Penile Implant FAQs
Although the medical treatments of ED (pills, injections, suppositories, VED) may provide satisfying erections, they unfortunately do not provide a long-term “cure” to the problem. They are, after all, “bandaids” for the symptoms but not a total solution.
Most men and their partners want, ultimately:
- An erection that is rigid and satisfying for sexual activity
- The ability to be spontaneous in their sex lives
- The ability to predict and control how long the erection lasts and how often they can use it
- Lack of “paraphernalia”. In other words, the erection should be natural, not associated with devices or other impediments
Because of all of these factors, penile implants offer a very compelling alternative to treating ED.
There are several types of implants. In each case, the implant goes into the “erection bodies” of the penis and converts the non-functioning penis into a functioning penis.
In this case, flexible (a good analogy is a goose-neck lamp) or semirigid cylinders are placed into the erection bodies. The penis is rigid enough for sex but soft (“flaccid”) enough that it can be concealed in the clothes.
Benefits: least expensive type of implant, fewer mechanical parts to fail
Downsides: least natural erection, no antibiotic coating. Worst rigidity, worst flaccidity
Good for: men with poor hand function (e.g. multiple sclerosis, parkinsons disease), men with “buried penis” who need a prosthetic to hold on a condom-style catheter
In this case, the cylinders are filled with fluid and there is a pump in the scrotum (totally concealed, like a 3rd small testicle). The man uses the pump to get an erection, and “bends” the penis to move the fluid out and become flaccid again.
Benefits: excellent rigidity, no need to place any parts in the pelvis/abdomen.
Downsides: no antibiotic coating, not as good flaccidity. Not good for very thin men, not good for larger penises (because of poor flaccidity)
Good for: men who have complex pelvic issues that make placement of a “three-piece” (see below) undesirable, e.g. men who have had pelvic crush injuries or those with complex vascular reconstruction.
These are by far the most commonly used devices. There are fluid-filled cylinders, a pump in the scrotum (that has parts for both pumping up and deflating the cylinders), and a reservoir in the pelvis/abdomen that holds the fluid when the penis is flaccid.
Benefits: excellent rigidity and flaccidity, total control over the erection, antibiotic coatings available
Downsides: need for placement of reservoir
Good for: most men with ED, including ED from prostate cancer, diabetes, vascular disease, spinal cord injury, etc.
No, sensation of the penis or sensation of orgasm is not affected by having an implant.
Yes, very well. Satisfaction rates for patients and their partners in most studies is well above 90%.
Most insurance companies, including Medicare, cover the device and surgery although the patient needs to check with their individual insurer and of course we preauthorize any procedures.
For those without insurance or who have insurers who do not cover these services, we have specialists who can work with the patient on costs and payment. We recognize that, in some cases, men may need to pay cash. We strive to offer care as inexpensively as possible. As a general ballpark, a penile implant costs around $20,000 (which includes the device, facility, anesthesia, etc), which is much less than it would be in other locations outside of Utah. We have many men find that coming to Utah, including flights and hotel, still save money by travelling here.
As with any surgical procedure, there are potential risks. The most significant is infection. Just like having a knee or hip prosthesis, having a penile implant means there is a “foreign body” in place and an infection can be quite serious (just like with a hip or knee).
Implants are safe for getting an MRI if needed.
It is important to tell other health care providers that you have an implant. For example, if you are having a dental procedure you will likely need additional antibiotics.
Infection rates with modern implants are quite low. In our own experience, the risk of infection is much less than 1%.
There are certain conditions that do increase the risk of infection:
- Spinal cord injury
- Diabetes (especially if the blood sugars are consistently high)
- Redo surgery or in the setting of extensive scarring
- Taking chronic steroids such as prednisone
One of the great advances of modern implants is the use of coating that hold in antibiotics to prevent bacteria from getting on the device. These antibiotics slowly absorb over weeks to months.
We use many techniques to minimize infection in patients, both before the operation and during the operation. It is critical that surgeons are very meticulous in technique and are aware of the many things that can be done to prevent infections.
When a man has had ED for a long time, the penis shrinks and scars. This is similar to a weightlifter who stops working out and the muscles shrink. For this reason, the penis is often shorter than it was when he was younger. Sometimes this is made worse by “bad memory” (i.e. a man thinks he was larger in the past when he actually was), gaining weight, having pelvic surgery such as a radical prostatectomy, etc. This loss of length is the most common cause for dissatisfaction. We have developed techniques to maximize your penile length while still performing safe surgery. These include things the patient does before the operation and afterwards.
Depending on the patient’s individual situation, there are two “expandable” devices that are available that will allow the penis to stretch to its full potential.
The devices are typically put in through a very small incision on the upper part of the scrotum. This takes about an hour. Usually, this is the only incision that is necessary.
The procedure is almost always done as an outpatient. The patient returns to clinic the next day to have dressings etc removed.
The procedure is done in the operating room, either in the hospital or at a surgery center.
These devices are mechanical and so eventually they will fail. With modern devices, they usually last 10-15 years and may last even more than 20 years. When they fail, an additional surgery is required to replace the device (very similar to the original surgery).
As with other specialized surgeries, the patient should be careful about who they choose to perform it. With implants, surgeons often do 1-10 per year and may not have specialty training in implant and penile surgery. As with most things, the patient should enquire about the experience of the surgeons performing these cases and only go to someone who is comfortable with all aspects of these cases. For over a decade, we have had the highest volume by far in the intermountain west for prosthetic surgery (both penile implants and urinary incontinence implants). Of course, high volume only matters in the context of the desire for clinical excellence and improvement and we are constantly making improvements to make the procedures safer and more satisfying for the patient. Currently, Dr. Brant is one of two surgeons fellowship-trained in prosthetic surgery in the Intermountain West, and the only one currently operating.
It is obvious to most people that you want a surgeon (or a contractor, or a car mechanic, etc) who has a lot of experience. It is only with experience that someone can not only know all the nuances but also can deal with any unusual situations or complications that might arise. In surgery, often things are not as straightforward as they seem and a surgeon needs a deep and detailed knowledge of normal and abnormal anatomy, and how do deal with things that are not the norm.
When you are meeting your surgeon, it is important to ask how many of that case they have done and either try to verify that or at least feel you are getting an honest answer. Surgeons should know their own numbers and not just quote from the general medical literature.
Be very suspect of any surgeon who says they are “the best”. Any surgeon who says they are the best is likely not. You don’t want a big ego getting in the way of your operation. Rather, you want someone who is never quite satisfied, who always wants things to be better, and who takes 100% responsibility for your outcome. And as always, the most important thing is that you, as a patient, are comfortable with your physician and surgeon and comfortable with their levels of experience and skills.
Additionally, it is important to know who is doing your surgery. You should clarify whether your surgery is being done by a trainee (student, resident, fellow) or by the surgeon you have chosen. For more information on why it’s important to know who’s performing your surgery, check out this article in Medpage Today.