Penile Implant

A penile implant/prosthesis is a device that is inserted within the penis to restore erection in men with erectile dysfunction (ED). Doctors recommend these implants when all other treatment options for the condition have failed.

Penis has two chambers, called corpora cavernosa, that run along its length. The chambers include a web of blood vessels like the shape of a sponge. During sexual excitement, nerve impulses from the brain relax the muscles of the corpora cavernosa, enabling blood to rush in. This creates pressure in the chambers that allows the penis to expand and leads to an erection.

Erectile dysfunction in men refers to the inability to get or maintain an erection for satisfactory performance during sexual intercourse or other sexual activity. It is a prevalent problem in men, especially over the age of 40 years. Erectile dysfunction can occur due to physical causes like an injury, hormonal problems, narrowing of blood vessels in the penis (associated with diabetes and high blood pressure) and psychological issues such as depression and anxiety. The condition is usually managed through injections, medicines, and other non-surgical therapies. However, when these treatments fail, a penile implant is recommended.

Penile implants are inserted within the penis to replace the corpora cavernosa. These implants are primarily available in two types: 

• Non-inflatable implants: These implants are permanently firm and contain two cylinders that are implanted inside the penis. These are positioned outwards during sex and inwards during everyday activities.
• Inflatable implants: These implants consist of a pair of cylinders, a reservoir, and a pump. The reservoir contains salt water. The pump pushes the salt water from the reservoir to the cylinders to create an erection. It has a release valve to remove the salt water from the cylinder and back into the reservoir. Inflatable implants are available in two types:
  • Two-chamber inflatable implant: This type of implant has the reservoir at the bottom of the penis (at the start of the cylinder), while the release valve and pump are located in the scrotum. The pump can be squeezed to inflate the implant and bending the penis will deflate the implant.
  • Three-chamber inflatable implant: This implant has a larger reservoir located in the abdomen. The release valve and pump are placed in the scrotum, and the cylinders are located in the penis.

This surgery is recommended in men with ED or erection problems. These problems can occur as a result of pelvic surgery, diabetes, diseases that affect blood vessels, or an injury to the spinal cord, genitals, or pelvis. Penile implant surgery is also performed in men with Peyronie’s disease, and those who have changes in the curvature of the penis caused due to the formation of scar tissue.

This surgery is contraindicated in men with the following conditions:

• Recurrent urinary infections
• Poorly controlled diabetes
• Spinal cord injury
• Undergoing immunosuppressive therapy
• Erection problems caused due to psychological issues

You will be asked to visit the hospital about two weeks before the surgery for a preoperative assessment wherein the surgeon will perform a few tests to ensure that you are prepared for the procedure. The tests include:

• Blood tests
• Examination of the heart, chest, and abdomen
• Physical examination

The surgeon will study your medical history and ask you about the presence of any coexisting conditions. He/she will give you certain instructions to prepare for the surgery and may ask you to:

• Share a list of all the medicines that you take, including over-the-counter medications and herbs.
• Discontinue blood-thinning medicines such as aspirin, warfarin, or ibuprofen a week before the surgery.
• Stop smoking.
• Shower and remove all the body piercings, nail polish, and make-up before arriving at the hospital on the scheduled day of the surgery.
• Arrange for a family member, friend, or responsible adult to drive you home after discharge from the hospital.
• Fast from midnight prior to the surgery. Fasting is essential to prevent vomiting (risk of anaesthesia) during the surgery.
• Sign a consent form to grant your permission for the surgery.

After admission to the hospital, the hospital staff will provide you with a hospital gown. They will insert an intravenous line in your arm to supply essential fluids and medicines during the surgery. The surgery will be done in the following way:

• An anesthesiologist will administer general anaesthesia (medicine that induces sleep) or spinal anaesthesia (medicine that numbs the lower half of the body) to you.
• Someone from the medical team will shave the hair from your scrotum and surrounding skin.
• The surgeon will make a cut (incision) on the upper part of your scrotum, beneath your penis.
• He/she will insert special instruments through this cut and stretch the corpora cavernosa to make space inside your penis.
• Thereafter, the surgeon will flush this area with antibiotic fluid to reduce the chances of infection.
• He/she will insert two cylinders inside your penis if it is a non-inflatable implant. If an inflatable implant is inserted, the surgeon will insert a valve and pump inside your scrotum. The reservoir will also be inserted via the same incision. However, in men who have previously undergone groin hernia surgery, another cut will be made in the lower belly to insert the reservoir.
• Once all the parts of the prosthesis are in position and functioning, the surgeon will close the incisions using dissolvable stitches.
• He/she will insert a catheter (tube) in your urethra (which connects the urinary bladder to the penis) to drain urine and place in another tube to the side your penis to drain and prevent the build-up of blood near the operated area.
• Finally, the surgeon will fill the inflatable implants to prevent bleeding, and cover your penis with bandages.

The surgery will last for one to two hours. After the surgery, the medical staff will move you to the recovery ward wherein your vital signs will be monitored for a while. You will be shifted to the hospital room once your condition becomes stable. You will be required to stay overnight or longer at the hospital depending on your condition. During your stay, you will be given pain-relief medications regularly. The dressings and tubes inserted in the penis will be removed on the next day. The inflated implant will be deflated before you are discharged.

Once you reach home, you will need to take the following care:

• Wound care:
  • Keep the operated area clean and dry. 
  • You will be allowed to take a shower on the next day of surgery. However, avoid soaking the wound for long durations. 
  • Do not apply soap on the surgical site as it may cause irritation. 
  • If the wound gets wet, gently pat it dry. Do not rub on the incision.
• Pain:
  • You will experience some pain and discomfort after surgery. It will subside in three to seven days. The surgeon will prescribe pain-relief medication and antibiotics.
  • Use an ice pack in the groin to minimise pain and swelling.
• Activities:
  • Avoid lifting heavy objects and doing rigorous exercises for the initial four weeks after the surgery.
  • You will be advised to not participate in any sexual activity for at least six weeks following the procedure.
  • The surgeon will ask you to take rest for two to six weeks, depending on the nature of your work.

Once the operated site heals completely, the prosthesis will be undetectable. According to studies, about 80% to 90% of the men who have undergone this surgery are satisfied with the results.

When to see the doctor?

Contact the surgeon immediately if you experience any of the following after the procedure:

• Fever over 100^°F (38^°C)
• Persistent bleeding or discharge from the incision
• Pain that persists even after taking medications
• Swelling or redness in the operated area
• If the implant inflates by itself

The potential risks and complications associated with the surgery include:

• Infection at the site of the implant
• Injury to the tissues near the prosthesis
• Formation of scar tissue
• Displacement of the pump or reservoir
• Leakage from the cylinders of the prosthesis
• Incorrect positioning of the implant
• Mechanical failure of the implant
• Breaking of the prosthesis through the skin
• Defective implant
• Risks of general anaesthesia such as confusion and lung infection

Modern penile implants last for about 10 to 20 years. When the prosthesis fails, you may require another surgery similar to the original one to replace the device.

Your follow-up appointment will be scheduled two weeks after the surgery wherein the surgeon will provide you with instructions to use the implant.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.