Impotence/Erectile Dysfunction (cont.)

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Medical Author:

Stephen W Leslie, MD, FACS

Coauthor:

Stanley A Brosman, MD

Medical Editor:

Joseph A Salomone III, MD

Medical Editor:

Francisco Talavera, PharmD, PhD

Medical Editor:

Richard Harrigan, MD

Surgical Treatment

Penile implants: In the past, the placement of prosthetic devices within the penis was the only effective therapy for men with organic ED. Now, this is the last option considered. Nevertheless, this remains a reliable form of therapy. Before selecting this form of management, your doctor will discuss the benefits and risks of this procedure with you and your partner. Nearly 100% of the men with implants express satisfaction. Part of this enthusiasm is related to the failure of other therapies and a highly motivated user. Two types of devices are available, a semirigid and a multi-component inflatable system.
- With the semirigid device, 2 matching cylinders are implanted into the penis. These devices provide enough rigidity for penetration and rarely break. The major drawbacks are the cosmetic appearance of the penis, the need for a surgery, and the destruction of the natural erectile mechanism when the device is implanted.
- The inflatable devices consist of 2 cylinders inserted into the penis, a pump placed in the scrotum to inflate the cylinders, and a reservoir that is contained either within the cylinders or in a separate reservoir placed beneath the tissue of the lower abdomen. The inflatable prosthesis generally remains functional for 7-10 years before a replacement may be necessary. Complications include infections in 2% of users, device malfunction in 4%, erosion of the device through the urethra or skin in 2%, and painful erections in 1%.

Types of Surgical Therapies for Erectile Dysfunction

Treatment	Advantages	Disadvantages
Semi-rigid or malleable rod implants	Simple surgery Relatively few complications No moving parts Least expensive implant 70-80% success rate Highly effective	Constant erection at all times May be difficult to conceal Does not increase width of penis Risk of infection Permanently alters or may injure erection bodies Most likely implant to cause pain or erode through skin If unsuccessful, interferes with other treatments
Fully inflatable implants	Mimics natural process of rigidity-flaccidity User controls state of erection Natural appearance No concealment problems Increases width of penis when activated 70-80% success rate Highly effective	Relatively high rate of mechanical failure Risk of infection Most expensive implant Permanently alters or may injure erection bodies If unsuccessful, interferes with other treatments
Self-contained inflatable unitary implants	Mimics natural process of rigidity-flaccidity User controls state of erection Natural appearance No concealment problems Simpler surgery than fully inflatable prosthesis 70-80% success rate Highly effective	Sometimes difficult to activate the inflatable device Does not increase width of penis Mechanical breakdowns possible Long-term results not available Risk of infection Relatively expensive Permanently alters or may injure erection bodies If unsuccessful, interferes with other treatments
Vascular reconstructive surgery	Restores natural erections when successful Natural appearance No implant required If unsuccessful, does not interfere with other treatments 40-50% overall success rate Moderately effective	Most technically difficult surgery Only 50% of men are potential candidates Extensive testing required Risk of infection, scar tissue formation with distortion of the penis, and painful erections May cause shortening or numbness of the penis Long-term results not available Relatively high relapse rate Very expensive