Urology Prosthetic Surgery

Penile Prosthesis SurgeryFor patients with erectile dysfunction (ED), a penile prosthesis offers a highly successful treatment option. A penile implant is usually the best option when there is a clear medical cause for ED that is unlikely to resolve or improve naturally or with other medical treatments. Sometimes a penile prosthesis is implanted during surgery to reconstruct the penis when scarring has caused erections to curve (Peyronie’s disease).

These devices are either malleable (bendable) or inflatable. The simplest consists of a pair of malleable rods surgically implanted within the erection chambers of the penis. With this type of implant, the penis is always semi-rigid and merely needs to be lifted or adjusted into the erect position to initiate sex. Today, many men choose a hydraulic, inflatable prosthesis, which is much easier to conceal yet allows a man to have an erection whenever he chooses. It’s also more natural.

About 90 to 95 percent of inflatable prosthesis implants produce erections suitable for intercourse. Satisfaction rates with the prosthesis are very high, and typically 80 to 90 percent of patients are satisfied with the results and say they would choose the surgery again.

Two- and Three-piece Prosthesis

The inflatable penile prosthesis consists of two attached cylinders — a reservoir and a pump. The surgeon inserts the two cylinders in the penis and uses tubing to connect them to a separate reservoir of fluid. The reservoir is implanted under the groin muscles. A pump is also connected to the system and sits under the loose skin of the scrotal sac, between the testicles.

This penile prosthesis is referred to as a three-piece inflatable penile prosthesis, due to the three different components. A two-piece inflatable penile prosthesis consists of only two components: the attached cylinders and the combined reservoir and pump unit. With the two-piece prosthesis, the reservoir is combined with the pump into one housing unit that fits comfortably within the scrotum, instead of being placed behind the groin. The advantage of a two-piece prosthesis in that the surgery is quicker and less complicated, and there are no device parts in the abdomen. The disadvantage of the two-piece prosthesis is that the smaller reservoir may not produce adequate erections in some men.

To inflate the prosthesis, the man presses on the pump. The pump then transfers fluid from the reservoir to the cylinders in the penis, inflating them and causing an erection. Pressing on a deflation valve at the base of the pump returns the fluid to the reservoir, deflating the penis and returning it to the normal flaccid state.

While men who have had the prosthesis surgery can see the small surgical scar where the bottom of the penis meets the scrotal sac, other people probably will be unable to tell that he has a prosthesis. Most men would not be embarrassed in a locker room or public restroom, for example.

Sex With the Prosthesis

When the penis is inflated, the prosthesis makes the penis stiff and thick, similar to a natural erection. Most men rate the erection as shorter than their normal erection; however, newer models have cylinders that may increase the length, thickness and stiffness of the penis.

A penile prosthesis does not change sensation on the skin of the penis or a man’s ability to reach orgasm. Ejaculation is not affected. Once a penile prosthesis is surgically implanted, however, it may destroy the natural erection reflex. Patients usually must inflate the implant to get an erection. Removing the implant may also result in a loss of natural erections.

No surgery is totally free of possible complications. Complications associated with penile implants include:

  • Uncontrolled bleeding after the surgery, possibly leading to re-operation;
  • Infection;
  • Scar tissue formation;
  • Erosion (tissue around the implant may break down), requiring removal;
  • Mechanical failure leading to re-operation and removal.