Erectile dysfunction (ED) is a major quality-of-life disorder that affects hundreds of millions of men worldwide and increases with age.
The introduction of phosphodiesterase type 5 inhibitors (Viagra™) in 1998 contributed to increased awareness and patients requesting therapy for ED. However, ED pills do not work for many men and their efficacy can weaken with time. Among the many erectile dysfunction treatment options, implantation of a penile prosthesis has been associated with high patient satisfaction rates and low mechanical failure rates. These devices are either malleable or inflatable.
Among the many erectile dysfunction treatment options, implantation of a penile prosthesis has been associated with high patient satisfaction rates and low mechanical failure rates.
Specifically, penile surgery with placement of a three-piece inflatable penile prosthesis (IPP) offers the highest rates of satisfaction in surgery for ED. The inflatable penile prosthesis (IPP) has become a widely-accepted solution for erectile dysfunction treatments among men resistant to medical therapies. Insurance coverage for these operations is often quite good, providing a medical cause of ED is established. Medicare covers the surgery, but Medicaid does not, except under extreme circumstances and only in certain states.
Surgery for erectile dysfunction with placement of an IPP has been done for more than 40 years and much longer than that for rods (malleable) devices. The simplest type of prosthesis consists of a pair of malleable (bendable) rods surgically implanted within the erection chambers of the penis. Today, many men choose a hydraulic, inflatable prosthesis, which allows a man to have an erection whenever he chooses; this hydraulic prosthesis is much easier to conceal and is also more natural.
NO SURGERY IS TOTALLY FREE OF POSSIBLE COMPLICATIONS.
Complications associated with penile implants include:
- Scar tissue formation
- Injury to nearby organs and tissue
- Mechanical failure
To minimize infection risks, many patients are asked to undergo a preoperative and postoperative regimen by their prosthetic urologist. For example, I ask my patients to do a special preoperative groin scrub and to discontinue all blood thinners prior to surgery. Following surgery, I ask patients at the time of hospital discharge to wear brief-type underwear for the first month with their penis pointing up (cephalad) in their shorts. This encourages capsule formation around the cylinders permitting normal physiologic upward deflection of the erect penis.
As to sexual activity and post-surgical recovery, the penile implant or prosthesis is usually cycled the first time at an office visit when swelling has decreased.
The penile implant surgery is typically a 1-2” incision done under an outpatient status. The patient is put into a light sleep, but not intubated or paralyzed, as is the case for larger surgeries. Many prosthetic urologists inject patients with long-acting local anesthesia to numb the surgical area for minimal immediate post-operative pain. One of the keys in surgery recovery is to walk several times daily, starting the day after surgery. Initially, as with most penis surgery of any kind, there is swelling and bruising of the genital area that decreases with time. Pain most often is eased after 5 to 7 days.
As to sexual activity and post-surgical recovery, the penile implant or prosthesis is usually cycled the first time at an office visit when swelling has decreased. This will be about 4 to 6 weeks after your surgery. Most patients at 3 months after surgery can inflate their IPP in less than 20 seconds and deflate it in even less time. And because it is entirely concealed within the body, men can feel free to do normal activities, such as shower at the gym. A penile prosthesis does not change sensation on the skin of the penis or a man’s ability to reach orgasm. Ejaculation is not affected.
Surgery for ED is a common, well-established procedure that has great long-term outcomes in many peer-reviewed publications. Per those publications, penile implant surgery patients have high patient satisfaction rates and low mechanical failure rates. For many men, it is a great option that should be considered.
This physician is a Boston Scientific consultant but was not compensated for the creation of this article.