occurs in one case every thousand implants”.
“Today, a penile prototype is being tested at the Eleuterio Gonzalez university hospital of the Universidad Autonoma in Monterrey, Mexico, which has the advantage of being activated without the need to manually pump the scrotum, as typically occurs in conventional plumbing systems – says Simone Cilio, andrologist of the Department of Neuroscience, Reproductive Sciences and Odontostomatology, Urology Unit of the Federico II University of Naples – In this case, it is a modular neurotransmitter that perceives the excitatory stimulus from the central nervous system to trigger an erection. , another mechanism is also being studied which allows the erection function to be triggered by thermal induction, thanks to the activation of an electromagnet”.
The prosthetic implant, which has also been introduced in Italy a few years ago and is now being tested at the Urological Institute and Department of Urology of the Johns Hopkins University School of Medicine in Baltimore, USA, was described in the study published in ‘The Journal of Sexual Medicine ‘. The prototype prosthesis consists of an implantable cylinder that uses nickel-titanium alloy tubing instead of rigid silicone. This type of non-inflatable prosthesis eliminates the need for tanks and pumps, making the device easier to use.
The technological leap that could allow many men to have a fulfilling sex life is stopped in Italy by bureaucracy, the specialists point out. “After 50 years, the intervention is safe, effective, minimally invasive and easier to use in the future, but it is not yet included in the Lea of our country – denounces Sia – despite the recent approval of the tariff decree. Thus, for budget limits, only a few public facilities ensure it and just 10% of Italians who need a penile prosthesis manage to have surgery in the hospital to return to normal sexual activity.The remaining 90% are forced to resort to the private sector. The intervention must be included as soon as possible in the essential levels of assistance because gender differences in cancer treatments are no longer acceptable, despite the problem affecting thousands of men and requiring a decisive change of pace”.
“Every year in Italy about 20,000 men undergo radical prostate removal surgery following a tumor and, of these, at least 10,000 undergo erectile dysfunction with indications for penile prosthesis implantation to resolve it”, recall the andrologists . “Penile prostheses are not a habit or a luxury, but a right to continue a normal and dignified life as a couple when medical therapies fail”, warns Palmieri.
“The therapeutic efficacy of these devices and the ‘non-aesthetic’ nature of the intervention – continues President Sia – are in fact widely recognized by the most recent European guidelines for men recovering from oncological surgery for the prostate, but also for the bladder and rectum, who overcome cancer and yet lose their sexual function while still young.But the problem also concerns other diseases, from diabetes to neurological pathologies, up to deformation diseases of the penis that prevent erection.However, contrary to what is now consolidated for women, for whom the reimbursement of breast implants following a mastectomy has long been foreseen, men do not receive the same treatment after radical pelvic surgery”.
“This happens because these are principals not included in the Lea that present a Drg that does not cover the expenses: 2,740 euros against a cost for the prosthesis alone of around 8,500 euros, plus the operating room and surgeons – remarked Marco Bitelli, co- president of the Sia congress and medical director of the Urology complex hospital unit at the San Sebastiano hospital in Frascati – The consequence is that these aids are granted with a dropper, no more than 3-5 a year for each center where this surgery is practiced According to data from the SIA National Register, out of 3,000 requests, around 400 prostheses are supplied a year, 75% concentrated between the North and Centre. On balance, less than one patient out of 10 eligible accesses the system through public and affiliated healthcare: all the others must go to private structures”.
“The Italian Society of Andrology – concludes Palmieri – renews its appeal to the Ministry of Health and the Regions to modify the recently approved tariff decree and penile prosthesis surgery to be included in the Lea as soon as possible, to guarantee all cancer patients and not, candidates for the implant, a fair and homogeneous access to treatments, destined to affect critical aspects related to the psychophysical health of thousands of men of all ages”.
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