Surgical Treatment of Erectile Dysfunction

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Surgical Options for Erectile Dysfunction

Your doctor may suggest surgery to treat your erectile dysfunction or ED if other forms of therapy are not satisfactory.

Surgery is generally used to accomplish one of the following goals:

  • Implanting a prosthetic device within the penis, which causes an erection
  • Reconstructing the arteries within the penis to increase blood flow, which helps to facilitate an erection
  • Blocking off veins within the penis that allow blood to leave the penis, which helps to maintain an erection

Penile Implants for Erectile Dysfunction

In the past, the placement of a prosthetic device (also called a penile implant) within the penis was the only effective therapy for a man with an organic (having to do with a bodily organ or organ system) cause of erectile dysfunction.

Now, a penile implant is the last option considered. Nonsurgical treatment options are always tried before resorting to surgical options. Nevertheless, a penile implant remains a reliable form of therapy in highly motivated men when other treatments are unsuccessful.

Your doctor will discuss the benefits and risks of a penile implant with you and your sexual partner.

  • Almost all men with penile implants express satisfaction.
  • Part of this enthusiasm is related to the failure of other therapies and highly motivated users.

Two types of penile implants are available: a semirigid or malleable rod implant and an inflatable implant.

Semirigid or Malleable Rod Implants for Erectile Dysfunction

With the semirigid or malleable rod implant, 2 matching cylinders are surgically implanted into the penis. To achieve an erection, you manually adjust the position of the penis. This implant provides enough rigidity for penetration and rarely breaks.

Advantages of the semirigid or malleable rod implant include:

  • Simple surgery
  • Relatively few complications
  • No moving parts
  • Least expensive implant
  • 70-80% success rate
  • Highly effective

The major drawbacks of the semirigid or malleable rod implant are:

  • Cosmetic appearance of the penis
  • Need for surgery
  • Destruction of the natural erectile mechanism when the device is implanted

Other disadvantages of the semirigid or malleable rod implant include:

  • Constant erection at all times
  • May be difficult to conceal
  • Does not increase the width of the penis
  • Risk of infection
  • Permanently alters or may injure erection bodies
  • Most likely implant to cause pain or erode through the skin
  • If unsuccessful, interferes with other treatments

Inflatable Implants for Erectile Dysfunction

The inflatable implant consists of:

  • Two cylinders, surgically inserted into the penis
  • A pump, placed in the scrotum
  • A reservoir, contained either within the cylinders or in a separate reservoir placed beneath the tissue of the lower abdomen

With an inflatable implant, you squeeze the pump placed within the scrotum to inflate the cylinders. The pump moves fluid from the reservoir implanted in the lower abdomen to the cylinders implanted in the penis. The expansion of these cylinders creates an erection.

The inflatable implant generally remains functional for 7-10 years before a replacement typically is necessary. Most, if not all, companies offer lifetime warranties for both the parts and the components of these devices.

Although effective, some overall complications of the inflatable implant include:

  • Infections
  • Device malfunctions
  • Erosion of the device through the urethra or the skin
  • Painful erections

Two types of inflatable implants are available: a fully inflatable implant and a self-contained inflatable unitary implant.

Fully Inflatable Implants

  • Advantages of a fully inflatable implant include:
    • Mimics the natural process of rigidity-flaccidity
    • User controls the state of erection
    • Natural appearance
    • No concealment problems
    • Increases the width of the penis when activated
    • 70-80% success rate
    • Highly effective
  • Disadvantages of a fully inflatable implant include:
    • 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

  • Advantages of a self-contained inflatable unitary implant are:
    • Mimics the natural process of rigidity-flaccidity
    • User controls the state of erection
    • Natural appearance
    • No concealment problems
    • Simpler surgery than the fully inflatable implant
    • 70-80% success rate
    • Highly effective
  • Disadvantages of a self-contained inflatable unitary implant include:
    • Sometimes difficult to activate this type of implant
    • Does not increase the width of the penis
    • Possible mechanical breakdowns
    • Risk of infection
    • Relatively expensive
    • Permanently alters or may injure erection bodies
    • If unsuccessful, interferes with other treatments

Vascular Reconstructive Surgery for Erectile Dysfunction

Vascular reconstructive surgery is another surgical treatment option for men with erectile dysfunction.

  • Surgery to reconstruct the arteries within the penis can be performed. By increasing blood flow to the penis, a man is able to achieve or maintain an erection.
  • Surgery to block off the veins within the penis can be done. By blocking off these veins, blood is not allowed to leave the penis, which enables a man to achieve or maintain an erection.

Your doctor will discuss the benefits and risks of vascular reconstructive surgery with you and your sexual partner.

Advantages of vascular reconstructive surgery include:

  • Restores natural erections when successful
  • Natural appearance
  • No implant required
  • If unsuccessful, does not interfere with other treatments

It must be stressed that very few men are potential candidates for vascular reconstructive surgery. In addition, extensive testing is required of men prior to undergoing this type of surgery. Additionally, there are very few medical centers that have experience in the management of vascular surgery for erectile dysfunction.

Although moderately effective, the long-term effectiveness of vascular reconstructive surgery is generally only 2 years or less. Also, vascular reconstructive surgery is very expensive and associated with a relatively high relapse rate.

Other disadvantages of vascular reconstructive surgery are:

  • Technically difficult surgery
  • Risk of infection, scar tissue formation with distortion of the penis, and painful erections
  • May cause shortening or numbness of the penis

Pictures of Surgical Treatment for Erectile Dysfunction

Two rigid cylinders have been placed into the penis. This type of implant has no inflation mechanism but provides adequate rigidity to the penis to allow penetration.
Two rigid cylinders have been placed into the penis. This type of implant has no inflation mechanism but provides adequate rigidity to the penis to allow penetration. Click to view larger image.

Inflatable penile device has 3 major components. The 2 cylinders are placed within the penis, a reservoir is placed beneath the rectus muscle, and the pump is placed in the scrotum. When the pump is squeezed, fluid from the reservoir is transferred into the 2 cylinders, producing a firm erection. Squeezing the top of the pump causes a reversal of flow of the fluid from the cylinders back into the reservoir.
Inflatable penile device has 3 major components. The 2 cylinders are placed within the penis, a reservoir is placed beneath the rectus muscle, and the pump is placed in the scrotum. When the pump is squeezed, fluid from the reservoir is transferred into the 2 cylinders, producing a firm erection. Squeezing the top of the pump causes a reversal of flow of the fluid from the cylinders back into the reservoir. Click to view larger image.

This inflatable penile prosthesis has fluid located at the base of the device. When the tip of the device is squeezed, the fluid is transferred into the cylinder.
This inflatable penile prosthesis has fluid located at the base of the device. When the tip of the device is squeezed, the fluid is transferred into the cylinder. Click to view larger image.

Reviewed on 11/20/2017

Medically reviewed by Michael Wolff, MD; American Board of Urology

REFERENCE:

"Surgical treatment of erectile dysfunction"
UpToDate.com

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