Penile Implant

Penile implants are devices known as prostheses that can restore erection in many men with erection dysfunction (ED). Penile implants require a surgical procedure and it is the most common surgery performed for treating ED.

The penis contains two chambers called the corpora cavernosa, which runs along the length of the organ. A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa and is surrounded by the corpus spongiosum.

Erection begins with sensory or mental stimulation, or both. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining erection. When muscles in the penis contract to stop the inflow of blood and open outflow channels, erection is reversed.

Types of Penile implants

There are two main types of implants:

Malleable implants: Malleable implants usually consist of paired rods which are inserted surgically into the corpora cavernosa. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.

Inflatable implants: Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurised fluid. Tubes connect the cylinders to a fluid reservoir and a pump, which are also surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis. They also leave the penis in a more natural state when not inflated.

Procedure

Penile Implant surgery is performed under sterile conditions in the operating room with the patient under general or spinal anasthesia. The operation usually takes between 1 and 2 hours and is performed as an outpatient day surgery with no overnight stay required in the hospital. The surgery involves the following steps:

• An incision is made across the top of the scrotum at the base of the penis
• Special instruments are inserted through the incision to stretch the spongy tissues inside the hollow chambers of the penis (corpora cavernosa)
• Your surgeon then flushes the chambers with antibiotic fluid to reduce the risk of infection post-operatively
• The implant rods or cylinders are then inserted into position inside the penis
• If an inflatable prosthesis is used, a pump and valve is inserted into the scrotum and a fluid reservoir is implanted under the abdominal wall through an incision made internally by the surgeon
• When the prosthesis is in place and functioning, then incisions are finally sutured by the surgeon

Patients are advised to apply an ice pack to the groin area to minimise pain and swelling, and also given oral antibiotics to decrease the risk of post-operative infection. The surgeon will instruct you on how to use your new implant once the pain and swelling has subsided. Most patients can resume sexual activity in 6-8 weeks.

Risks & Complications

As with any surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place. Complications can be medical (general) or specific to Penile Implant surgery. Medical complications include those of the anasthesia and your general well being. Most patients do not have complications after Penile Implant surgery; however complications can occur and depend on which type of surgery your doctor performs as well as the patient’s health status. (obese, diabetic, smoker, etc.).

Specific complications for Penile Implant surgery include:

Infection: Infection can occur with any operation. Infection rates vary but are generally low for healthy men. Infection can occur weeks after penile implant surgery or longer, and may present as pain, swelling of the scrotum, fever or drainage. If infection occurs it can usually be treated with antibiotics but may require further surgery to remove the implant until the infection has resolved. In rare cases, the prosthesis can erode through the skin requiring surgical intervention.

Mechanical Breakdown: Although rare, mechanical breakdown can occur and requires surgery to repair or replace the broken prosthesis. Mechanical problems with implants have diminished in recent years due to technological advances.

Injury to the Urethra: Damage to the urethra is rare but can occur during surgery and requires repair.