Diagram of Penile Implant
What is a Penile Implant?
A penile implant is an inflatable prosthesis that is surgically inserted into the penis. An implant can consist of either an inflatable device or non-inflatable semirigid rods composed of silicone or polyurethane. Both types of penile implants are completely concealed in the body.
Penile implants are usually reserved for men who have a clear medical cause for erectile dysfunction that has not improved with erectile dysfunction pills, penile injections, or other treatments. Penile implants typically are not inserted until at least 12 to 18 months after prostatectomy to make sure a man has tried and not responded to other treatment attempts.
Inflatable Penile Implants
An inflatable penile implant is the more commonly used device, and it is available in two different forms: two-piece and three-piece. The two-piece inflatable penile implant consists of a pair of fluid-filled cylinders that have reservoirs at the end of each cylinder. The cylinders are implanted into the penis and the second piece–a tiny pump–is implanted in the scrotum.
The three-piece penile implant includes a pair of cylinders, a pump, and a fluid-filled reservoir, the latter of which is implanted in the lower abdomen. Both forms of inflatable penile implant work on the same principle as a bicycle pump.
Basically, when a man wants to achieve an erection he “pumps it up” by squeezing and releasing the pump a few times.
When the erection is no longer needed, the man simply bends the penis (for the two-piece penile implant) or releases a valve on the pump to deflate the device (three-piece device).
If you choose the inflatable type of penile implant, you have the ability to have an erection whenever you want one within five to 15 seconds. Penile implants have a high satisfaction rate for both men and their partners because they provide a 100 percent rigid erection virtually on demand. Most men can also expect to have their penile implant for life, as less than 16 percent of men require re-operation because of wear and tear on the device. Penile implants also are not associated with any change in penile length, orgasm, or ejaculation. However, the three-piece inflatable penile implant can result in an increase in the girth of the penis.
The surgical procedure to implant an inflatable penile implant is more complex than for implanting the non-inflatable rods. Therefore, men can expect up to three weeks of pain, swelling, and bruising after the procedure to implant the device. Insertion of an inflatable penile implant is irreversible. If the implant ever needs to be removed for any reason, no subsequent treatment for erectile dysfunction will work well once an implant has been used.
Non-Inflatable (Semirigid) Penile Implants
A non-inflatable penile implant involves surgically implanting semirigid rods in the chambers of the penis. Because the penis is always in a partial erection stage, it is necessary to bend and tuck the penis in order to conceal it. Some men find this awkward, and therefore it’s one of the main reasons why men typically choose the inflatable, hydraulic penile implant, which is also more natural looking than the non-inflatable, semirigid type.
When a man is ready for sexual intercourse, he simply lifts the penis and straightens the implant. After sexual activity, the implant can be bent and tucked into a position that is comfortable and concealed by clothing.
The non-inflatable penile implant has some advantages: it requires a less complicated surgical procedure, it is better for men who have less manual dexterity (it does not require men to squeeze a pump), and it is easy for men and their partners to use.
Surgery for Penile Implants
The preferred surgical approach for penile implants is to make a small incision between the penis and the scrotum under the penis. This technique leaves no visible scar, allows the surgeon excellent access, and avoid injury to the nerves in the penis. The procedure usually takes less than 2 hours and typically is done with general anesthesia, although men may choose an epidural. After an overnight stay in the hospital, during which men are given a urethral catheter that is removed the day after surgery, men can return home. Swelling can be managed with ice packs.
Advantages and Disadvantages of Penile Implants
If you choose the inflatable type of penile implant, you have the ability to have an erection whenever you want one within five to 15 seconds. Penile implants have a high satisfaction rate for both men and their partners because they provide a 100 percent rigid erection virtually on demand. Most men can also expect to have their penile implant for life, as less than 16 percent of men require re-operation because of wear and tear on the device. Penile implants also are not associated with any change in penile length, orgasm, or ejaculation.
The disadvantages of a penile implant include the need for surgery, which is associated with up to three weeks of pain, swelling, and bruising after the procedure to implant the device. There are also other possible side effects. Insertion of an inflatable penile implant is also irreversible. If the implant ever needs to be removed for any reason, no subsequent treatment will work well once an implant has been used. For men who choose the semirigid implant, the penis is always in a partial erection stage, which can be difficult to conceal. That’s one of the main reasons why men typically choose the inflatable, hydraulic penile implant, which is also more natural looking than the semirigid type.
Side Effects of Penile Implants
Between 2 and 3 percent of men experience an infection associated with a penile implant. The risk of infection is kept low with the help of antibiotics, which are used to coat the implant before it is inserted. If an implant causes an infection, the device should be removed. An option is a salvage procedure, which involves cleaning the wound with antiseptics and replacing a new prosthesis at the same time. This approach has had an 85 percent success rate. The alternative is to remove the infected penile implant and wait until a later time to replace the prosthesis, but this approach is more complicated. (Mulcahy) Infections typically occur within the first eight weeks following surgery, but in some cases they can occur as late as one year post-surgery.
The pumps or cylinders in an penile implant malfunction in about 2 percent of men within the first few months of surgery. If this occurs, the device must be replaced. Over a longer term, there is a risk of mechanical failure, which happens to about 15 percent of men over the first decade of use.
While temporary bruising and swelling of the scrotum, inner thighs and lower abdomen is common for a short time after surgery, in rare cases the bruising collects and causes significant swelling. This can be prevented by wearing a scrotal support according to your physician’s instructions. Other rare side effects can include migration of the implant and implant erosion.
Following a penile implant, men should not have any sexual activity for four to six weeks. Men should also expect it to take more than six months before their penis feels “normal” again.
Reference
Mulcahy JJ. Penile prosthesis infection: progress in prevention and treatment. Curr Urol Rep 2010 Nov; 11(6): 400-4
