Penile implant

What are the penile implants?

  • Penile implants are devices placed inside the penis to allow men with erectile dysfunction (ED) to get an erection. Penile implants are typically recommended after other treatments for ED fail.
  • There are two main types of penile implants, semirigid and inflatable. Each type of penile implant works differently and has various pros and cons.
  • The placement of penile implants requires surgery. Before choosing penile implants, make sure you understand what surgery involves, including possible risks, complications and follow-up care.

When is the use of penile implants indicated?

For many men, erectile dysfunction can be successfully treated with medications (oral, intracancerous or intracavernosal injection) or by using a penile pump (vacuum constriction device).
The penile prosthesis is a treatment that can be used when pharmacological treatments are not effective.

However, the Clinical Guidelines of the American Association of Urology recognize the penile prosthesis may -after being assessed with the patient- be indicated as a first therapy, on the basis of the level of satisfaction provided to the patient & the couple (> 90%).

About the penile implant:
  • Penile implants are a very safe treatment in experienced hands and a good indication.
  • They provide a high satisfaction rate in sexual relations, both for the patient and the couple.
  • The surgery is generally safe and short stay.
Before considering a penile implant:
  • It is important that you consult your surgeon about the experience and results, as long as you inform the medical team about your expectations.
  • Comprehensive information on techniques, success rates and complications should be provided before the intervention.

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Which are the main risks of penile prosthetic surgery?

Infection

As with any surgery, infection is possible. You might be at an increased risk of infection if you have a spinal cord injury or diabetes. However, nowadays with new devices available coated with antibiotics, the risk is really low, less than 2%.

Implant problems

New penile implant designs are reliable, but in rare cases the implants might malfunction. Surgery is necessary to remove, repair or replace a broken implant.

Initially, you’ll talk to your doctor or a urologist about penile implants:

  • Review your medical history. Current and past medical conditions, especially your experience with ED. Talk about any medications you’re taking or have taken recently, as well as any surgeries you’ve had. Your doctor will confirm the presence and nature of ED.
  • Do a physical exam. To make sure penile implants are the best options for you, your doctor will do a physical exam, including a complete urologic exam. He or she will also try to determine whether there’s any reason that penile implant surgery is likely to cause complications. Your doctor will also examine your ability to use your hands, since some penile implants require greater manual dexterity than others.
  • Discuss your expectations. Make sure you understand what the procedure involves and the type of penile implant that suits you best. It’s also important to know that the procedure is considered permanent. Your doctor will also explain the benefits and risks, including potential complications. Ideally, you’ll include your partner in the discussion with your doctor.

There are three basic types of implant:

  • Malleable: two flexible rods that produce permanent rigidity but are “bendy” so they can be concealed. They are quick and easy to insert, rarely develop mechanical problems and are especially useful in men with complex medical problems;
  • Three-piece inflatable: two paired cylinders in the penis, a pump in the scrotum and a fluid-filled reservoir in the abdomen. The pump is activated by hand and most closely mimics a normal erection. Because they have many parts, they take longer to put in and have a higher risk of mechanical problems which may require surgical repair; and
  • Two-piece inflatable: two pre-filled cylinders which require a scrotal pump but have no fluid reservoir. They are useful if you have had pelvic or abdominal surgery which makes reservoir insertion difficult. They do not become as flaccid (floppy) when deflated as three-piece devices.

Before the procedure, you will have a full counselling session, with your doctor and specialist nurse, regarding the different types of implant, and you will be shown how they look and work.

Typically, an implant lasts 10 years, after which it will need to be exchanged for a new one.

How is the penile implant procedure?

Before the procedure

Penile implant surgery is usually done at a surgery center or hospital. IV antibiotics are given to help prevent infection. The surgery site will also be shaved immediately before surgery to reduce the risk of infection. Never shave the genital skin by yourself at home before going to the hospital.

During surgery

Surgical technique implantation may be either infrapubic or peno-escrotal.

A tube (catheter) might be inserted into your bladder via your penis to collect urine at some point during surgery. Your surgeon will make an incision at the base of the penis.

Next, your surgeon will stretch the spongy tissue in the penis that would normally fill with blood during an erection. This tissue is inside each of the two hollow chambers called the corpora cavernosa. Your surgeon will choose the correct size implant and place the implant cylinders inside your penis. All sizes are customized to your exact body measurements.

If your doctor is implanting a two-piece inflatable device, a pump and valve are placed inside the scrotum. For a three-piece device, your doctor will also implant a fluid reservoir under the abdominal wall through an internal incision.

Once the device is in place, your surgeon will sew the incisions closed. Penile implant surgery usually takes 45-60 minutes.

After surgery

After penile implant surgery, you’ll likely need to take medications to ease pain. Mild pain might persist for several weeks. You might also need to take antibiotics for one week to prevent infection.

Your doctor will provide specific instructions during the healing process and about when you can resume normal activities. You’ll likely need to return to your doctor every other two weeks.

At this point, your doctor might recommend fully inflating and deflating inflatable penile implants twice a day to give you practice using them and stretch the area surrounding the cylinders.

Most men can resume sexual activity about four to six weeks after surgery.

 

How to use a penile implant?

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