Surgery Overview

Penile implants to treat erection problems (erectile dysfunction) are either semirigid (noninflatable) or inflatable cylinders that replace the spongy tissue (corpora cavernosum) inside the penis that fills with blood during an erection. The implants come in a variety of diameters and lengths.

Noninflatable (or semirigid) implants are always firm. They can be bent into different positions (outward to have sex; back toward the body to conceal under clothing).

There are two kinds of inflatable implants. Both have cylinders in the shaft of the penis, a reservoir that holds salt water, and a pump to move the salt water from the reservoir to the cylinders. You create an erection by pumping salt water out of the reservoir and into the cylinders. The release valve on the pump drains the salt water out of the cylinders and back into the reservoir.

• A three-chamber inflatable implant has the cylinders in the penis, the reservoir in the belly, and the pump and release valve in the scrotum. The reservoir in this type of implant is larger and separate from the cylinders.
• A two-chamber inflatable implant has the reservoir at the beginning of the cylinders (at the base of the penis) and the pump and release valve in the scrotum.

See a picture of a penile implant.

Surgery will be done using regional or general anesthesia. The implants are inserted through an incision made in the penis, lower abdomen, or scrotum. A thin flexible tube (catheter) is inserted briefly up the urethra and into the bladder to drain urine.

A three-chamber implant is usually more reliable than a two-chamber implant. Inserting the three-chamber implant is a slightly more complicated surgery.

What To Expect After Surgery

Generally, you stay 1 or 2 days in the hospital. You will take antibiotics for up to 2 weeks after surgery to prevent infection.

The urinary catheter is used for about 1 day after surgery.

Do not wear tight underwear or clothing until the surgical incision has healed. Men with inflatable implants may need to avoid tight clothing for 6 weeks to avoid pushing the saline reservoir out of position.

You can generally return to strenuous physical activity and sex after about a month. Inflatable implants usually are not inflated for a month.

Why It Is Done

Penile implants are an option when other, less invasive treatments for erection problems have not been successful and further treatment is desired.

Implants may be the treatment of choice for young and middle-aged men with erection problems from physical causes. Penile implants may be appropriate treatment for men with erection problems caused by:

• Diabetes.
• Pelvic surgery.
• Blood vessel disease.
• Injury to the pelvis, genitals, or spinal cord.
• Peyronie's disease, a curvature of the penis caused by scar tissue.

Because implants permanently change the tissue in the penis, they are not used for men whose erection problems are psychological.

How Well It Works

The satisfaction rate for most men is high for both noninflatable and inflatable implants.¹ An erection with a properly working implant may seem more natural than one from other, nonsurgical methods, such as a vacuum device. The head (glans) of the penis is not made fully rigid by the devices. Noninflatable (semirigid) implants do not increase the size of the penis or produce the fullness of a natural erection.

Implants do not interfere with ejaculation, although ejaculation and orgasm are not ensured. Implants neither increase nor decrease sexual desire.

Noninflatable implants and inflatable devices can last indefinitely.

Risks

The site of the implant may become infected. The risk of infection is higher in men with diabetes, spinal cord injuries, or urinary tract infections. If the infection is severe, the implant must be removed.

Pain may occasionally require removal of the implant.

The most common cause of failure is leakage from the cylinders. Other, less common complications include the following:

• Tissue near the implant may be injured (erosion).
• The implant may break through the skin.
• The implant may break.
• The implant may be positioned incorrectly.
• The implant may be defective and not work.

What To Think About

When considering surgery for erection problems, it is important to include your partner in your decision.

It is important that you have realistic expectations about the type of erections you can have with an implant. The use of penile implants is declining as men consider the risks of surgery—including infections—and as other options become available, such as vacuum pumps, injections, and medicines.

No problems have been reported from the shedding of silicone particles from the implants.

Semirigid (noninflatable) implants are the least expensive option. This surgery is usually covered by insurance policies and by Medicare.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

References

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