Penile implants for erectile dysfunction is a surgical option suitable for some men. 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 for erectile dysfunction are completely concealed in the body.
Penile implants for erectile dysfunction 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 is available in two different forms: two-piece and three-piece. The two-piece inflatable penile implants for erectile dysfunction consist of a pair of fluid-filled cylinders that have reservoirs at the end of each cylinder. The cylinders are implanted into the penis and a tiny pump is implanted in the scrotum.
The three-piece penile implants for erectile dysfunction include 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).
Non-Inflatable (Semirigid) Penile Implants
A non-inflatable penile implant involves surgically implanting semirigid rods in the chambers of the penis. 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 for erectile dysfunction 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 avoids 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.
Inflatable implants for erectile dysfunction give you 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 increase the girth of the penis.
The disadvantages of penile implants for erectile dysfunction 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.
Between 2 and 3% of men experience an infection associated with implants for erectile dysfunction. 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% 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% 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% 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.
Mulcahy JJ. Penile prosthesis infection: progress in prevention and treatment. Curr Urol Rep 2010 Nov; 11(6): 400-4