Penile Implant for Erectile Dysfunction

What is a Penile Implant?

A penile implant, also called a penile prosthesis, is a medical device which is surgically implanted into the erection chambers of the penis in case of severe erectile dysfunction (ED).

When Should I Consider Penile Implant Surgery??

A penile implant is an option if you have tried oral medication such as phosphodiesterase 5inhibitors (PDE5Is)—Cialis or Viagra—or other treatments with little or no effect on ED. It may also be recommended if you cannot use PDE5Is or other treatments. Further, if you have tried PDE5Is and other treatments but are unhappy with the results and you want a permanent solution, a penile implant may be an option for you.

How Does a Penile Implant Work?

There are two types of penile implants: semirigid, noninflatable implants and inflatable implants. Semi-rigid implants consist of two bendable rods that are implanted in the erection chambers of the penis. They can be bent into position during sexual activity. With this type of implant, the penis is always semi-rigid, which may be difficult to conceal. Inflatable penile implants are devices filled with fluid which consist of two inflatable cylinders placed in the erection chambers of the penis, a hand-controlled pump placed in the scrotum, and a reservoir which stores fluid when the penis is not erect. The device is inflated by squeezing the pump several times to move the fluid from the reservoir to the cylinders. Afterward, the pump is also used to move the fluid back to the reservoir (Fig. 1). You need surgery for both types of implants. Both types of implants are placed completely inside the body. Inflatable implants are used more often because they result in a more natural-appearing erection and flaccid state. In complicated cases, semi-rigid implants may be more suitable. Discuss the choice between the two implants with your urologist.

There are two main companies that make the inflatable implants, Boston Scientific/AMS and Coloplast. Both types of inflatable implants have excellent short and long term outcomes. For more information regarding the Boston Scientific/AMS implant, you can watch an educational video by clicking this link: https://youtu.be/oj-C8jyW418. For more information regarding the Coloplast implant, you can watch an educational video by clicking this link: https://youtu.be/yilEAVvQW4Q.

Fig. 1: A common type of inflatable penile implant.  

Fig. 1: AUS implantation in the male lower urinary tract. 

Fig. 2: Male urethral sling implantation in the male lower urinary tract. 

The Procedure

For penile implant surgery, you will receive general anesthesia. You will also get a urinary catheter and a drain, which are usually removed the day after surgery (in the office). Once you are under anesthesia, the doctor will make a small incision either just above the penis or between the penis and the scrotum. The incision exposes the erectile chambers, and the surgeon measures them to place a penile implant of the correct length. Once the cylinders are in place, the reservoir is placed behind the abdominal wall, and the pump is placed in the scrotum between the testicles to conceal the pump. Finally, all elements of the implant are connected, and the incision is sutured closed. The wounds are cleaned, and a compressive bandage is applied.

How to Prepare

Your doctor will advise you in detail about how to prepare for the procedure. WITH THE APPROVAL OF YOUR PRIMARY CARE PHYSICIAN AND/OR CARDIOLOGIST, you will have to stop all aspirin-containing medications and STOP ANY BLOOD THINNING MEDICATIONS such as Warfarin, Coumadin, Plavix, Xarelto, Eliquis, Brilinta or Effient. Some patients may need to remain on blood thinners if mandated by another physician; this MUST be discussed with your surgeon EXPLICITLY prior to proceeding with surgery. You must not eat, drink, or smoke after midnight before surgery to prepare for the anesthesia. If you are taking any prescribed medication, discuss it with your doctor. You may need to stop taking it several days before surgery.

After the Procedure

Usually, you can leave the hospital after surgery on the same day. You may experience pain, soreness and swelling of the penis and scrotum in the first few days and up to several weeks after surgery. This is normal and can be treated with analgesics and cold packs. In the first 2-3 days after surgery, there may be a small amount of discharge from the incision. There is no need to treat this because it usually stops on its own. 1-3 days following surgery: follow up with the nurse in the office for removal of your catheter, dressing and drain. Some men may be requested to keep their dressing and/or drain for longer depending on their unique situation. You are free to shower 24 hours after the drain, dressing and catheter are removed. You will be prescribed multi-modal pain medication to aid in post-operative analgesia. You may also be prescribed several days of antibiotics to reduce the chance of developing a post-operative infection. Further, you will be prescribed a stool softener to avoid constipation.

For 6 Weeks After the Surgery

  • Do not lift anything heavier than 10 pounds.

  • Do not do any heavy exercise and avoid bike riding.

  • Do not take thermal baths or go to the sauna or the pool.

  • Discuss any prescribed medication with your doctor.

  • Your doctor will schedule an appointment to inflate the implant for the first time. This is done once the swelling and soreness have gone, about 4-6 weeks after the procedure. After the appointment, you may start having sexual activity.

If you’re able to safely and comfortably inflate and deflate your implant, you are ready to use your implant. If you aren’t quite ready to use your implant yet, DO NOT WORRY! Some patients may require more time to heal and learn how to work their implant. We will schedule a follow-up visit 1-2 weeks later to try again.

  • We strongly encourage all our patients to inflate and deflate their implant at least once daily.

  • Motivated patients should try to complete the following exercises at least TWICE daily

  • Fully inflate your device using both thumbs until you can’t pump it anymore. Stretch your penis up, down, left, and right. Fully rotate ‘around-the-clock’. Then try to see if you can get any more pumps in. Most men can. This means better girth and a larger, more firm erection!

For more information, you can watch a video of “The Exercise” by following the following link: https://www.youtube.com/watch?v=WJaZCeJjxIM.

You Should Notify Your Urologist and/or Go to the Emergency Room if:

  • The swelling is severe or not improving

  • You have discharge of a large amount of fluid each day

  • The pain gets worse or does not improve despite pain medication

  • You notice increased redness or tenderness around the incision site

  • You have a fever

  • You are unable to urinate

  • Any allergic reaction to your prescribed medications such as hives, rash, nausea, or vomiting.