Although the medical treatments of ED (pills, injections, suppositories, VED) [link to all four sections] may provide satisfying erections, they unfortunately do not provide a long-term “cure” to the problem. They are, after all, “bandaids” for the symptoms but not a total solution.
Most men and their partners want, ultimately:
- An erection that is rigid and satisfying for sexual activity
- The ability to be spontaneous in their sex lives
- The ability to predict and control how long the erection lasts and how often they can use it
- Lack of “paraphernalia”. In other words, the erection should be natural, not associated with devices or other impediments
Because of all of these factors, penile implants offer a very compelling alternative to treating ED.
What Is a Penile Implant?
There are several types of implants. In each case, the implant goes into the “erection bodies” of the penis and converts the non-functioning penis into a functioning penis.
- “One-piece” [pic]. In this case, flexible (a good analogy is a goose-neck lamp) or semirigid cylinders are placed into the erection bodies. The penis is rigid enough for sex but soft (“flaccid”) enough that it can be concealed in the clothes.
- Benefits: least expensive type of implant, fewer mechanical parts to fail
- Downsides: least natural erection, no antibiotic coating. Worst rigidity, worst flaccidity
- Good for: men with poor hand function (e.g. multiple sclerosis), men with “buried penis” who need a prosthetic to hold on a condom-style catheter
- “Two-piece” [pic]. In this case, the cylinders are filled with fluid and there is a pump in the scrotum (totally concealed, like a 3rd small testicle). The man uses the pump to get an erection, and “bends” the penis to move the fluid out and become flaccid again.
- Benefits: excellent rigidity, no need to place any parts in the pelvis/abdomen.
- Downsides: no antibiotic coating, not as good flaccidity. Not good for very thin men, not good for larger penises (because of poor flaccidity)
- Good for: men who have complex pelvic issues that make placement of a “three-piece” (see below) undesirable, e.g. men who have had pelvic crush injuries or those with complex vascular reconstruction.
- “Three-piece” [pic of AMS and Colo devices]. These are by far the most commonly used devices. There are fluid-filled cylinders, a pump in the scrotum (that has parts for both pumping up and deflating the cylinders), and a reservoir in the pelvis/abdomen that holds the fluid when the penis is flaccid.
- Benefits: excellent rigidity and flaccidity, total control over the erection, antibiotic coatings available
- Downsides: need for placement of reservoir
- Good for: most men with ED, including ED from prostate cancer, diabetes, vascular disease, spinal cord injury, etc.
Does the Implant Work Well?
Yes, very well. Satisfaction rates for patients and their partners in most studies is well above 90%.
Does My Insurance Pay for It?
Most insurances companies, including Medicare, cover the device and surgery although the patient needs to check with their individual insurer.
For those without insurance or who have insurers who do not cover these services, we have specialists who can work with the patient on costs and payment [link to costs]
Does It Change the Sensation?
No, sensation of the penis or sensation of orgasm is not affected by having an implant.
What Are the Risks?
As with any surgical procedure, there are potential risks. The most significant is infection. Just like having a knee or hip prosthesis, having a penile implant means there is a “foreign body” in place and an infection can be quite serious (just like with a hip or knee).
Implants are safe for getting an MRI if needed.
It is important to tell other health care providers that you have an implant. For example if you are having a dental procedure you will likely need additional antibiotics.
What Can I Do to Avoid Infection?
Infection rates with modern implants are quite low, around 1%.
There are certain conditions that do increase the risk of infection:
- Spinal cord injury
- Diabetes (especially if the blood sugars are consistently high)
- Redo surgery or in the setting of extensive scarring
- Taking chronic steroids such as prednisone
One of the great advances of modern implants is the use of coating that hold in antibiotics to prevent bacteria from getting on the device.
We use many techniques to minimize infection in patients, both before the operation and during the operation. It is critical that surgeons are very meticulous in technique and are aware of the many things that can be done to prevent infections.
Are People Ever Dissatisfied?
When a man has had ED for a long time, the penis shrinks and scars. This is similar to a weightlifter who stops working out and the muscles shrink. For this reason, the penis is often shorter than it was when he was younger. Sometimes this is made worse by “bad memory” (i.e. a man thinks he was larger in the past when he actually was), gaining weight, having pelvic surgery such as a radical prostatectomy, etc. This loss of length is the most common cause for dissatisfaction. We have been working on techniques to maximize your penile length while still performing safe surgery. These include things the patient does before the operation and afterwards.
Depending on the patient’s individual situation, there are two “expandable” devices that are available that will allow the penis to stretch to its full potential.
How Is the Device Put In?
The devices are typically put in through a very small incision on the upper part of the scrotum. This takes about an hour. Usually, this is the only incision that is necessary.
Do I Need to Stay in the Hospital?
The procedure may be done as an outpatient or with an overnight stay. If done as an outpatient, the patient needs to return to clinic the next day to have dressings etc removed.
Where is It Done?
The procedure is done in the operating room, either in the hospital or at a surgery center.
Do the Devices Ever Fail?
These devices are mechanical and so eventually they will fail. With modern devices, they usually last 10-15 years and may last even more than 20 years. When they fail, an additional surgery is required to replace the device (very similar to the original surgery).
Who Should Do the Surgery?
As with other specialized surgeries, the patient should be careful about who they choose to perform it. With implants, surgeons often do 1-10 per year and may not have specialty training in implant and penile surgery. As with most things, the patient should enquire about the experience of the surgeons performing these cases and only go to someone who is comfortable with all aspects of these cases.
What Do I Need to Do to Prepare for the Procedure?
You will need to meet with the physician to make sure that you are a suitable candidate for this procedure.
Most patients require only a short workup, including cystoscopy (look inside bladder with a small camera) and urine flow studies. These can be done on the day of the consultation.
We must make sure that laboratory studies, including urine culture, are normal. If there are abnormalities or something in your health history that may compromise your ability to receive anesthesia, you may need to visit your regular doctor or a specialist (cardiologist, anesthesiologist) to make sure your health is optimized so you get the best possible outcome.
You will need to shower with a special antibiotic soap for several days before the operation and we can provide this in clinic or have you pick it up locally.