Excellence in Penile Prosthesis Surgery: High-Volume Success in Turkey

Penile prosthesis surgery is a highly effective surgical treatment for men suffering from severe erectile dysfunction (ED) that is unresponsive to medical therapy. In Turkey, the demand for this treatment has increased significantly, and certain medical centers have emerged as high-volume leaders in prosthetic urology.

As a urologist with years of experience at one of the highest-volume penile implant centers in Turkey, I have participated in hundreds of penile prosthesis surgeries.

What Is a Penile Prosthesis Surgery?

Penile prosthesis surgery involves implanting a medical device into the penis to help men with erectile dysfunction (ED) achieve an erection suitable for sexual intercourse. There are two main types of implants:

• Inflatable (3-piece or 2-piece):
  Offers a natural-looking erection and flaccidity. Most popular in high-volume centers.
• Malleable (semi-rigid):
  Easier to use but less natural in appearance. Preferred for older patients or those with manual dexterity issues.

Patient Selection and Surgical Indications

Ideal candidates include patients with:

• Severe ED unresponsive to PDE5 inhibitors or injections
• Peyronie’s disease with significant curvature and ED
• Post-prostatectomy or pelvic surgery-related ED
• Diabetes-induced or vascular ED

A thorough evaluation — including hormonal, vascular, and psychological assessments — is essential before proceeding.

Why Penile Prosthesis Surgery High-Volume Matters: The 100+ Case Standard

International urological guidelines and surgical outcome studies suggest that centers performing more than 100 penile prosthesis surgery per year experience:

• Lower complication rates (infection, erosion, mechanical failure)
• Faster surgical times and reduced hospital stay
• Greater patient and partner satisfaction
• Higher surgeon confidence and proficiency

These observations are supported by data from New York State in the study by Kashanian et al., which showed that hospital and surgeon volume significantly influenced the type of penile prosthesis inserted.

In another volume-based analysis using the Atlas All-Payor Claims dataset, surgeons were categorized into quartiles based on annual prosthesis implantation rates:

• Lowest quartile: 0–5 implants/year
• Second quartile: 6–13 implants/year
• Third quartile: 14–31 implants/year
• Highest quartile: >31 implants/year

Surgeons in the top quartile had significantly lower reoperation rates, consistent with findings by Onyeji et al., suggesting that >31 cases/year should be the minimum for defining high-volume centers.

Although cash-based procedures were not captured in this dataset, the findings still support a volume-outcome relationship that favors centralized, experienced providers — especially for complex or revision cases.

In their review of over 14,000 cases from 2000–2014, they noted that inflatable prostheses comprised 88% of all cases, and that high-volume centers favored their use due to greater expertise and better infrastructure
(Kashanian JA et al., J Sex Med 2018;15:245–250).

Our Center’s Role

Our center has consistently met and exceeded this threshold for several years, making us a referral hub for complex and revision cases.

Preoperative Protocols

• Urine culture and HbA1c, especially in diabetic patients
• Preoperative antiseptic wash with chlorhexidine (Hibiclens)
• Oral antibiotics starting 48 hours prior to surgery:
  • TMP-SMX
  • Ciprofloxacin
  • Cephalexin
• In diabetic patients: antifungal prophylaxis (e.g., fluconazole)

Surgical Techniques

1. No-Touch Technique: We utilize the “no-touch” technique, minimizing skin contact with the implant to reduce infection risk.

2. Placement Methods:

• Infra-pubic: Preferred for quicker exposure and pump placement
• Penoscrotal: Better for concealed pump positioning and larger reservoir placement

3. Duration:

• Malleable prosthesis: ~30–45 minutes
• Inflatable prosthesis: ~60–90 minutes

4. Special Cases:

• Peyronie’s disease correction (modeling, grafting)
• Corporeal fibrosis from prior surgeries
• Salvage procedures

Postoperative Care

• 1–2 nights of hospital stay
• Pain control with NSAIDs and opioids
• Antibiotics for 7–10 days
• Activation training at 4–6 weeks
• Regular follow-up for device assessment

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Complications and Their Management

• Infection (<3%): Prevented with antibiotic-coated implants and strict asepsis
• Mechanical failure (~5–10%): More common with older generation devices; modern implants last 10–15+ years
• Erosion or migration: Prompt removal or repositioning
• Glans hypermobility (floppy glans): Prevented with glanulopexy when needed

Success Rates and Patient Satisfaction

According to peer-reviewed literature and our own institutional data:

• Overall success rate: >90%
• Patient satisfaction: 85–95%
• Partner satisfaction: 80–90%

The Kashanian study also supports the association between high hospital volume and better device selection and outcomes, reinforcing the benefits of centralized expertise in penile implant surgery.

Why Choose Our Center?

• Over 100 penile prosthesis surgery annually
• Years of experience working at one of Turkey’s top centers
• Specialized in both primary and complex/revision cases
• Multilingual patient support for international patients
• Access to all FDA-approved implant brands (AMS, Coloplast, Rigicon)

Final Thoughts

Penile prosthesis surgery remains the gold standard for men with severe, treatment-resistant erectile dysfunction. Selecting a high-volume, experienced center dramatically improves outcomes and patient satisfaction.

With over 100 procedures performed yearly, our clinic exemplifies surgical expertise and compassionate care in penile implant surgery.

Contact us today to learn more or schedule a consultation.