Penile prosthesis surgery

1. What is it? Any common name for this procedure?

Penile Prosthesis Surgery (or Penile Implant Surgery) is a procedure to place a medical device inside the penis to allow men with erectile dysfunction (ED) to achieve an erection. This is typically considered the "final" solution for ED when all other treatments, such as pills (Viagra/Cialis), injections, or vacuum devices, have failed or are not suitable.

Unlike other treatments, the prosthesis provides a "mechanical" erection that is controlled by the user.

Common Names:

• Penile Implant
• ED Surgery
• Inflatable Penile Prosthesis (IPP)

2. Common Indications: When is it Recommended?

This surgery is recommended for men with severe, chronic ED that has a clear physical cause:

• Organic ED: Damage to the blood vessels or nerves caused by diabetes, heart disease, or high blood pressure.
• Post-Prostatectomy ED: For men who have lost erectile function following surgery for prostate or bladder cancer.
• Peyronie’s Disease: When severe curvature of the penis makes intercourse impossible or painful.
• Pelvic Trauma: Nerve or vascular damage resulting from major accidents or pelvic fractures.

3. List of Associated Risks and Conditions

• Infection: This is the most serious risk. If an implant becomes infected, it must usually be removed entirely. Most modern implants are coated with antibiotics to prevent this.
• Device Malfunction: Like any mechanical device, it can wear out or leak over time, typically requiring a replacement after 10–15 years.
• Erosion: In rare cases, the implant can wear through the internal tissue or skin.
• Loss of Natural Erection: Because the surgery involves hollowing out the internal chambers (corpora cavernosa), the patient will no longer be able to achieve a "natural" erection after the device is removed or if it fails.

4. List of Screening Tests and Assessment Tools

5. Am I Eligible for This Evaluation?

1. Refractory ED: You have tried and failed standard treatments like oral medications and penile injections.
2. Stable Medical Health: You must be healthy enough for surgery and have no active urinary or skin infections.
3. Manual Dexterity: For inflatable models, you must have enough strength and coordination in your hands to operate the pump located in the scrotum.
4. Realistic Expectations: Understanding that the implant will not change your libido (sex drive) or the sensation of orgasm, but will provide a firm erection.

6. Types of Penile Implants

• Three-Piece Inflatable (IPP): The most popular and natural-feeling option. It consists of two cylinders in the penis, a pump in the scrotum, and a fluid reservoir in the lower abdomen.
• Two-Piece Inflatable: Similar to the three-piece but with the reservoir integrated into the pump; used if there is extensive scarring in the abdomen.
• Semi-Rigid (Malleable) Rods: Two firm but flexible rods. The penis is always semi-firm and can be bent into position for sex or bent down for concealment. It is simpler to use for men with limited hand strength.

7. Days Required for Hospitalization

• Surgical Time: 60 to 90 minutes.
• In-Hospital Stay: 0 to 1 Day. Many patients go home the same evening; some stay overnight for observation.
• Recovery: Most men return to work in 1 to 2 weeks. You must wait 4 to 6 weeks before "activating" the device for sexual activity to allow internal healing.
• Hospitalization: 0–1 Day.

8. Benefits of Penile Prosthesis

• High Satisfaction: Patient and partner satisfaction rates are typically over 90%, the highest of all ED treatments.
• Spontaneity: Unlike pills that take time to work, an implant allows for an erection whenever desired, for as long as desired.
• Predictability: The erection is guaranteed to be firm and will not fade until you manually deflate it.
• Concealment: The device is entirely internal; no one can tell you have an implant when you are clothed or even in a locker room.