A penile implant is a mechanical device that can be used to achieve an erection in a patient with otherwise untreatable ED (erectile dysfunction). This article is a guide to help you understand the different types of penile implants, some details of penile prosthesis surgery, and the risks and possible side effects. It also reviews who are good candidates for these devices, the pros, and cons of each type of implant, and some before and aftercare instructions that patients typically receive from their doctors.
Definition of Corpus Cavernosum
To understand how penile implants work, it is important to know the meaning of the term “corpus cavernosum”.
The majority of the penis is formed by two separate corpus cavernosum regions. Together, these sponge-like masses of erectile tissue form the bulk of the penis shaft. In men with normal sexual function, these cavernous bodies are flooded with blood to cause natural erections.
Goal for Penile Prosthesis Surgery
The goal of penile implant surgery is to allow a man with ED to achieve an erection that is sufficient for sexual intercourse. The procedure is usually recommended for men who have had no luck with other ED treatment options like medications or vacuum constriction devices (penis pumps). Penile prosthetics may also be used to treat a condition marked by curved, painful erections called Peyronie’s disease.
Note that penile implants do not increase libido, cause the head of the penis to become erect, improve sexual performance or stamina, increase sensation, or affect orgasm. A penile implant simply mimics a natural erection, allowing the shaft of the penis to become rigid enough to facilitate intercourse.
A penile prosthesis will not make the penis longer or larger than it is naturally. Since the implant does not make the head of the penis hard, many men find that their erections are somewhat shorter than they were naturally. However, most men who have the surgery, and their sexual partners, report high satisfaction rates.
Pros & Cons of the Procedure
Following are some of the pros and cons associated with each type of penile implant:
Semi-rigid Non-Inflatable Penile Implant These are the least complex type of implant. Having fewer parts means a simpler surgery and less chance for a mechanical malfunction. They are also the least expensive option and the easiest to operate, even for those with limited physical dexterity due to arthritis or other medical conditions.
On the downside, non-inflatable penile implants are always semirigid, making them difficult to conceal underneath clothing. Further, having a permanent erection can be uncomfortable and otherwise bothersome. Because of this, they are the least popular implant type.
2-Piece Inflatable Penile Implants The main advantage of this type of implant relative to a semi-rigid implant is that it includes a release valve. When the valve is opened, the saline solution is allowed to return to the fluid reservoir (inside the pump), causing the erection to subside. This allows the patient to achieve an erection when desired, and not have to have it constantly.
The cons of this type of implant include that it appears abnormal to others even when deflated, has a small pump that is difficult for those with limited dexterity to operate, and creates a less firm erection than a 3-piece device does.
3-Piece Inflatable Penile Implant This type of implant looks and feels more natural than the others. When deflated, the penis appears completely flaccid with no rigidity as with the other two types. Its pump is larger and easier to operate than that of a 2-piece device. It also produces the firmest erections, is the most expensive, and the most popular.
The downside of this type of implant is that it has a higher risk for mechanical failure simply because it contains more components than the other types.
Discuss the best type of device for you with a board-certified plastic surgeon or licensed urologist who specializes in penile implant surgery.
Penile implants are used for ED treatment but not as a first option. Up to 70% of men with erectile dysfunction are able to achieve erections sufficient for sexual intercourse by using PDE5 inhibitor drugs like Viagra® (sildenafil), Cialis® (tadalafil), Levitra (vardenafil), and Stendra (avanafil), and therefore have no need for a penile prosthesis implant.
Good candidates for penile implant surgery:
- Are of stable mind and in good physical health
- Have chronic erectile dysfunction that detracts from a quality sex life
- Have tried using a vacuum constriction device (penis pump) with little success
- Have realistic expectations about the risks and possible benefits of the procedure
- Have Peyronie’s disease or another medical condition that is not likely to be treated successfully with other treatment options
Penile implant devices are not well-suited for all men equally. Your surgeon or urologist might recommend against this treatment if your ED symptoms are situational or reversible, if you have a pulmonary infection or urinary tract infection (UTI), or if you have diabetes that is not well managed.
Penile implants may also not be recommended for men who lack sexual desire, cannot feel sexual sensations, have skin lesions on the penis or scrotum, and/or have ED caused by emotional/psychological issues.
Risks and Side Effects
All surgeries have risks for the formation of scar tissue, bleeding, swelling, pain, and infection. Penile implant surgery also has risks for mechanical malfunction and/or internal erosion or adhesion. Any subsequent surgeries needed to repair or replace defective or broken components could cause increased scar tissue formation and/or decreased penis length.
Types of Penile Implants
Like choosing the surgeon you feel comfortable working with, choosing between the three primary types of penile implants is an important decision that you should take your time making. Your doctor can help you choose the best type for you based on your ED symptoms, medical history, age, and various other personal factors.
The 3 penile implant types are:
- Non-Inflatable (semirigid)
- Two-piece Inflatable
- Three-piece Inflatable
Non-Inflatable Penile Implant This type of semirigid penile implant consists of two malleable rods placed into the corpus cavernosa. There is no pump or liquid reservoir. The implant allows the penis to be used during intercourse but it always remains semirigid, even when not in use.
2 Piece Inflatable Penile Implant A two-piece penile implant is made up of a pump and two flexible rods that create rigidity. A saline solution is housed either in the pump or the rods, which is forced by pressure to achieve penile rigidity at the owner’s discretion. The pump and expanding rods are surgically placed into the scrotum and the corpus cavernosum shafts, respectively.
3 Piece Inflatable Penile Implant Instead of reserving the solution in the pump or the inflatable cylinders like a two-piece device, a three-piece penile implant surgery places the liquid reservoir in the patient’s abdominal cavity. The pump is placed inside the scrotum, and two inflatable tubes are placed into the corpus cavernosum shafts of the penis.
Steps of Penile Implant Surgery
The surgical placement of a penile prosthetic implant is an invasive procedure that is performed under general anesthesia or spinal anesthesia. The operation involves making an incision to allow the insertion of the implants at the base of the penis and/or in the lower abdomen.
The surgeon will customize the sizes of the pump, reservoir, tubing, and 2 shaft implants based on the patient’s measurements.
In two-piece inflatable implant surgery, the pump, saline solution reservoir, and release valve are all placed inside the scrotum. During a surgery to insert a 3-piece prosthesis, the pump and the release valve are placed inside the scrotum and a separate fluid reservoir is placed under the lower abdominal wall.
This procedure does not involve the removal of any penile tissue. It is typically performed on an outpatient basis and takes between 30 minutes and an hour for a surgeon to complete.
Aftercare and Recovery
Arrange transportation home from the surgery center or hospital where you have this procedure, and have someone stay with you for the first night or so. Your surgeon will prescribe pain medications and anti-inflammatory drugs as needed to help you manage post-surgical discomfort and swelling. You will also likely be given antibiotics to help fight off infections.
The doctor's staff will give you instructions about how to care for your incisions sites, change bandaging, and other aftercare protocols. Following these instructions closely will help expedite your recovery.
You will also receive instructions about how to operate your prosthetic device. Your doctor may recommend keeping your penis pointed upward toward your stomach during recovery to prevent an abnormal downward curvature from developing.
You will be encouraged to practice using the device twice daily during recovery, which helps familiarize you with its operation and stretches the areas of tissue that surround the inflatable rods.
You will return to see your surgeon to remove stitches and monitor your progress about 2 weeks after the surgery. Some patients can return to non-strenuous work and other light activities within a few days, but complete recovery can take several months. Most patients can resume sexual activity and other strenuous activities 4-6 weeks post-op.
Penile prosthetic implants are the most invasive and least popular ED treatment option and are typically reserved for patients who have had little luck with other treatments like PDE5 drugs, penis pumps, and herbal remedies. Although patients do achieve erections that are sufficient for sexual intercourse, they do not affect libido, sexual performance, sexual stamina, or sexual sensation.
However, these prosthetic devices have high satisfaction rates among the men who do have them placed. 90-95% of penile implant surgeries are considered successful, and about 70% of patients report general satisfaction with their decision to have one surgically inserted.
Talk to a board-certified plastic surgeon or urologist to determine your candidacy for this procedure. Remember that it is very important to remain realistic about what the surgery can and cannot achieve.