Surgery Overview

Penile implants to treat erection problems (erectile dysfunction) are either noninflatable (malleable) or inflatable cylinders. They 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 implants are always firm. They can be bent into different positions (outward to have sex and back toward the body to conceal under clothing).

There are two-piece and three-piece inflatable implants. Both have two cylinders in the shaft of the penis and a pump in the scrotum.

• The two-piece implant stores the salt water (saline) at the base of the cylinders. The saline is pumped toward the head of the penis, creating an erection. Bending the implant opens a valve that releases the saline to the base of the cylinders.
• The three-piece implant has a reservoir in the belly that holds the saline. A pump moves the saline from the reservoir into the cylinders, creating an erection. Pressing the release valve on the pump moves the saline from the cylinders back to the reservoir.

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

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

What To Expect

You likely will stay overnight in the hospital. But some people go home the same day. You will take antibiotics for up to 2 weeks after surgery to prevent infection.

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

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

You can typically return to strenuous physical activity after about a month and have sex after 6 to 8 weeks. Inflatable implants usually aren't inflated for a month.

Why It Is Done

A penile implant is an option if you can't get or keep an erection that's firm enough for sex and other treatment options haven't worked.

Implants may be used when erection problems have a physical cause, such as:

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

How Well It Works

Experts agree that penile implants are likely to help with erection problems. There are reports that most people are satisfied with the results.

An implant allows an erection that's firm enough for sex whenever and as often as you want. And the erection can last for as long as you want.

Implants don't affect ejaculation. Ejaculation and orgasm may or may not happen. Implants don't affect sexual desire.

Penile implants usually don't need to be replaced.

Risks

The site of the implant may become infected. If the infection is severe, the implant must be removed.

Sometimes, the implant may have to be removed because of pain.

Other possible problems include:

• The risk of the surgery itself.
• Injury to tissue near the implant. This is called erosion.
• A leak or break in the implant.

Penile implant surgery isn't reversible. This means that if the implant is removed, there aren't any other kinds of treatments for erection problems that will work. But the implant may be replaced.