An implantable penile prosthesis is a medical device surgically placed inside the penis to help men achieve an erection. This procedure addresses erectile dysfunction (ED), a condition where a man cannot get or maintain an erection firm enough for sexual intercourse. The primary purpose of this device is to restore the ability to engage in sexual activity for individuals for whom other treatments have not been successful. These devices are designed to be entirely internal, offering a discreet and effective approach to managing ED.
Understanding Implantable Penile Prostheses
An implantable penile prosthesis serves as a permanent solution for erectile dysfunction, functioning as a substitute for the natural erectile process. There are two primary types of penile prostheses: inflatable and malleable.
Inflatable Prostheses
Inflatable penile prostheses are the most common type and are comprised of two cylinders, a pump, and a fluid reservoir. The cylinders are surgically placed within the penis, while a small pump is positioned in the scrotum, and a fluid reservoir is located under the lower abdominal muscles. To achieve an erection, the user presses the pump in the scrotum, which transfers sterile saline solution from the reservoir into the cylinders, causing them to inflate and harden the penis. Deflation occurs by pressing a release valve on the pump, which allows the fluid to return to the reservoir, making the penis flaccid again. This system offers a more natural feel and appearance when inflated and can be deflated for concealment.
Malleable Prostheses
Malleable penile prostheses, also known as non-inflatable or semi-rigid implants, consist of two flexible rods implanted within the penis. These rods are made of silicone and are always firm, providing constant rigidity. While the penis remains semi-rigid at all times, it can be manually bent upward for sexual activity and then positioned downward against the body for concealment. This type of implant is simpler in design, with fewer parts, which can mean a lower risk of mechanical failure.
Determining Candidacy
An implantable penile prosthesis is considered when other less invasive treatments for erectile dysfunction (ED) have proven ineffective or are not suitable. These may include oral medications, penile injections, or vacuum constriction devices. The decision to pursue a penile implant follows a thorough evaluation by a healthcare provider, often a urologist, who assesses the underlying causes of ED and the patient’s overall health.
Various medical conditions can lead to severe ED, making a penile prosthesis a viable option. These include significant vascular disease, nerve damage, or complications arising from prostatectomy (prostate removal surgery). Peyronie’s disease, a condition causing scar tissue inside the penis that leads to painful, curved erections, can also be effectively managed with an implantable prosthesis, as it can help correct the penile deformity while providing rigidity. Uncontrolled diabetes or active infections, such as pulmonary or urinary tract infections, may contraindicate the surgery.
Patient counseling is an important part of the candidacy process, ensuring that individuals have realistic expectations about the procedure and its outcomes. While penile implants restore the ability to achieve an erection, they do not increase sexual desire or sensation, nor do they make the penis larger than its size at the time of surgery. These aspects, along with the irreversible nature of the procedure, are discussed during the evaluation to ensure psychological readiness for the implant.
The Surgical Procedure and Recovery
The surgical placement of an implantable penile prosthesis is a specialized procedure performed by a urologist in an outpatient setting or with a short hospital stay. A small incision is made, commonly in the scrotum or above the pubic bone, through which all components of the prosthesis are inserted. This approach allows for discreet placement of the device.
Following the surgery, patients can expect some discomfort, swelling, and bruising around the surgical site, which subsides within the first few days to a week. Pain medication and ice packs are often prescribed to manage these symptoms. Elevating the scrotum and wearing supportive underwear can also help reduce swelling and improve comfort during the initial recovery period.
Light activity, such as short walks, can be resumed within a few days, but strenuous exercise and heavy lifting should be avoided for at least two weeks to prevent strain on the surgical area. Sexual activity is advised to be delayed for four to six weeks post-surgery to allow for complete healing and proper integration of the implant. Follow-up appointments with the urologist are scheduled to monitor healing, remove any temporary drains or staples, and instruct on how to use the device. While rare, potential early complications include infection, which may necessitate removal of the implant, or mechanical issues, which might require repair or replacement.
Life with a Penile Prosthesis
Living with a penile prosthesis offers a high degree of satisfaction for both patients and their partners. The device allows for on-demand erections, providing spontaneity in sexual activity that may have been lost due to erectile dysfunction. Sensation, orgasm, and ejaculation remain unaffected by the implant, as the prosthesis does not interfere with the nerves responsible for these functions. Patients report that the devices are easy to use and provide adequate rigidity for intercourse.
The longevity of a penile prosthesis varies, but devices are designed for many years of use. Over time, mechanical wear or component failure can occur, potentially necessitating revision surgery to repair or replace parts of the device.
Routine maintenance of the prosthesis itself is not required, but ongoing follow-up appointments with the urologist are important to monitor the device’s function and address any concerns. Common concerns like airport security scanners do not detect the implant, and participation in sports or other physical activities is possible once fully recovered. The internal nature of the device ensures discretion, as it is not visible externally.