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Penile Implants: A Surgical Option for Men with Erectile Dysfunction

Reviewed by Drogo K. Montague, MD

Viagra and other drugs used to treat erectile dysfunction (ED) don't work for every man, but penis implants may help some men who do not respond to drugs. ED is a physical and psychological problem defined by the inability to maintain an erection long enough to engage in sexual intercourse.

Penis implants can help men achieve and maintain an erection. However, they do not improve sexual desire or sensation, nor do they increase penis length.

Penis Implant Surgery: Am I a Candidate?

Not all men are candidates for penis implant surgery. Those who are candidates include:

  • Men who have trouble achieving an erection and do not respond to ED drugs, suppositories, vacuum devices or injections.
  • Men with Peyronie's disease, a disorder marked by pain and bending of the penis during erection, if this disorder is accompanied by significant ED.

Your surgeon will take a careful history and perform a physical examination to determine if you are a candidate for penile implant surgery. During this exam, your surgeon will attempt to determine the cause of your ED as well as whether there are any co-existing problems such as loss of desire, inability to ejaculate or premature ejaculation. Your surgeon will also assess the length, stretchability and overall condition of your penis.

If you are deemed an appropriate candidate and decide to have penile implant surgery, you will receive an extensive list of preoperative instructions, including what medications you can and cannot take in the days leading up to your implant surgery. In addition, your surgeon might suggest that you bathe with antibiotic soap before your surgery to reduce the risk of infection. You will also be told not to shave the area yourself.

Types of Penile Implants

There are two main penile implants available: inflatable implants and semi-rigid rods.

Inflatable Implants. Inflatable penis implants are the most commonly used penile implant in the United States. Some inflatable implants are composed of two pieces, while others have three pieces.

In the two-piece model, two cylinders are inserted into the penis and attached to a pump in the scrotum. A small fluid-filled reservoir is part of this system.

Like the two-piece model, the three-piece model also has two cylinders that are inserted into the penis, and a larger fluid-filled reservoir. The models differ in that the three-piece model's reservoir is implanted under the abdominal wall, not in the scrotum.

Both inflatable models work in a similar fashion. Before intercourse, the man squeezes the pump, filling the cylinders with a saline solution from the reservoir; this causes an erection. After intercourse, he deflates the cylinders.

The three-piece penis implant usually produces a better erection than the two-piece system.

Benefits of inflatable penile implants include:

  • Ability to inflate and deflate on command
  • Reduced risk of damage to the inside of the penis that could come with constant internal pressure

Semi-rigid Rod Penis Implants. These penis implants are malleable rods placed within the erection chambers of the penis. They can be bent into an erect or non-erect position. These body implants are always firm, and as a result, there is constant pressure on the inside of the penis.

Benefits of semi-rigid rod penis implants include:

  • Less expensive than inflatable penis implants
  • Surgery is simpler than surgery with inflatable penis implants
  • Fewer parts than inflatable penile implants

Penis Implantation Procedure

Penis implantation surgery takes up to 90 minutes and can be performed on an outpatient basis. Some men may need to stay overnight at the hospital.

During the surgery — which involves the use of general or spinal anesthesia — a catheter is usually placed into the man's bladder through the urethra to drain urine. The catheter is typically removed within 24 hours after surgery.

The penile implant surgeon begins the operation by making an incision below the head of the penis, at the base of the penis or in the lower abdomen. The starting location is determined by the type of penile implant chosen, and the surgeon's preference.

Next, the surgeon dilates the corpora cavernosa, the tissue-filled chambers inside the penis. The surgical site is then flushed with antibiotic fluid to stave off infection, and the cylinders or semi-rigid rods are implanted inside the penis. If the implant surgery involves an inflatable penis implant, the surgeon places a pump inside the scrotum and a fluid-filled reservoir in the scrotum or lower abdomen. Once the device is in place, the surgeon closes the incisions.

Penile Implant Aftercare: What to Expect

Your surgeon will likely give you a list of instructions to follow after your penile implant surgery. This postoperative instruction list may include taking antibiotics to prevent infection and wearing loose-fitting underwear and clothing.

Most men can resume strenuous physical activity approximately one month after surgery and can resume sexual activity approximately four to six weeks after surgery.

Penile implant surgery is permanent. If the implant is removed, ED will return.

Penile Implantation: What are the Risks?

There are risks associated with all surgeries, including penile implant surgery. Notable risks of penile implantation include infection and mechanical failure. The more components an implant system has, the greater the risk of mechanical failure. For example, there is a greater risk of mechanical failure with a two- or three-piece inflatable implant than with a semi-rigid rod system. However, three-piece inflatable implants are considered the most effective, producing the best erections.

Penile Implants Surgery Cost

The cost of penis implant surgery includes the surgeon's fee, anesthesia fee, operating room fee and implant fee. Penis implantation surgery can cost up to $20,000, depending on the type of implant chosen. Medicare and many insurers will cover the cost of penile implant surgery, but may require precertification. Make sure to call your insurer and find out the exact policy before committing to surgery.

Choosing a skilled and experienced surgeon for your penile implant surgery is important. Board-certified urologists and plastic surgeons are the specialists with the most experience performing penile implant surgery. Start your search now.

Enlargement Options: All Hype, No Hope

Many men assume that penile implants increase size. They don't. While many companies hawk penis enlarging potions, pills and stretching weights, there is no evidence that these products will do anything more than deplete your wallet. In addition, these products may have risks attached to them, including impotence.

Unlike fat grafting to the breast and other parts of the body, fat injections to the penis are not considered an effective or safe method of enlarging the penis. Risks may include infection, bleeding and contour deformities. In addition, any gains in girth will likely be temporary, as the injected fat will likely be re-absorbed by your body in a few months. The bottom line is that there is no evidence backing the use of any methods of penile enlargement for cosmetic reasons. Buyer Beware!

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About the Reviewer of This Article

Drogo K. Montague, MD, is professor of surgery at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. In addition, he is director of the Center for Genitourinary Reconstruction in the Glickman Urological and Kidney Institute at the Cleveland Clinic, where he also serves as associate director of the urology residency program.

Dr. Montague completed his undergraduate education and attended medical school at the University of Michigan and received the degree Doctor of Medicine cum laude in 1968. He completed his residency training in urology at the Cleveland Clinic from 1968 to 1973 and has remained there since. He is certified by the American Board of Urology.

Dr. Montague has special interests in prosthetic surgery for both ED and urinary incontinence as well as penile reconstructive surgery for Peyronie's disease and congenital penile curvature.