Treating erectile dysfunction (ED) is not always as easy as using the blue pill.
There are many types and causes of erection problems, and treatments should aim for each one of them. In most cases, especially in young patients, the cause of erectile dysfunction is psychological or related to stress and anxiety.
However, the penis has a nervous and circulatory system that contributes to erections, and they can be damaged, too.
Sometimes, the defect is found in a structural part of the penis that does not have an easy fix. In these cases, there’s no other way to recover erections. That’s when penile implants are used.
What are penile implants or penile prostheses? Who is a good candidate, and what happens before, during, and after the procedure? In this article, you will find the answer to all of these questions.
What is a penile implant?
A penile implant is an ED treatment option. It consists of a specialized device that facilitates erections and improves sexual function. It is placed inside the penis and replaces other anatomical structures that control erections.
Ideally, erectile dysfunction treatment should use the natural structures of the penis and make them work. That’s what Viagra and intracavernous injections do. However, that is not possible sometimes, especially when these erectile structures are severely compromised.
A penile prosthesis is introduced in the penis after a complicated surgical procedure. Thus, it is an auxiliary treatment when nothing else improves erectile dysfunction.
Before using a penile implant, most patients undergo other treatments. Oral medications, injection therapy, urethral suppositories, and vacuum devices are suitable options. When none of them work, doctors may recommend a penile implant to recover erections (1).
Types of implants
There are different types of implants, but depending on how they work, we can divide them into two types. As you will see, each type has different subtypes (1, 2):
- Semi-rigid penile implants: It is an implant that stays rigid but can be bent forward or towards the body. When it is turned forward, there’s an erection, and the user can perform the sexual act. When it is bent towards the body, the penile implant is concealed, and the penis stays flaccid. There’s another semi-rigid rod penile implant with different segments and sprints to accommodate the implant for sex. It is not the most common implant because there’s an inflatable implant option that feels more natural for the patient.
- Inflatable penile implants: As the name implies, the inflatable implant is one that the patient pumps to achieve an erection. This type of implants has its own fluid reservoir placed in the scrotum or the abdomen. It is a malleable prosthesis that becomes hard when inflated. On the outside, we have a control pump we can use to fill the inflatable implant. The fluid is pushed into the implants, and the penis achieves an erection.
After the sexual act is done, the user can press a release valve. It drains the fluid into the reservoir, and the penis becomes flaccid. There are two types of an inflatable penile prosthesis, depending on the number of inflatable cylinders. Devices with two inflatable cylinders are less complicated, and the reservoir is placed inside the scrotum.
Devices with three inflatable cylinders offer a more rigid erection, but the procedure is more complex, and the reservoir is located in the abdomen.
The most common type of implant is the inflatable type. It provides significant control to the user, and it is not intrusive or difficult to use. However, semi-rigid implants can also be used in some cases.
If you’re considering penile implants, talk to your doctor. You might need to evaluate other options before. And if you’re a right candidate for this procedure, your doctor will have a suitable penile implant type recommendation according to your condition.
Who’s a good candidate for this procedure?
As mentioned in the first section of this article, not all patients with erectile dysfunction are good candidates for penile implant surgery. They are not offered as a first-line therapy against erectile dysfunction. Quite the opposite, because doctors will always try to prompt spontaneous erections instead of introducing a foreign device in the body.
Thus, you might be a good candidate for a penile prosthesis implant if (2, 3):
- You have severe nerve injuries that do not allow for natural erections
- After prostate cancer therapy, especially radical prostatectomy. When erectile dysfunction is a side effect, and you have failed to recover erections after a few months
- In case you have a blood flow problem to the penis that is not recovered with oral or injected medications
- Patients with Peyronie’s disease are sometimes managed with a two-piece hydraulic penile prosthesis
Even in some cases listed above, your doctor may prefer trying with less invasive methods first. Penile implants will be recommended after you’re confident that nothing else works, and this is the best choice.
What do you need to do to prepare?
Your doctor will give you instructions and probably order a few tests before penile implant surgery. This is what patients typically undergo to prepare for a penile implant (4):
- Oral antibiotic therapy: Even if you do not have an infection, your doctor will probably recommend antibiotic treatment starting 2 days before surgery. Oral antibiotics are preferred, especially trimethoprim-sulfamethoxazole. Other options include doxycycline, ciprofloxacin, and cephalexin.
- Antimycotic therapy if you have diabetes: In diabetic patients, there’s a high risk of fungal infections after penile implant surgery. Thus, antimycotic treatment is recommended in this group, starting 2 days before the penile implant procedure. The most common medication is fluconazole.
- Preoperative studies: You may need to undergo X-Ray studies, an ECG, and a series of blood tests before surgery. In diabetic patients, it is especially important to evaluate HbA1c levels.
- Home care before surgery day: 2 days before surgery day, you will be instructed to wash your genitals with Hibiclens soap or a similar product twice a day. You don’t need to shave in an attempt to prevent skin cuts and bacterial colonization.
It is essential to follow the recommendations by your doctor before and after the procedure. This way, you will reduce the risk of infection and other complications of surgery.
Remember that if your doctor gives you different instructions, this information is not meant to replace the advice given by a healthcare professional. Follow his instructions to the letter and ask questions if you ever have any doubts.
What happens during the procedure?
In a penile prosthesis surgery, you will arrive in the preoperative room and undergo a physical exam. The goal is detecting any active infection and making sure you’re fine for the intervention. Then, the area is shaved and washed before the procedure starts.
Before entering the operating room, you will be given general anesthesia or spinal anesthesia. After this time, the operation is relatively quick and does not take more than 45 minutes.
The operation starts with a small cut in the scrotal sacs or superior to the penis, in the lower abdomen. The location of the initial cut depends on the penile implant and the procedure in use. The corpora cavernosa is stretched through this incision, and the inflatable penile prostheses are placed inside the penis.
The next step is placing the saline reservoir and the valve. In a two-piece inflatable device, the reservoir is placed in the scrotal bags. In a three-piece inflatable device, it is placed under the abdominal wall. In both cases, the valve and pump are placed in the scrotum.
After this, the surgeon closes the incision, and after recovering from anesthesia, the patient usually goes home the same day (2,4).
How effective is the surgery?
Penile prosthesis implantation surgery is very effective, and the results are usually considered successful.
Up to 95% of patients have successful surgery without any complication. Satisfaction ranges between 80 and 90%, and most patients have a successful erectile function and resume sexual activity after recovery (1, 2).
After penile prosthesis implantation, you may recover the hardness of the erections and the penile length. However, keep in mind that penile implants would only inflate the penile shaft. They do not inflate the glans or penis head. They do not change sensation during sexual intercourse and do not change orgasms.
What are the risks and complications?
Every surgical procedure has potential complications. In the case of a penile implant, this is what goes wrong in some cases (2, 5):
- A skin infection or bleeding, usually in the area of the incision
- A prosthetic infection, especially in diabetic patients and those with injuries in the spinal cord. Still, the chance of prosthetic infection is lower than 1%
- A device failure, which is unlikely in the first 8 years
- Extrusion of the device, usually through the incision
- In some cases, the urethra or another structure is cut during the procedure. When this happens, the procedure is stopped.
- Penile pain upon device inflation, which is unlikely but slightly more common in diabetic patients.|
- Penile numbness, mostly if the incision is made on the upper part of the penis.
The surgery is usually very effective, and these side effects and complications are unlikely. The most common infection is the surgical wound, which can be prevented if you follow your doctor’s instructions.
Do not hesitate to talk to your doctor if you suddenly have a fever, feel severe pain, or notice blood in the urine, a discharge from the incision, or swelling that does not go away.
After the surgery is done, you will probably have a surgical drain you need to keep one night. It is usually removed the day after without a problem.
For 24 hours, you will also need a compressive dressing that will be removed the day after. The stitches are absorbable, so you don’t need to revisit the doctor to remove them.
The recovery process is usually not complicated. Doctors will prescribe antibiotics. You will also be recommended with pain medication to be used only if you need it. A stool softener may also be recommended to reduce strain and abdominal pressure, which may compromise the surgery outcome.
During this recovery time, you may have some discomfort and scrotal swelling. It usually goes away after two weeks. However, you need to abstain from sexual activity, exercise, or weight lifting for up to 6 weeks (2, 3).
Achieving a satisfactory erection is usually not a problem in young males, but even they can experience erectile dysfunction. However, most of these cases are caused by performance anxiety and other issues. But when the causes of ED are biological instead of psychological, the solution is more complicated.
We have oral medications, intracavernous prostaglandin E1 injections, and even suppositories to prompt erections. But sometimes, none of these options recover natural erections. In these cases, penile implants are sometimes the best choice to regain sexual function.
There are two types of penile implants, but the most common is the inflatable device with two or three chambers. They are only recommended for patients who cannot recover their natural erections with other means. The surgical procedure is complicated, but it is often performed in an outpatient modality. The patient usually goes home the same day, and recovery lasts 3-4 weeks maximum.
Complications are not common, and the success rate is very high. Thus, penile implants are an excellent option for patients who cannot recover their erectile function. They can still enjoy sex with their partners and improve their quality of life but should follow recommendations before and after the procedure to reduce the risk of complications.