Penile Implants

The insertion of a penile implant (or prosthesis) is a specialised surgical procedure in which an internally placed device takes the place of a patient’s own existing, but poorly-functioning penile tissues. Some devices consist of a pair of malleable (semi-rigid) rods which can be bent up or down to provide erection or concealment, and others comprise a multi-part inflatable system.

What are the indications for this procedure ?

Most men with erectile dysfunction will have tried tablets such as Cialis, Levitra ,Viagra or Spedra(called PDE5 inhibitors). These provide good results in the vast majority of men and are certainly to be recommended long before a surgical option to E.D. is discussed. However, there are a number of situations where drug therapy is not the long-term answer:

  • those in whom these drugs are ineffective
  • those in whom other prescription drugs make their use contraindicated because of drug interactions
  • those who do not tolerate these drugs due to side effects
  • those with Peyronie’s disease and E.D.
  • men who fail to respond to drug treatment and who have undergone radical pelvic surgery (e.g. prostatectomy, cystectomy, anterior resection)

Will my erection be the same with an implant ?

Any man (and his partner) considering this type of surgery should be aware that the erection will be different in some ways. It is important to accept that erection will now occur due to active inflation or mobilisation of the implant rather than spontaneously as a result of arousal. The mechanics of inflatable devices are such that expansion of girth is much greater than length expansion (for most devices this is very limited), and for semi-rigid implants there is no change in size from the “flaccid” or concealed state. It must also be made clear that no implant leads to hardness of the head of the penis. This does cause minor difficulties for some men in penetration, but many will find the use of medication may subsequently allow engorgement of the head even when an implant is in place.

What are the complications of penile implant surgery ?

This type of surgery is particularly specialised and best results are seen in surgeons performing more than ten of these procedures each year. Complications can still arise, and these are broadly of two types:

  • infection
    • risk in a “virgin” procedure less than 5%
    • higher in diabetes, patients with spinal cord injury, those with urinary infections or catheters
    • chance of infection raised in revision procedures
    • minimised by the use of administered broad-spectrum antibiotics and the use of implants which are coated in antibiotics
    • can be associated with failure or erosion of the device
    • generally requires removal of all parts of the implant
  • mechanical failure
    • all devices are at risk of mechanical failure of any of the component parts although this is uncommon
    • most devices will function for at least 10 years
    • failure generally necessitates replacement of whole device