A penile prosthesis, also known as a penile implant, is a medical device surgically placed within the penis to help men achieve an erection. This device serves as a solution for erectile dysfunction (ED) when other treatments have not been successful. Introduced in the early 1970s, the technology has advanced significantly, leading to its widespread acceptance. The primary goal of a penile implant is to restore the ability to maintain an erection firm enough for sexual activity.
Understanding Penile Implants
Penile implants are broadly categorized into two main types: malleable and inflatable prostheses. Malleable implants consist of a pair of semi-rigid rods that are surgically inserted into the penis. These rods allow the penis to be manually positioned for sexual activity or bent downward for concealment, offering a straightforward and always-firm solution. Malleable implants have a lower risk of mechanical failure.
In contrast, inflatable penile prostheses (IPPs) offer a more natural-feeling erection and flaccidity. The most common type is the three-piece inflatable implant, which includes two cylinders placed in the penis, a pump located in the scrotum, and a fluid reservoir hidden near the bladder or within the abdomen. To achieve an erection, the patient activates the scrotal pump, which transfers saline solution from the reservoir into the cylinders, causing the penis to become rigid. After sexual activity, a release valve on the pump allows the fluid to return to the reservoir, returning the penis to a non-erect state. Two-piece inflatable devices also exist, integrating the reservoir with the pump.
Who is a Candidate
Penile prosthesis implantation is considered for individuals with erectile dysfunction when other, less invasive treatments have not provided satisfactory results. These prior treatments can include oral medications like PDE5 inhibitors, intracavernosal injections, or vacuum erection devices. A thorough medical evaluation is performed to determine suitability for the procedure.
Common medical conditions that may lead to considering a penile implant include diabetes, erectile dysfunction following prostatectomy, spinal cord injuries, and Peyronie’s disease, which causes penile curvature due to scar tissue. In cases of severe Peyronie’s disease, an implant can help counteract the deformity and facilitate more comfortable erections. Patients must also be healthy enough for surgery, meaning conditions like uncontrolled diabetes or active infections should be managed beforehand to minimize risks. Counseling is beneficial to ensure patients and their partners have realistic expectations about the outcomes.
The Surgical Process and Recovery
The surgical procedure for implanting a penile prosthesis is performed under anesthesia, on an outpatient basis. The surgeon makes a small incision, either in the scrotum or above the pubic bone, through which all components of the device are inserted. For inflatable implants, the cylinders are placed within the erectile tissue of the penis, the pump in the scrotum, and the fluid reservoir is positioned in the lower abdomen or pelvis.
Following the procedure, patients can expect pain, soreness, and swelling at the surgical site, along with potential bruising. A drainage tube may be placed temporarily to remove excess fluid and blood, removed within 2 to 3 days post-surgery. Patients are advised to rest and avoid strenuous activities or heavy lifting for 2 to 4 weeks. Light activities, such as short walks or driving, may be resumed within the first week or two, but vigorous exercise like jogging or swimming should be avoided for approximately six weeks.
Immediate post-operative care involves managing pain with prescribed medications and taking antibiotics for up to two weeks to prevent infection. Patients are instructed to wear snug underwear or compression shorts and to keep the penis pointed upward towards the belly button to help reduce swelling and aid healing. Showering is permitted after 48 hours, but baths and soaking should be avoided for at least two weeks. Most individuals return to full daily activities within about three weeks, though sexual activity is advised to be delayed for four to eight weeks, or until cleared by their physician, to ensure proper healing and device integration.
Living with a Penile Prosthesis
Individuals can use their penile prosthesis to achieve an erection for sexual activity. The device is designed to be discreet, with components hidden within the body, allowing for a natural appearance and feel in both flaccid and erect states, particularly with inflatable models.
Patient satisfaction rates with penile prostheses are consistently high. Many patients report significant improvements in their sexual life and overall quality of life. The implant does not affect penile sensation, the ability to ejaculate, or orgasm, as these functions are separate from the mechanical rigidity provided by the device. The implant does not increase penile length, and some men may perceive a slight shortening compared to their natural erections.
The durability of penile prostheses has improved over time with advancements in materials and design. While specific lifespans can vary, studies indicate high mechanical survival rates over many years. Long-term follow-up care is recommended to monitor the device and address any potential issues. Although revision surgery may be required in a small percentage of cases, the overall safety and effectiveness of penile implants provide a durable solution for restoring sexual function.