Impotence/Erectile Dysfunction (cont.)
Medical Author:
Stephen W Leslie, MD, FACS
Medical Editor:
Joseph A Salomone III, MD
Medical Editor:
Francisco Talavera, PharmD, PhD
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 treatment |
| 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 |
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