Dealing with erectile dysfunction (ED) can be challenging. It impacts physical intimacy, self-esteem, and relationships significantly. When common treatments like pills are ineffective, many men feel lost about their next steps for improving their male sexual health.
For some facing severe ED, especially after treatments like prostate cancer surgery, penile implant surgery offers a highly effective solution. It is a path many consider when other methods have not restored the desired intimacy. Considering any surgery is a major decision; understanding the details is important.
Let’s discuss what penile implant surgery involves, the different types of implants available, and who might benefit from this procedure. We will cover the process, recovery, and important considerations for this aspect of men’s health care.
Understanding ED After Prostate Surgery
A frequent reason men explore advanced ED treatments is following prostate removal surgery, often performed robotically for prostate cancer. For example a 78-year-old patient, in good health, experiencing constant ED after his prostatectomy. He noted that Viagra and vacuum pumps did not help him.
This situation is unfortunately common in men’s health. The nerves controlling erections are located very close to the prostate gland. Even with careful nerve-sparing techniques used during surgery, these nerves can be damaged or removed, resulting in severe ED.
When nerve function is significantly compromised, medications like Viagra or Cialis often show limited or no effectiveness. These pills require an existing nerve signal to initiate their action, which might be absent post-surgery. This reality makes exploring other treatment options necessary for restoring sexual activity.
What About Non-Surgical Treatments?
Before considering implant surgery, exploring all available options is logical. However, understanding their limitations is crucial, particularly with severe ED after prostate surgery. A thorough review of your medical history with a healthcare professional is essential.
Shockwave Therapy: A Word of Caution
Low-intensity shockwave therapy for ED is sometimes promoted. The theory involves stimulating blood vessel growth and nerve regeneration. However, for men whose ED stems from nerve removal during prostatectomy, this approach is unlikely to succeed.
Dr. Mistry observes patients spending considerable money on shockwave therapy without results in these specific post-prostatectomy cases. If the necessary nerves are absent, stimulating regeneration is not feasible. Setting realistic expectations based on the root cause of ED is vital, distinguishing it from treatments like laser therapy used for other conditions.
Vacuum Erection Devices (VEDs)
Vacuum pumps, also known as vacuum constriction devices, are mechanical aids. They use suction to draw blood into the penis, creating an erection. A constriction device (ring) is then applied to the base of the penis to maintain the erection.
The listener mentioned that pumps didn’t work for him. This often suggests incorrect usage; achieving a proper seal against the body is fundamental for the suction mechanism to function effectively. Using lubrication can help create this seal.
The constriction ring’s role is also critical. The rings supplied with the pump might not fit correctly or provide the right tension. Finding an appropriate ring might require experimentation; specialized companies offer various designs. Issues like scrotal skin being drawn into the cylinder can hinder function; minor procedures like scrotoplasty might help by repositioning the scrotum.
Penile Injections (Trimix)
Injecting medication directly into the penis represents another effective treatment avenue. Trimix, a common compounded medication, is frequently used. It circumvents the need for nerve signals, acting directly on penile tissues to induce an erection.
Trimix proves very effective for numerous men and offers a lower cost per dose compared to older alternatives like Caverject. However, it requires careful handling as one component degrades quickly once thawed. Proper medical education on usage is important.
Patients must understand storage requirements: once removed from the freezer, a vial typically remains potent for about 30 days. Failing to use all doses within this timeframe leads to wasted medication. Selecting the appropriate vial size based on the frequency of sexual activity is important for cost-effectiveness.
Some men find injections effective but may experience difficulties with orgasm. Issues achieving orgasm can relate to medications, underlying health conditions such as diabetes, psychological factors, or even the Trimix dosage needing adjustment. Difficulty reaching orgasm is a separate issue from achieving an erection.
Help is available for orgasm difficulties. Pelvic floor physical therapy can help relax muscles involved in the orgasmic reflex. At NAU Urology Specialists our in-house Pelvic Floor Physical Therapist, Cindy Villasana, PT, DPT can help find the right exercises for you! Certain supplements or topical gels might enhance penile sensitivity for some individuals. Discussing these concerns with your urologist or healthcare professional is recommended.
Is Penile Implant Surgery the Next Logical Step?
For men who found pills, shockwave therapy, and injections ineffective or causing undesirable side effects, penile implant surgery becomes a significant consideration. questioned if it was the next logical step toward a fulfilling sex life. For many in similar situations, the answer is affirmative.
When less invasive treatments fail or are poorly tolerated, an implant provides a permanent, reliable solution for erectile dysfunction. It doesn’t depend on nerve function or complicated medication regimens. It offers a mechanical method to achieve an erection whenever desired.
This step represents a move towards patient-centered care, focusing on restoring function and quality of life when other methods fall short. It addresses a core aspect of male sexual health directly.
What Exactly is Penile Implant Surgery?
A penile implant, technically known as a penile prosthesis, is a medical device placed entirely within the body through implant surgery. The most prevalent type is the three-piece inflatable penile implant. A three-piece inflatable penile implant consists of three main parts:
- Two cylinders inserted inside the corpora cavernosa (the erection chambers) of the penis.
- A small pump placed discreetly within the scrotum.
- A fluid reservoir, typically filled with sterile salt water (saline), placed under the abdominal muscles or behind the abdominal wall.
All these components are concealed internally; nothing is externally visible when the device is deflated. These inflatable devices represent advanced medical engineering, refined over many years since initial developments. There are also two-piece inflatable penile implants and malleable (semi-rigid) piece penile implants, though the three-piece inflatable offers the most natural flaccidity and rigidity.
The procedure involves careful placement by skilled medical professionals. Understanding how the penile implant consists of these integrated parts helps clarify how it functions. The release valve mechanism within the pump controls the flow of fluid.
Types of Penile Implants
While the three-piece inflatable implant is common, it’s helpful to know the main types available:
- Three-Piece Inflatable Penile Implants: These offer the most natural-feeling erection and complete flaccidity when deflated. The separate fluid reservoir allows for maximum fluid transfer to the cylinders. Operating these inflatable implants requires some manual dexterity to use the pump and release valve.
- Two-Piece Inflatable Penile Implants: This type combines the fluid reservoir with the pump unit placed in the scrotum. It involves fewer implanted parts but may result in a slightly less firm erection and less complete flaccidity compared to the three-piece system. This two-piece inflatable option might be chosen for specific anatomical reasons.
- Semi-Rigid (Malleable) Piece Penile Implants: These consist of bendable rods placed in the erection chambers. The penis is always semi-firm and can be positioned for intercourse or bent downward for concealment. They are simpler mechanically with lower failure rates but offer less natural flaccidity.
The choice between these types depends on individual needs, anatomy, health status, and personal preference, discussed thoroughly with a healthcare professional. Each piece penile implant has its advantages and disadvantages.
Who Benefits Most from This Surgery?
Penile implants are generally recommended for men with severe ED who have not found success with other treatments. Ideal candidates often include:
- Men experiencing ED after prostate cancer treatment (surgery or radiation).
- Individuals with severe diabetes-related ED.
- Men with ED due to spinal cord injury or other neurological conditions. A cord injury can severely disrupt nerve signals needed for erections.
- Men suffering from severe Peyronie’s disease, where penile curvature (sometimes bent upward) causes pain or prevents intercourse. The implant cylinders can help straighten the penis during the procedure.
- Men who cannot tolerate or are dissatisfied with other treatments like injections or the vacuum constriction device.
- Some men with urinary incontinence alongside ED might also be candidates, although the implant itself doesn’t treat incontinence.
Age alone is usually not a determining factor. We advised to consider the remaining quality years. Delaying treatment can sometimes create psychological barriers to resuming sexual activity later. If intimacy remains important, exploring all options, including surgery, is reasonable if general health permits the procedure.
The Penile Implant Surgery Procedure: What to Expect
Experienced surgeons typically perform penile implant surgery in approximately one to one and a half hours. Penile implant surgery typically occurs under general or spinal anesthesia. A single small incision is usually made, either at the base of the penis where it meets the scrotum (penoscrotal approach) or just above the pubic bone (infrapubic approach).
Through this incision, the surgeon meticulously places the cylinders, pump, and fluid reservoir. The reservoir implanted position is commonly behind the pubic bone or abdominal wall. While some medical centers offer this as an outpatient procedure, many surgeons prefer an overnight hospital stay.
An overnight stay facilitates better initial pain management and allows for intravenous antibiotics to minimize the increased risk of infection. A temporary urinary catheter is typically inserted during surgery and removed the following morning. Selecting a surgeon with extensive experience in prosthetic urology, like Dr. Yang at NAU Urology Specialists, is crucial for achieving the best outcomes; look for specialists within reputable health care systems or community health centers focused on men’s health.
The procedure involves careful surgical technique to avoid injury to the urinary tract or surrounding tissues. Understanding the steps the surgery typically includes helps manage expectations.
Recovery and Life with an Implant
Recovery involves some expected soreness and swelling during the first few days to a week post-surgery. Pain medication helps manage this initial discomfort effectively. Most men can return to light activities within about a week.
The healing period is a critical phase. Activation and use of the implant for sexual activity must typically wait about six weeks. Premature use can lead to pain, bruising, or damage to the surgical site.
Following the healing period, your doctor or a trained staff member will provide instruction on operating the device. Squeezing the small pump located in the scrotum transfers the salt water fluid from the reservoir into the cylinders, creating a firm erection. Pressing the deflation button or release valve on the pump allows the fluid to return to the reservoir, returning the penis to a flaccid state.
A major advantage of inflatable devices is their reliability. An erection can be achieved whenever desired and maintained for as long as needed. Patient satisfaction rates are remarkably high, frequently reported above 90% in medical literature, reflecting the device’s effectiveness for men who previously had limited options.
When deflated, the penis looks and feels natural. The implant does not alter sensation in the penile skin, nor does it usually interfere with the ability to achieve orgasm or ejaculate, although underlying conditions like diabetes might affect ejaculation separately. Operating the implant requires some manual dexterity, which is a consideration for men with hand arthritis or other limitations.
Weighing the Risks and Potential Complications
Like all surgical procedures, penile implant surgery involves potential risks and complications. Infection is a primary concern, although the rate is low (typically 1-3%) when performed by experienced surgeons using proper sterile techniques and antibiotic protocols. Diabetics require well-controlled blood sugar levels (often checked via Hemoglobin A1c) before surgery to reduce this increased risk. Any signs of a urinary tract infection (tract infection) must be treated before surgery.
Mechanical failure of the device is possible over the long term, though modern inflatable penile implants are quite durable. Should a component malfunction years later, it can usually be surgically revised or replaced. It’s also important to understand that the surgery is generally irreversible; the natural erectile tissue is displaced to accommodate the cylinders, meaning natural erections will likely not be possible afterward, even if they were previously weak.
Other potential complications, though less common, include device erosion (where part of the implant pushes through the skin), injury to the urethra or bladder, bleeding, or chronic pain. Adhering to post-operative care instructions is vital for minimizing risks. Discussing these potential complications thoroughly with your healthcare professional is part of informed consent.
Having realistic expectations regarding penile size is also important. The implant provides rigidity for intercourse but does not significantly increase penile length compared to pre-ED measurements. Some men may even perceive a slight decrease in length due to tissue changes or scarring.
Does Insurance Cover Penile Implants?
This is a frequently asked question. In most situations, the answer is yes. When erectile dysfunction has a documented physical cause (supported by medical records and medical history) and other treatments have proven unsuccessful, penile implant surgery is typically considered medically necessary.
Most insurance plans, including Medicare, Tricare, VA benefits (like TriWest), and many Medicare Advantage plans, provide coverage for the procedure. However, coverage specifics, deductibles, co-pays, and pre-authorization requirements vary significantly between different insurance plans. Confirming coverage details with your specific insurance provider beforehand is essential.
Urology practices and hospital patient services departments often employ staff experienced in navigating the insurance verification and pre-authorization process. They can assist patients in understanding their financial responsibility. Financial assistance programs may also be available through manufacturers or foundations for eligible individuals.
Beyond the Physical: The Emotional Impact
Erectile dysfunction extends beyond a physical issue. It profoundly affects a man’s confidence, mood, and intimate relationships. Partners may sometimes feel rejected or unattractive, misinterpreting the physical limitation as a lack of desire, which can impact women’s health and well-being in the relationship too.
Restoring sexual function with a penile implant can yield significant positive emotional effects. It enables couples to reconnect intimately and rebuild closeness. For men, regaining control over this aspect of their lives often leads to a substantial improvement in self-esteem and overall quality of life, contributing positively to their mental health.
Open communication between partners throughout the decision-making and recovery process is very helpful. Support from medical professionals specializing in sexual health can also address emotional adjustments. Many find resources in community health settings or through patient advocacy groups.
Frequently Asked Questions
Here are answers to some frequently asked questions about penile implant surgery:
- How long does the implant last? Modern penile implants are durable, but like any mechanical device, they can eventually wear out or fail. Many devices function well for 10-15 years or longer. If failure occurs, revision surgery to replace components is usually possible.
- Will it feel different for my partner? Most partners report high satisfaction and do not notice the implant during intercourse other than the reliable rigidity it provides. Open communication about preferences and sensations is always beneficial for both partners.
- Can I still have children after getting an implant? The implant itself does not affect fertility (sperm production or ejaculation). However, the underlying causes of ED (like diabetes or nerve damage) might impact fertility separately. Procedures like vasectomy reversal are unrelated to implant function.
- Are there ongoing clinical trials? Research in health sciences continues to improve implant technology and surgical techniques. Occasionally, clinical trials testing new devices or approaches may be available. Your urologist or resources like health library databases might have information. Compliance with review board standards is necessary for such trials.
- What if I have other health conditions like Peyronie’s disease or had a spinal cord injury? Implants are often effective solutions for ED related to these conditions. During surgery for Peyronie’s disease, the implant helps straighten the penis. Special considerations might apply for individuals with a spinal cord injury, discussed with the surgical team.
Conclusion
For men facing severe erectile dysfunction where treatments like pills, the vacuum constriction device, or injections have failed or are unsuitable, penile implant surgery offers a dependable and highly satisfactory route back to intimacy. It stands as a permanent solution providing an erection on demand, enabling men and their partners to reclaim an important dimension of their lives. This procedure, a significant part of comprehensive health care for affected men, addresses a critical aspect of men’s health.
While implant surgery is a major step, the procedure is well-established, boasting high success rates when performed by experienced medical professionals. It represents a culmination of advances in health sciences applied to male sexual dysfunction. Choosing this path often follows careful consideration of one’s medical history and personal goals.
If you are contemplating penile implant surgery, consulting a urologist specializing in prosthetic surgery is crucial. They can provide a clear assessment based on your individual situation, discuss the specific procedure involves, detail potential complications, review your medical records while respecting privacy policy standards, and help you determine if this is the right choice for your health and relationship needs. Accessing reliable information through a health library or trusted community health resources can also support your decision-making.