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Department of Urology
University of Washington | School of Medicine
Department of Urology
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Figure 1 - malleable penile prosthesis
Figure 1
Figure 2 - inflatable penile prosthesis
Figure 2
Figure 3 - inflatable penile prosthesis
Figure 3

Treatments & Procedures - Surgical

Penile Implant Surgery

Overview

Patients considering penile implant surgery for male erectile dysfunction can expect that the main outcome of surgery will be to provide rigidity of the penis so that he can penetrate his partner and have successful sexual intercourse.

Erectile dysfunction is a complex condition which is described in the Diseases and Conditions section of the website.  For men who have failed other treatment options, such as PDE5 inhibitors (Viagra, Levitra, Cialis), and have either failed penile injection therapy or not comfortable with this option, penile implant surgery provides an excellent chance for sexual rehabilitation.

Prior to surgery for penile implantation, a careful history and physical examination are necessary.  This confirms the nature of the erectile dysfunction, and identifies any additional sexual dysfunction such as loss of desire, inability to ejaculate, or premature ejaculation.  Penile implant surgery will not affect these other aspects of sexual function.  Physical examination is focused on the genitalia in order to identify any skin or urinary infection which would be a contraindication to surgery.  Additional features include the length and stretchability of the penis, previous surgical scars, and any penile fibrosis or scarring which may complicate the implant surgery.  There are two main categories of penile implant.

  1. Malleable penile implant (Figure 1)
  2. Inflatable penile implant (Figure 2 and Figure 3)

Malleable and inflatable penile implants share many risks and benefits.  Below will be found brief descriptions of the two operations followed by shared risks and complications.

Malleable Penile Prosthesis

A malleable penile prosthesis is always the same length.  The largest and longest device which can be accommodated by a man’s penile dimensions will be inserted via a small incision at the base of the penis in the penis-scrotal junction.  Concealment is achieved by bending the rods downward.  Sexual intercourse is possible by bending the malleable rods in the desired direction.  Implantation is straight forward, usually requiring one to one and a half hours of surgery, and can be performed as an outpatient. 

Inflatable Penile Prosthesis

Inflatable penile prosthesis uses fluid to achieve rigidity.  This fluid is shifted from a reservoir placed next to the bladder into two paired cylinders placed on either side of the penis through an incision at the base of the penis at the penis-scrotal junction.  Fluid movement is controlled by a pump, which is placed in the scrotum next to either the left or right testis.  The main advantage of the inflatable penile prosthesis is complete flaccidity and concealment when the device is deflated.  Additionally, when the device is inflated, excellent girth is achieved, with full rigidity and a sense of change in penile size similar to an erection.  Of note, the head of the penis may not become rigid with this device, as it is merely supported by the device.  Inflatable penile prosthesis implantation takes one and a half to two hours to insert, and generally patients remain in the hospital overnight with a small closed suction drain placed adjacent to the device.  This is removed the first day after surgery.

Risks and Complications

Penile implants share common risks and complications.  The most serious, and luckily rare complication is infection of the penile implant.  This happens 1-4% of the time depending on the nature of the implant, previous surgical history, and other factors which can influence the rate of infection.  Bleeding is rare, but maybe manifest as hematoma or bruising of the scrotum.  Mechanical failure occurs approximately in 5% of cases within the first 5 years after surgery.  Ultimately, like any mechanical device, failure depends on the amount of use and wear-and-tear on the device.  The penis will never be longer than it was before surgery, and usually there is a mild amount of shortening.  Some inflatable devices may undergo temporary inflation, termed auto-inflation.  This usually only lasts for several months and eventually goes away.

Resources

AMS Website
The following link will appear in a new window. www.americanmedicalsystems.com

Coloplast Urology & Continence Care
The following link will appear in a new window. http://www.ucc.coloplast.com

Request an Appointment

At UWMC

Call (206) 598-4294.

The following link will open a new window. For more information, go to the UWMC Urology Clinic Web page.

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