Penile Implant

What is a penile implant (prosthesis)?

A penile implant is a device that is surgically placed in your penis to allow you to get an erection. This device is used for men who have tried other erectile dysfunction (ED) treatments like oral medications, urethral suppositories, vacuum devices, or injection therapy without success.

There are two types of implants: 

• Inflatable: A reservoir of fluid is placed in the abdomen or scrotum and attached to inflatable cylinder tubes in the penis. A control pump with a release valve is placed in the scrotum. The control pump is squeezed to push the fluid into the cylinders to produce an erection. The release valve is used to return the fluid to the reservoir after sexual activity. When deflated, the penis will have a normal flaccid appearance. This type is most commonly used.
• Semi-rigid: This implant stays rigid all the time. It is bent forward for sexual activity or bent up towards the body to conceal it when not in use. This article does not talk about this type of implant. Talk to your urologist for more information.

How is the implant placed?

Penile implant placement is a minor surgery often done on an outpatient basis so that you can go home that day. General (meaning you will be asleep) or spinal anesthesia (also called spinal block) is used. The operation usually takes about 45 minutes. It is done through a small incision (cut) in the scrotum or just above your penis, depending on your case. 

If there is bleeding, a small drain will be placed and you may stay overnight in the hospital. The drain is removed the next morning. In general:

• A dressing that applies pressure will be placed around your penis and scrotum for 24 hours. This can usually be removed the day after surgery. The stitches used to close the incision are absorbable, meaning they do not need to be removed and will go away on their own.
• Pain after surgery is often 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. This often goes away within one to two weeks.
• You should not lift anything heavier than 10 pounds, and avoid exercising and sexual activity until 4-6 weeks after surgery.
• You may shower the day after surgery. You should not bathe or submerge your penis in water for a week after surgery.
• If you have an inflatable implant, you will be taught how to use the pump. You 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.

What are the possible side effects of the procedure?

These can include:

• Skin infection.
• Bleeding.
• Prosthetic infection (<1%). Infections are also more common in diabetics and patients with spinal cord injuries.
• Implant failure (the average device lasts 8-10 years).
• Extrusion of the device (comes through the skin).
• Perforation (cutting) of the urethra or erectile body during surgery (usually the surgery will be stopped).
• In very rare cases, there can be damage to the bowel, bladder, or large blood vessel during the placement of the reservoir balloon.
• At times, patients will complain of penile pain, either with the device inflated or in the deflated position. This seems to be more common in diabetics.
• 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.

What should I notify my provider about?

You should notify your provider right away if you have any of the following symptoms after surgery:

• Severe pain.
• Fever.
• Discharge (drainage) from the incision.
• Blood in the urine.
• Severe swelling.

Your provider will tell you when to return for follow-up.  

What else do I need to consider?

Although the cylinders expand in length and width, the erection that you get with an implant is often smaller than your natural erection before having erectile dysfunction. The erectile bodies in some men do not extend fully into the tip of the penis. This is 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 should not affect sexual activity.

An implant does not change the sensation (feeling) on the skin of the penis. It does not affect the ability to reach orgasm or ejaculate.

If the device is removed, you 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.

Picture of inflatable penile implant.