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Penile implants

Definition

Penile implants are devices put inside the penis that allow men with erectile dysfunction (ED) to get an erection.

Penile implants require an involved surgery. There's a risk of infection and a risk that the device won't work. But new materials, designs and surgical procedures have greatly improved results. 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 or if other methods cause undesirable side effects.

Penile implants are also used to treat some cases of Peyronie's disease — a condition that causes scarring inside the penis, leading to bent, painful erections. For Peyronie's disease, penile implant surgery is considered only when penis curvature is severe and other treatments have failed.

Risks

Risks of penile implant surgery include:

* Infection. As with any surgery, infection is a possibility. You may be at an increased risk of infection if you have a spinal cord injury or diabetes. 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.
* Implant problems. New penile implant designs are reliable, but in rare cases the implants may not work correctly. For example, in some semirigid devices, internal parts can break down over time. In inflatable devices, fluid can leak or the pump device can fail. Surgery is necessary to remove, repair or replace a broken implant.
* Internal erosion or adhesion. In some cases, an implant may stick to the skin inside the penis or wear away the skin from inside the penis. Rarely, an implant breaks through the skin. These problems are sometimes linked to an infection.

Treating an infection
An infection can occur at any time after surgery. In rare cases, an infection occurs years later. A serious infection can cause swelling of the scrotum, pus buildup and fever. Surgery to remove the implant is always necessary to treat an infection. Replacing a penile implant can be complicated and costly and can lead to buildup of scar tissue, loss of sensation in the penis and a decrease in penis length.

How you prepare

Prior to the procedure, your doctor will want to make sure an implant is the best option. Your doctor may ask you questions or do tests to help pinpoint the cause of your erectile dysfunction. Your doctor will want to be absolutely certain that your erectile dysfunction can't be treated in another way. Your doctor will also want to determine whether there's any reason that implant surgery is likely to cause complications.

Penile implant surgery is usually done at a surgery center or hospital by a urologist. Your surgeon may request that you do several things before surgery. You may need to take the following steps:

* Meet with your doctor. You'll meet with your doctor to make sure you understand what the procedure involves, and what you need to do to prepare. Your doctor will explain the risks and potential complications. You'll discuss which type of implant suits you best. If possible, include your partner in the discussion with your doctor.
* Stop taking certain medications. Your doctor may recommend that you temporarily stop taking medications that could increase your risk of bleeding. Examples include the prescription medication warfarin (Coumadin) and over-the-counter pain relievers such as aspirin and ibuprofen (Advil, Motrin, others).
* Use antibiotic soap. Your doctor might ask you to bathe with antibiotic soap each day, starting a few days before surgery. This will reduce the risk of infection. Don't shave the surgery site yourself. This will be done immediately before surgery to reduce the risk of infection.
* Arrange for a ride home. Ask your doctor when you'll be able to go home from the surgery center or hospital. Penile implant surgery generally requires at least an overnight stay.

What you can expect

Penile implant surgery usually takes 45 minutes to an hour. Your doctor may give you medication to make you unconscious during the surgery (general anesthesia) or may give you medication that blocks pain in the lower part of your body (spinal anesthesia).

Immediately before surgery

* Your doctor will give you IV (intravenous) antibiotics. This will help prevent infection.
* You'll get a general anesthetic to make you unconscious or a local anesthetic to numb the lower part of your body.
* A tube called a urinary catheter may be inserted into your bladder via your penis. 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 will stretch the spongy tissue 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 implant cylinders inside the penis. All sizes are customized to your exact body measurements.
* 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 doctor 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

* You'll need to stay in the hospital for at least one night.
* You'll need to take antibiotics to prevent infection. After surgery, take antibiotics exactly as your doctor tells you to. If you miss doses or you don't take the entire course of medication, the antibiotics may not be effective.
* You may need to take medications to ease pain after surgery. Mild pain may persist for several weeks.
* Most men can resume strenuous physical activity about six weeks after surgery. This can vary, so ask your doctor about any limitations on what you can safely do.
* Ask your surgeon when you can resume sexual activity. For most men, this is about six weeks after surgery.

Types of penile implants
There are two types of penile implants: inflatable implants and semirigid rods.

Inflatable implants are the most common type of penile implant used in the United States. Inflatable devices are more natural than semirigid types are 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 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 are 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

* Creates a more natural erection than does a semirigid implant
* Creates a firmer erection than does a two-piece implant
* Takes pressure off the inside of the penis when deflated, reducing the chance for injury

* Has more parts that could malfunction than does any other implant
* Requires the most extensive surgery of any implant
* Requires a reservoir inside the abdomen

Semirigid

* Requires the least extensive surgery of all implant types
* Has fewer parts than any other implant, so less of a chance of malfunction

* Results in a penis that is always slightly rigid
* Is more difficult to conceal under clothing than are other devices
* Puts constant pressure on the inside of the penis, which can cause injury in some men

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, most men who have the procedure say they're satisfied with the results.

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 implant won't make your penis any larger than it naturally is at the time of surgery. 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 replacement surgery can be difficult.