Dawn sat down with [Dr. Tom Walsh](http://depts.washington.edu/uroweb/directory/bios/walsh.html) of the [University of Washington’s Department of Urology](http://depts.washington.edu/uroweb/index.html)to ask what are the most important things to consider before contemplating penile prosthesis surgery. An excellent speaker, Dr. Walsh called out three things patients should consider:
- Patients that have had the surgery have a remarkably high satisfaction rate (95%)
- It’s not a completely natural erection – don’t expect the erection you had when you were 18. However, as the erection does not depend on blood flow, it will last as long as you want it to, which may partially explain the high levels of satisfaction
- Like people, every surgery is unique so spend sometime finding an experienced surgeon. Experience also counts before surgery as a good surgeon will lead you to a penile prosthesis on a pace that is best for you.
This is Dawn’s last post with Brokenhandle. She’ll be providing us with some advice going forward but her schedule is too busy for her to commit on a regular basis. We really appreciate her helping us establish the site!
**Below is the transcript of the video**
**Dawn:** Hi! This is Dawn with BrokenHandle and I’m here with Dr. Tom Walsh from the University of Washington Medical Center. What I want to ask Dr. Walsh today is: what is the most important thing a patient should know before contemplating having a penile prosthesis implanted?
**Dr. Walsh:** I think that’s a complex question and I would answer it in two ways. I would say that there are really two issues that men should think about when they’re embarking on a penile implant. Number one is a positive and number two is a negative.
The positive is to realize that penile prosthetics have remarkably high satisfaction rate, so that if we look at our studies both among my patients and published studies, you’ll find that patients and their partners when queried about “How satisfied are you with this device? Would you do it again? Would you tell your best friend or your brother to do it?” they can expect that 95% of men (95 out of 100 men) will say, “Absolutely.” And that goes with their partners, too. It’s a highly effective, very reliable way to restore sexual function. I think that’s the most important positive thing to know.
The most important negative thing to realize when you’re thinking about embarking upon penile prosthetic surgery is that this is not a completely natural erection, meaning that it’s not the erection that you have when you’re 18 years of age. It’s not based upon blood flow. It is based upon hydraulics and mechanical cylinders. So if the expectation is to reproduce identically what you had before you lost sexual function, then there will be disappointment. The benefit is that since it’s not a blood flow-based erection, it’s the first erection that most men can have that will last for as long as they want and they actually decide when to take the erection away. I think that’s also what contributes so much to satisfaction.
**Dawn:** Good to know. Dr. Walsh, how important do you think it is that a patient goes to see someone who does a lot of prosthetic surgery?
**Dr. Walsh:** I think it’s critical. I think that there are a lot of nuances both in advancing toward the decision to elect a penile prosthesis and to the surgery itself. The surgery is very intricate. While I think that many general urologists are well-trained in doing it, I think that doing it elegantly and having a really excellent outcome comes from somebody who has a lot of experience. That experience may be doing one prosthesis a month, that may be doing 50 to 100 a year. But you do want to see somebody who has that experience who when encountering unusual scenarios of which each patient is unique, that those scenarios can be dealt with. That’s at least as important as making sure that you have somebody who’s leading you toward a penile prosthesis at the correct pace, at a pace that’s appropriate for you and is indicated based upon your individual scenario.
In all of our patients we make sure that they really truly have exhausted all the medical treatments. The reason is that issue of getting back to we want men to have the most natural erection possible for as long as they possibly can. So that when men decide to have a penile prosthesis, it is absolutely without a doubt the right decision for them and it’s really the only decision for them to really get back the intimacy that they’ve lost and their sexual function. I say that because you need to remember that penile prosthesis is an irreversible treatment in many ways. Yes, we can take out the penile prosthesis but part of the implantation of the device will take away any mechanism that a man has for a normal vascular erection.
**Dawn:** Great. Thank you very much for sharing with us.
**Dr. Walsh:** Sure.
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