by Vera Martinella
Erectile dysfunction drugs are reimbursed by the NHS, while penile prostheses have not yet been included in the Lea (unlike breast implants, which have been recognized for years for women with breast cancer)
Half a century ago a team of surgeons in Texas had the intuition to create the first prosthesis that replaces the hydraulic system of the penis. But 50 years later, the intervention is now safe, effective, minimally invasive and easier to use in the future, and has not yet been included in the Lea (Essential Levels of Assistance) of our country, despite the recent approval of the tariff decree.
So due to budget constraints, 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% forced to resort to the private sector. Also include this operation in the Lea the request of the experts of the Italian Society of Andrology (SIA), made again during the recent national congress of the scientific society held in Rome.
Impotence drugs free
According to several studies, about 60% of cancer patients have intimacy problems that can be caused, in women and men, by both surgery and radiotherapy as well as drugs, chemo and hormone therapy. There are treatments for both males (such as various erectile dysfunction drugs) and females (creams, ointments, gels, or lasers). And psychological support can prove to be very useful in overcoming difficult moments: sometimes all it takes are precautions, for the sick person and for the couple.
With 36,000 new cases diagnosed every year in Italy, prostate cancer is the most frequent type of cancer in men after the age of 50, but the numbers are also increasing among the youngest: drugs for impotence (a problem that affects many patients) can be obtained free of charge by patients through the National Health System. According to note 75 of the Italian Medicines Agency, men undergoing radical prostatectomy and those treated with radiotherapy can receive drugs against erectile dysfunction (sildenafil, tadalafil, vardenafil, avanafil) with NHS coverage, according to an established therapeutic plan by the specialist. The same is true of alprostadil, which is given by intracavernous injection, i.e., by injections inside the penis.
When the prosthesis is indicated
If the drugs do not obtain the desired effects, in young and motivated patients, penile prosthesis implantation can be a solution that guarantees a good quality of life, bearing in mind that it is a very delicate operation to undergo in treatment centres. great experience. Penile prostheses are not a habit or a luxury, but a right to continue a normal and worthy life as a couple when medical therapies fail – says Alessandro Palmieri, president of Sia and professor of Urology at the Federico II University of Naples -, but the most candidates do not have access to treatment because it is excluded from the new tariff decree and the Regions are not required to provide it. Thus there are very few facilities available, in a few public centres, distributed unevenly throughout the area.
The therapeutic efficacy of these devices and the non-aesthetic nature of the intervention have also been recognized by the most recent European guidelines for men who have undergone oncological surgery for the prostate, but also for bladder and rectum tumors, who lose their own sexual function. The problem also concerns other diseases, from diabetes to neurological pathologies, up to deformation diseases of the penis that prevent an erection, adds Palmieri.
The law discriminates against men
While the reimbursement of breast implants has long been expected for women undergoing mastectomies for breast cancer, men do not receive the same treatment after radical pelvic surgery. This happens because these are aids not included in the Lea, whose expenses incurred by the hospital are not, in practice, covered by the NHS: in fact, a reimbursement of 2,740 euros is provided for a cost for the prosthesis alone of around 8,500 euros. more operating theaters and surgeons – remarks Marco Bitelli, co-president of the Congress and medical director of Urology at the San Sebastiano Hospital in Frascati -. The consequence is that these principals are granted with a dropper, no more than 3 or 5 per 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 ten eligible accesses the system through public and affiliated healthcare: all the others must go to private facilities.
How does it work
Prosthesis implantation today is a safe, minimally invasive and effective procedure. The positioning takes about an hour and is completely hidden because there are no external components – clarifies Palmieri -. The convalescence is very short and the recovery times overall rapid: within about a month and a half you can resume having an active sexual life with a 100% restored erection. The main risk is that of infection of the prosthesis, which requires its immediate removal. A rare complication, but essential to consult expert surgeons.
Two types of prostheses
The penile prosthesis is a mechanical device that restores the internal mechanism of erection without altering the external sensitivity of the penis in the emission of seminal fluid. There are currently two classes of prosthetics: inflatable and non-inflatable. The first, also called semi-rigid, is a device made up of two rigid silicone cylinders that are inserted into the natural cylinders of the penis, called corpora cavernosa. The device gives a rigidity such as to allow penetration at any time, so the penis is always ready for use but has a malleable core at the base, which allows the organ to be placed in the groin cavity.
The inflatable prosthesis, also called hydraulic, can mimic a state of flaccidity or erection depending on whether it is inflated or not. constituted by a very sophisticated closed circuit, made of two silicone cylinders which occupy the inside of the cavernous bodies which fill up with water coming from a tank, positioned near the bladder inside the abdomen. The liquid from the tank passes to the cylinders of the prosthesis through what is known in the jargon as a pump.
Research is progressing
It is an activator inserted inside the scrotum whose crushing causes the water to pass from the tank to the two cylinders, which fill with fluid instead of blood and go into erection. Once the ratio is completed, the same activator is used to deflate the system, allowing the water to reverse from the cylinders to the tank. The prosthesis thus empties and the penis becomes flaccid again.
Research is making a lot of progress and today aims to create touchless prostheses, capable of functioning without a “pump”, easier and with lower risks of breakage of the hydraulic components – concludes Simone Cilio, andrologist of the Urology Unit at the Federico II University of Naples -. There are prototypes based on neurotransmitters that sense excitatory stimuli from the central nervous system to trigger an erection. Another mechanism, easier to use, is also being studied, which allows erection to be triggered by thermal induction, thanks to the activation of an electromagnet.
August 17, 2023 (change August 17, 2023 | 07:15 am)
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