Penile Prothesis (Implant) Surgery

Penile prothesis (implant) surgery is a procedure that assists men who have erectile dysfunction and have not responded to conventional therapies. Penile implants are devices placed inside the penis to allow men with erectile dysfunction (ED) to get an erection.
Modern penile implants were marketed for the treatment of erectile dysfunction (ED) almost 50 years ago with the introduction of the three-piece inflatable implant by Dr. Scott and the semirigid rod prosthesis by Dr. Small and Dr. Carrion. Penile implants are devices placed inside the penis to allow men with erectile dysfunction (ED) to get an erection. 
At that time these devices were the only effective treatment for ED, but as the years progressed, medical therapies in the form of oral medication, intracorporal injections, intraurethral pellets, and vacuum erection devices (VEDs) were marketed with varying success and acceptance. Penile implants have remained a very effective and satisfying treatment of ED, and improvements in design of the product and surgical placement and repair techniques have increased their longevity and functionality. Therefore, penile implants are typically recommended after other treatments for ED fail. European Association of Urology (EAU) guidelines on Sexual and Reproductive Health recommends penile prosthesis (implant) to patients other treatments fail or depending upon patient preference. Although penile implants are the most invasive treatment for erectile dysfunction, penile implants have the highest rate of satisfaction of all erectile dysfunction treatments.

Who Is a Good Candidate for Penile Implants?
And Who Is Not?

You are good candidates;
  • If you aren't a candidate for other treatments (such as oral or intracavernosal medications, penis pump vacuum constriction devices, LI-SWT, low-intensity shockwave therapy, platelet-rich plasma treatment, etc.) due to cardiac, cardiovascular, endocrine, metabolic problems.
  • If you can't get an sufficient erection for sexual activity by using other treatment methods
  • If you don’t want other treatments (sildenafil, tadalafil, vardeil, avafil, etc.)
  • If you are treated prostate, bladder, rectum or colon cancer and have erectile dysfunction
  • If you have severe scarring inside the penis with erectile dysfunction, curved and painful erections (Peyronie’s disease)
  • If you have penile deformity and/or atrophy
  • If you have severe worry as a result of erectile dysfunction

You are NOT good candidates;

  • If you have an active infection (such as pulmonary, urinary, gastrointestinal, etc..)

    Uncontrolled diabetes, smoking, alcohol consumption are not important in patient selection.

Risk and Side Effect

If you are considering to have a penile implant surgery, you should acknowledge and know that it is vital to understand that penile implants are permanent. The procedure cannot be undone. So, if you do have any kind of hesitation, please think on your decision one more time or re-examine that if you really need it or not. As a human being, we have only one life live out, we should be careful in the course of deciding what to do, especially if the thing you are considering to try is a situation that you will not be able to change again. Approximately 95% of inflatable prosthesis operations are successful, which means the implants create erections adequate for intercourse. However, as with any surgical procedure, there are some possible risks. These are:
  • Pain
  • Irritation
  • Uncontrolled bleeding following surgery; this condition may necessitate extra surgery. (<%0.1)
  • Infection. As with any surgery, infection is possible and infection rates are %1-3. You might be at an increased risk of infection if you have a spinal cord injury or diabetes. Infections after penile implant surgery typically occur within the first three months of surgery. If the patient receives delayed or inadequate antibiotic therapy, surgery to remove the implant often is necessary to treat an infection.
  • Formation of scar tissue
  • Displacement of a pump or reservoir
  • Mechanical breakdown. New penile implant designs are reliable, but in rare cases the implants malfunction. most commonly used three-piece prostheses (AMS 700CX/CXR™ and Titan Zero degree™) resulted in mechanical failure rates of < 5% after 5 years of follow-up. Surgery is necessary to repair or replace a broken implant, but a broken device can be left in place if you don't want another surgery.
  • Erosion. erosion involving the distal corpora, urethra, glans or other structures can occur
 
 
 
 
 
 
 
 
 
 

Before The Procedure

You temporarily stop taking aspirin and other anticoagulant drugs, which can increase your risk of bleeding. Penile implant surgery is done at hospital. Don't eat or drink anything after midnight before your surgery. Your anesthesia doctor might give you medication to make you unconscious during the surgery (general anesthesia) or medication that blocks pain in the lower part of your body (spinal anesthesia).

Your doctor will give you IV antibiotics to help prevent implant infection. The surgical incision site will also be shaved in operation room and washed with an alcohol-based antibiotic solution to decrease the risk of infection.

Types of Penile Implants

There are two main basic types of penile implants that are available.

The most basic type of penile implant is semi-rigid or malleable rods. A surgeon inserts two flexible rods into the penis in this form of penile implant. The implants never change size or stiffness and remain semi-rigid. They can, however, be simply moved to different places. Malleable penile implant has a low chance of mechanical malfunction due to the small number of parts.

Other type is inflatable penile prothesis. The two-piece inflatable penile implant is similar to and works in the same way as the three-piece inflatable device. Instead of a separate fluid-filled container, the fluid is maintained within the scrotum pump. The two-piece inflatable device, on the other hand, is not firm erection as the three-piece penile implant. The two-piece inflatable penile prosthesis is mechanically more complicated than semirigid (malleable) penile implant. The three-piece inflatable penile implant is made up of three parts: two cylinders in the penis, an inflated pump in the scrotum, and a fluid-filled container in the abdomen. All of these parts are linked together by special tubing. The three-piece implant creates the most natural erection mechanism in term of rigidity and flaccidity.

There are two major FDA approved trademarks of penile prostheses in the world. The implants introduced by Boston Scientific under the AMS brand and the implants promoted by Coloplast with the Titan brand are the most accepted and used products in the world. European Association of Urology (EAU) guidelines on Sexual and Reproductive Health shows penile prostheses models on the market. Neither of these prosthesis brands is superior to the other in respect to quality and patient satisfaction. Patient and partner satisfaction with inflatable penile prostheses is over 90% in almost every study.

During Surgery

>A tube (catheter) might be inserted into your bladder via your penis to collect urine in the operation room. Your doctor will make an incision at the base of the penis. Next, your doctor will stretch the spongy tissue in the penis that would normally fill with blood during an erection. This tissue is inside each of two hollow chambers called the corpora cavernosa. Your doctor will choose the correct size implant for the size of your total penis lenght (corpus cavernosum lenght) and place the implant cylinders inside your penis. All sizes are customized to your 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 above or under the abdominal wall using the initial incision. Sometimes a second incision in the abdomen in used.

Once the all parts of device are in place, your doctor 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 pain. Mild pain might persist for several weeks. You might be given an antibiotic to be taken by mouth for a week. Most men can resume strenuous physical activity and sexual activity about 4 to 6 weeks after surgery.

After you learn how to use the device, usually 3 to 6 weeks after surgery, inflating and deflating inflatable penile implants is recommended to give you practice using penile implant and stretch the area surrounding the cylinders.

Results

Although penile implants are the most invasive treatment for erectile dysfunction, most men who have them and their partners report satisfaction with the devices. In fact, penile implants have the highest rate of satisfaction of all erectile dysfunction treatments.

Recovery Timeline

In general, you should expect to be out of activity for one to two weeks following your penile implant procedure. Within the first 5 days after surgery, the incision should heal. During the first week, swelling and discomfort will also subside considerably. Simple post-operative procedures, such as elevating the scrotum and using ice to reduce swelling, can help enhance penile implant surgery recovery process. You should avoid putting ice directly on your scrotum or penis since this might cause skin injury and frostbite. Instead, use an old hand towel or a shirt tucked between your legs.

In the first two weeks after surgery, most doctors will not have the patient conduct penile implant activation and deactivation. This period of healing enhances comfort during the initial use. And the penile implant is normally triggered 2-4 weeks following surgery, and it is usually done at the surgeon’s office or the surgeon’s medical team to teach patients the beginning activation and deactivation of the penile implant.

Everyone is unique, and healing times vary. However, the average recovery time is 6 weeks before you may start any sexual activity. During this period, your surgeon will evaluate what you may and cannot do. For the best results, it is important to follow all instructions from your health care providers.
 
 
 
 
 
 
 
 
 
 
 

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1Is penile implant surgery safe?
Penile implant surgery is a safe medical procedure which involves no bleeding during surgery. There is no requirement for blood transfusion or a lengthy stay in the Intensive Care Unit (ICU). The patient will only have to stay in the hospital for one or two days after the surgery. They can walk around on their own and do all normal activities post recovery. Patients can even have a normal intercourse one month after penile implant surgery.
2Is surgery for penile implant placement painful?
No, it is generally not a painful procedure as anaesthesia is used during the surgery to numb the region. There might be slight pain for two or three days following the surgery, but it can be easily controlled with oral pain medicines.
3Are penile implant devices MRI safe?
Yes, most penile implant used now are MRI safe. People who have penile implant can comfortably undergo the MRI as any other person. As penile implant is placed in the lower part of the body, it doesn’t cause problem during MRI for chest, shoulder, neck and other upper body parts. For MRI of the pelvis region, the patient should inform the radiologist about their penile implant so that they can plan accordingly. This is because if a normal MRI is done, the image will get distorted and certain settings need to be done for the MRI, to take clear images even with the implant in the body.
4Is penile implant an option for patients with diabetes?
Diabetic patients are known to develop a severe ED. This is mainly because the blood supply to the penis is obstructed due to sugar deposits in the blood vessels, making it difficult to achieve erection strong enough for sexual intercourse the diabetics patients. This requires aggressive treatment as only medicines will not be as effective. Severe ED treatment for diabetic patients is recommended to be penile implant and the best implant for these patients is the malleable type penile implant.
5Will I lose any length after getting a penile implant?
Each penile implant is custom fitted to your anatomy.
6Will I be able to have spontaneous erections with a penile implant?
No. In order to place the implant in the body, the corpora containing the spongy tissue is removed to make room for the cylinders. If you are still able to have erections on your own, which are satisfactory for intercourse, you should consider very carefully whether or not an implant is the right fix for you. However, if you cannot have erections or if they are not satisfactory for intercourse, then an implant will be able to provide you with a more “instant” erection when compared to pills, or vacuum devices.
7What is the recovery time?
Each individual is different and therefore their recovery will be different as well. Typical recovery is between 4-6 weeks. Your physician will determine what you can and cannot do during this time. It is important to follow the recommendations that your physician gives to you to ensure the best outcome.
8Will anyone notice that I have an implant?
Since the implant is completely placed inside your body, no one will see the implant. In fact, no one will know unless you tell them.
9Can I have an orgasm with a penile implant?
You should be able to have an orgasm with a penile implant if you were able to have one before your procedure. Consult your physician about your expected outcome.
10Can you pick a size, as you can with breast implants?
In a word, no. This is because when inserting a penile implant, surgeons measure the exact size of the patient’s corpora cavernosa (the two longitudinal cylinders that run through the entire length of the visible and invisible penile shaft). Regardless of malleable or inflatable, the penile implant needs to fit perfectly into these cylinders. So every implant is a bespoke device, measured and put together during surgery to fit exactly into the individual penis. If too long, the implants will perforate it, if too short, it just won't, and intercourse or other sexual activities will be impossible. Hence, patients do not have any choice in the size of their implant.
11Does it affect feeling/sensitivity?
Most men report that the implant does not affect feeling or sensitivity. The procedure does not affect your libido, penile sensation or your sensation of orgasm
12Does it look any different to a natural penis - and would someone be able to tell it is an implant?
If done properly, it will be difficult for other people to detect the implant.
13How will sexual Intercourse with your partner be like?
Your partner will be happy because you will have always have an erection. When you desire your partner you will be able to do sex right away. You will have similar or the same feeling in orgasm.
14Will I need to replace the implant?
Generally speaking, the implant won’t be changed. The survival rate is almost 95 percent. The Firms are Rigicon or AMS and these are World recognized brands. If a problem persists the warranty document will be provided.
15What about security checkpoints at the airport? Will the implant be detected?
If the material will be detected then you can show your warranty papers to the security.
16Are there any risks associated with the surgery?
As in all surgeries, there could be a risk of infection therefore sterilization after the surgery is also very important.
17Will I be able to have children after penile implant surgery?
Yes, the implant only helps a man achieve erection and does not affect the quality of sperms. An otherwise healthy and fertile man should have no problem with fathering babies after the penile implant surgery.

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