The Surgical Solution: ED and Penile Implants (Prosthesis)

September 24, 2020

The penile prosthesis is an implant that allows patients to have direct control over erections using an implanted pumping device. It’s highly effective and often covered by insurance, so read on to see if it might be the erectile dysfunction treatment you need. To consult with one of our urologists (the type of specialist you need to see if you’re looking for an ED doctor) in-person or through a video visit, contact us.

What is Erectile Dysfunction?

Erectile dysfunction, or ED, is the inability to start or maintain an erection that is firm or rigid enough for satisfying sexual performance. Erectile dysfunction may be present in up to 50% of men after age 40 and is more common and present than most people think. ED has been shown to impact the quality of life for men. It can also be associated with anger, depression, and anxiety. It has also been shown to affect the levels of intimacy and levels of satisfaction in men and their partners.

What causes ED?

Erections happen when there is a successful complex interaction that happens between your blood vessels, nerves, and what goes on “between your ears.” For most men, however, it is usually due to other medical conditions.

Risk factors and causes for ED may include prior prostate or pelvic surgery, diabetes, blood vessel related issues such as coronary artery disease, heart disease, neurological conditions, high blood pressure, high cholesterol, obesity, and other diseases that affect your body as a whole.

How is ED Treated?

Erectile dysfunction can be treated with numerous options, including oral medications (like Viagra ™), Low intensity shockwave therapy (Pulsewave ™), vacuum devices, penile injections, and penile implants.

It is estimated that only approximately 50% of men who are taking oral medications are satisfied with their erections while 97% of men who have a penile implant are typically satisfied. Some men also end up stopping their pills because they either no longer work or they do not like them.

According to some studies, the cost of a bottle for 30 pills for erections can be the same as one implant procedure.

What is a Penile Implant and How is it performed?

A penile implant is used to treat ED in men. They are typically used when other treatments such as pills, injections, vacuum devices do not or no longer work for men. Men will sometimes also prefer having a penile implant over the other options or when they do not like the side effects associated with them.

The penile implant may either malleable (bendable), or inflatable. The type that you may receive will vary on either your preference and whether or not you feel comfortable operating them. Both options provide patients with direct control of both the timing and duration of your erection whenever you feel aroused. The inflatable system mimics the most natural feeling erection as it allows you turn it “on and off.”

The implant procedure is typically performed in an outpatient setting (go home the same day).

Dr. Tsai performs his implant technique in a manner where you will only have one small incision above the area of your pubic bone.

Dr. Tsai’s minimally invasive technique allows for:

  1. Improved recovery time
  2. Less soreness around the genital and scrotal area
  3. Easier and earlier  manipulation of the implant device post-operatively.

Is a Penile Implant right for me?

A penile implant may be right for you if pills, injections, or medications no longer work for you or if you dislike any of the previously mentioned treatments. The biggest benefits of your implant is that it will make your penis rigid. You are able to control when you would like to have your erections whenever you feel aroused.

Does the penile implant make my penis larger/longer?

Unfortunately, a penile implant does not increase the length of your penis. Preoperatively when you meet with Dr. Tsai, he will give you an idea of how things will look after your procedure.

What are the risks associated with having a penile implant?

  • The penile implant surgery is irreversible but not permanent.. Once you have an implant placed, you may have it removed if you do not like it or have issues with it. It is irreversible in the sense that once it is performed, the other treatments (pills, injections, vacuum device) will no longer work for you.
  • Although uncommon, potential complications of the implant and procedures are:
    • Infection – this can be up to 3% of patients who have an implant. This may increase if surgery needs to be repeated. If your implant gets infected, it needs to be replaced or removed. Infections usually happen within the first 2 months after surgery.
    • Malfunction – The device may break down in 2% of patients. If this is the case, the part that is broken will be replaced.
    • Self-inflation – Sometimes the device may inflate by itself. If this happens a part or revision will need to be replaced or performed. Great care is taken during the procedure to avoid this but it may happen if you are obese or had a history of pelvic surgery

  How do I prepare for surgery?

  • The night before and morning of your surgery, please shower with antibacterial soap.
  • You may be asked to receive preoperative clearance from your normal doctor
  • All supplements you are taking, including vitamins, fish oil, etc, should be held 5 days before your surgery and resumed 10 days after your surgery
  • If you are on blood thinners (Aspirin, Coumadin, Eliquis, Pradaxa, etc.), you will be asked to hold it at least 5 days before your procedure and resumed 10 days after your surgery
    • We will ask you to clear the ability to hold your blood thinners with your prescribing doctor prior to your surgery
  • If you are diabetic and are poorly controlled (Hemoglobin A1c levels are greater than 8%), your surgery may be postponed until you have better blood sugar control. This is to avoid the complication of infections after your surgery
  • Nothing to eat or drink after midnight before your surgery day.