Penile Prosthesis Implantation

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.
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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.

Why it’s done?

For most men, erectile dysfunction can be successfully treated with medications or the use of a penis pump (vacuum constriction device). You might consider penile implants if you aren’t a candidate for other treatments or you can’t get an erection sufficient for sexual activity by using other methods.

Penile implants can also be used to treat severe cases of a condition that causes scarring inside the penis, leading to curved, painful erections (Peyronie’s disease).

Penile implants aren’t for everyone. Your doctor might caution against penile implants if you have:

ED that’s situational, the result of a relationship conflict or potentially reversible.
An infection, such as a pulmonary infection or urinary tract infection
Diabetes that isn’t well-controlled

Keep in mind that while penile implants allow men to get an erection, they don’t increase sexual desire or sensation. Most penile implants also won’t make your penis any larger than it naturally is at the time of surgery. Your erect penis might be slightly shorter than it used to be.

Risks of penile implant 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.
Implant problems: New penile implant designs are dependable, but in rare cases, the implants might malfunction. Surgery is necessary to remove, repair or replace a broken implant.
Internal erosion or adhesion: In some cases, an implant might stick to the skin inside the penis or wear away the skin from inside the penis. Rarely, an implant breaks through the skin. These problems are sometimes linked to an infection.

Treating an infection

Infections after penile implant surgery typically occur in the first few weeks or possibly years later. Early infections can cause swelling of the scrotum, pus buildup and fever. Later infections might involve persistent or recurrent long-term pain.

Surgery to remove the implant is likely necessary to treat an infection. Replacing a penile implant can be complicated and can lead to a buildup of scar tissue and a decrease in penis length.

There are two main types of penile implants

Inflatable implants: Inflatable devices, the most common type of penile implant used, can be inflated to create an erection, and deflated at other times. Three-piece inflatable implants use a fluid-filled reservoir implanted under the abdominal wall, a pump and a release valve placed inside the scrotum, and two inflatable cylinders inside the penis.

To achieve an erection, you pump the fluid from the reservoir into the cylinders. Afterwards, you release the valve inside the scrotum to drain the fluid back into the reservoir. The two-piece model works similarly, but the fluid reservoir is part of the pump implanted in the scrotum.

Semirigid rods: Semirigid devices are always firm. The penis can be bent away from the body for sexual activity and toward the body for concealment.

A positionable penile implant is a semirigid device with a central series of segments held together with a spring on each end. It can keep upward and downward positions better than other semirigid rods can.

Other special designs can fit a shortened penis or one that’s larger than average. Some inflatable penile implants are also available with antibiotic coatings, which might help reduce the risk of infection.

What you can expect

Before the surgery

Penile implant surgery is usually done at a surgery centre or hospital. Your doctor might give you medication to make you unconscious during the surgery (general anaesthesia) or medication that blocks pain in the lower part of your body (spinal anaesthesia).

Your doctor will give you IV antibiotics to help prevent infection. The surgery site will also be shaved at once before surgery to reduce the risk of infection.

During surgery

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 below the head of the penis, at the base of the penis or in the lower abdomen.

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 minutes to an hour.

After surgery

After penile implant surgery, you’ll likely need to take medications to ease the pain. Mild pain might persist for several weeks. You might also need to take antibiotics for one week to prevent infection.
Your doctor might recommend keeping your penis up on your lower abdomen and pointing toward your belly button during the healing process to prevent downward curvature.
Your doctor will provide specific instructions about when you can resume normal activities. Most men can resume strenuous physical activity and sexual activity about four to six weeks after surgery. You’ll likely need to return to your doctor to have your stitches removed in about 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.

Results

Although penile implants are the most invasive and least often chosen treatment for erectile dysfunction, most men, and their partners report satisfaction with the devices. The reported success rate after a 3-piece inflatable penile prosthesis for patient and partner is about 95% and 90%, respectively. On the other hand, the 10-year device survival is between 60 and 80 per cent.

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