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Penile implants
By Mayo Clinic staffMayo Clinic Health Manager
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Definition
Penile implants are devices implanted inside the penis that allow men with erectile dysfunction (ED) to get an erection. Penile implants are also sometimes used to treat Peyronie's disease, a disorder that causes pain or bending of the penis during erections.
Penile implants require an involved surgery. There's a risk of infection and a risk that the device will malfunction. But, since they were first introduced, new materials, designs and surgical procedures have greatly improved outcomes for penile implants. Most men with penile implants and their partners say they're satisfied with the results.
Why it's done
For most men, erectile dysfunction can be successfully treated with medications or use of a penis pump (vacuum constriction device). Penile implants may be an option to consider if you can't get an erection sufficient for sex with these other methods.
Penile implants are also used to treat some cases of Peyronie's disease — a condition that causes scarring inside the penis, leading to bent or painful erections.
Risks
Rarely, penile implants become infected or malfunction and have to be removed.
Infection
- For men who are generally healthy, infection rates are low.
- Men with a spinal cord injury or diabetes have a higher risk of infection than average.
- Men who need surgery to adjust or replace an implant (revision surgery) are at higher risk of infection than they were with the first surgery.
If an infection occurs, it's usually not for several weeks or longer after you have surgery. In some cases, an infection occurs years later. Sign and symptoms can include long-term pain, the implant sticking to the skin inside the penis or, rarely, an implant that breaks through the skin of the penis. With inflatable models, the entire area around the implant can become infected. Serious infections cause swelling of the scrotum, drainage of pus and fever. Surgery to remove the implant is almost always necessary to treat an infection.
Malfunction
Although new penile implant designs are very reliable and may last a lifetime, in rare cases they can malfunction. For example, in some semirigid devices, internal parts can break down over time. In inflatable devices, fluid can leak or the valve or pump device can fail. Surgery is necessary to repair or replace a broken implant.
How you prepare
Penile implant surgery is usually done at a surgery center or hospital by a urologist.
- Most candidates for penile implant surgery are checked by their surgeon to determine the cause of their erectile dysfunction and to determine their risk of a surgical procedure.
- Once you and your doctor have determined that a penile implant may be a good choice for you, your doctor will help you understand the procedure, the risks and potential complications, and the type of implant that suits you best. If possible, include your partner in the discussion with your doctor.
- Follow your doctor's instructions about taking medications before and after your surgery. Often, during the two weeks before and after penile implant surgery, your doctor will tell you not to take medications that thin your blood.
- Your surgeon might suggest that you bathe with antibiotic soap for three nights before your surgery to reduce the risk of infection. Don't shave the surgery site yourself.
- You may be able to return home the day of surgery or you may need to stay overnight at the hospital, depending on the circumstances. Arrange for someone to drive you home from the surgery center or hospital.
What you can expect
Penile implant surgery usually takes between one and two hours and is done while you're under general or spinal anesthesia.
To insert the penile implant, your doctor will stretch these tissue-filled chambers inside your penis (corpora cavernosa). With an inflatable implant, your doctor may place a pump inside your scrotum or a fluid-filled reservoir in your lower abdomen.
Immediately before surgery
- Within a couple of hours before the surgery, you may be given antibiotics to reduce your risk of infection.
- You'll get an anesthetic to make you unconscious (general anesthesia) or a spinal anesthetic to block the pain.
- A tube called a catheter may be placed into the bladder through your urethra to drain urine. In most cases, the urinary catheter is removed in the first 24 hours after surgery.
During surgery
- Your surgeon will make an incision below the head of the penis, at the base of the penis, or in the lower abdomen.
- Next, your surgeon stretches the spongy tissues in the penis that would normally fill with blood during an erection. This tissue is inside each of the two hollow chambers called the corpora cavernosa.
- After flushing the area with antibiotic fluid to prevent infection, your surgeon will choose the correct size implant and place the cylinders or semirigid rods inside the penis.
- 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 surgeon will also implant a fluid reservoir under the abdominal wall through an internal incision.
- Once the device is in place, your surgeon will sew the incisions closed.
Recovery
- Most men go home within 24 hours of surgery.
- You'll need to take antibiotics as directed by your surgeon to prevent infection.
- After surgery, wear loosefitting underwear and clothing. Men with an inflatable device will need to make sure the scrotal pump stays in place during healing.
Most men can resume strenuous physical activity about a month after surgery. You can resume sexual activity four to six weeks after surgery, depending on the type of implant you have and the instructions of your surgeon.
Types of penile implants
There are two types of penile implants: inflatable implants and semirigid rods.
Inflatable implants
In the United States, inflatable devices are the most common type of penile implant. Inflatable devices are more costly than semirigid types are, but they're more natural because they can be inflated to create an erection — and deflated at other times. Inflatable implants also reduce the possibility of damage to the inside of the penis due to constant pressure — which can be a problem for some men with semirigid implants.
There are two- and three-piece inflatable implants.
- The two-piece model currently available in the United States works in a similar way to a three-piece design, but the fluid reservoir is part of the pump implanted in the scrotum.
- Three-piece implants use a fluid-filled reservoir implanted under the abdominal wall, a pump and a release valve placed inside the scrotum, and two inflatable cylinders inside the penis. Before you have sex, you pump the fluid from the reservoir into the cylinders to cause an erection. After sex, you release the valve inside the scrotum to drain the fluid back into the reservoir.
Semirigid rods
This type of implant is always firm. The penis may be bent away from the body to have sex and toward the body to conceal the device. Although less commonly used than the inflatable type, semirigid implants are less complicated, easier to place and have less risk of failure.
Comparing implant types
The decision about which type of implant you should have is based on both your preference and your medical situation. Your doctor may suggest one type of design over another based on factors including your age, risk of infection, and health conditions, injuries or medical treatments you have had in the past.
| Type of implant | Pros | Cons |
|---|---|---|
| Three-piece inflatable |
|
|
| Two-piece inflatable |
|
|
| Semirigid |
|
|
Cost
Penile implant surgery can be costly, but may be covered by Medicare and other types of insurance.
Results
New designs and surgical procedures have improved the function and safety of penile implants. Although implants are the most invasive and least often chosen treatment for erectile dysfunction, they have a high satisfaction rate. About three-fourths of the men who have the procedure, and their partners, say they're satisfied with the results.
While most men are satisfied with their penile implant, there are some things men should know before choosing to have the procedure:
- Implants cause an erection, but they don't increase sexual desire or sensation.
- The size of your erect penis may be slightly shorter than it used to be.
- Some partners feel that sexual pleasure is diminished by their lack of involvement in creating an erection.
- This surgery is permanent. If your implant is removed, you will not be able to get an erection.
- Infection is a possibility, especially if you have diabetes or certain other health problems. An infected penile implant has to be removed and replaced.
- You may have reduced sensation in the head of your penis. In some men, this improves when they also take erectile dysfunction treatment drugs, such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra).
A penile implant procedure may have a higher risk of failure if you have immune system problems, a chronic health condition such as diabetes or are at high risk of infections.
- Montauge DK. Prosthetic surgery for erectile dysfunction. In: Wein AJ, et al. Walsh: Campbell's Urology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/119551792-3/801941680/1445/26.html#4-u1.0-B978-0-7216-0798-6..50025-X--cesec13_1966. Accessed Feb. 6, 2009.
- Henry GD. Updates in inflatable penile prostheses. Urology Clinics of North America. 2007;34:335.
- Erectile dysfunction. Cornell University Sexual Medicine Program. http://www.cornellurology.com. Accessed Feb. 6, 2009.
- Carson CC. Penile prosthesis implantation: Surgical implants in the era of oral medication. Urololgy Clinics of North America. 2005;32:503.
