William I. Jaffe, MD
Assistant Professor of Urology in Surgery, PENN Medicine
Last Modified: April 10, 2014
The inflatable penile prosthesis is inserted during a minor operation and is used to treat Erectile Dysfunction. Generally this procedure is used for patients that fail or do not tolerate less invasive treatments (oral medications, urethral suppositories, vacuum devices or injection therapy). This implant has been in use for decades and has a long track record of safety and efficacy. Patient satisfaction rates are approximately 90%. The prosthesis will allow you to have an erection suitable for sexual activity on demand. In the deflated position the penis will have a normal flaccid appearance.
The vast majority of penile implants in the United States are manufactured by American Medical Systems, Inc. These implants have a proprietary antibiotic coating (InhibiZone) that reduces the risk of infection, the most problematic complication of prosthetic surgery, by 2/3.
This surgery is generally performed on an outpatient basis under general or spinal anesthesia. The operation usually takes about 45 minutes. It is performed through a small incision in the scrotum or just above the penis, depending on certain circumstances. Two fluid filled cylinders are placed in the erectile tubes of the penis (one on each side). A reservoir (balloon) that holds the fluid for the system is placed in the pelvis through the same incision. A control pump that operates the device is placed in the scrotum under the skin next to one of the testicles. You will need to squeeze the pump to transfer fluid from the reservoir into the cylinders to produce an erection. There is a separate button on the control pump used to deflate the cylinders. You will be given detailed instructions on operating the device after the operation. If you feel that you will not be able to use the control pump, you should not have this surgery.
Patients can usually go home the same day. Occasionally a small drain will be placed if there is bleeding; in this case patients are usually kept overnight and the drain is removed the next morning. You will have a compressive dressing around the penis and scrotum for 24 hours. This can be removed the day after surgery. The stitches used to close the incision are absorbable. Postoperative pain is generally mild. You will be sent home with prescriptions for antibiotics, pain medication and a stool softener. It is common to have some scrotal swelling and discomfort after surgery, it usually resolves within one to two weeks. Patients are instructed to avoid lifting greater than 10 pounds, exercise or sexual activity until 4-6 weeks after surgery. You may shower the day after surgery. Bathing should be avoided for a week.
You should notify your surgeon immediately if you have any of the following symptoms after surgery: severe pain, fevers, discharge from the incision, blood in the urine or severe swelling. You should schedule a follow up appointment in approximately one to two weeks after surgery for a wound check. You will be taught how to use the pump and will be given instructions to inflate and deflate the device for 15 minutes twice a day to help stretch the tissues and prevent capsule formation around the device.
Overall patient satisfaction rates are 90%. There are certain features of the device that are important to consider. Although the cylinders expand in length and width, the erection that patients get with a prosthesis is generally smaller than their natural erection prior to having erectile dysfunction. The erectile bodies in some men do not extend fully into the tip of the penis. This is actually a separate compartment that normally fills with blood in men who do not have ED. If the cylinders do not extend far enough into the tip of the penis, the head of the penis may "droop" somewhat with erections. This rarely produces difficulty with sexual activity. Complications of the procedure include skin infection, bleeding, prosthetic infection (<1%), mechanical failure (the average device lasts 8-10 years), extrusion of the device (erodes through the skin), perforation of the urethra or erectile body during surgery (usually the surgery will be aborted), and rare cases of damage to the bowel, bladder or large blood vessel during placement of the reservoir balloon (very rare). Occasionally patients will complain of penile pain, either with the device inflated or in the deflated position. This seems to be more common in diabetics. Very rarely, a patient will ask to have the device removed because of pain/discomfort. Infections are also more common in diabetics and patients with spinal cord injuries. Penile numbness is rare when using the approach through the scrotal incision and slightly more common when using the incision on top of the penis.
Please note that this operation is essentially irreversible. The device can be removed, but patients will generally be unable to have erections with any other form of treatment after having had a prosthesis. If your implant needs to be removed for any reason, you will likely need to have it replaced to have erections in the future.