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Penile Implants For Impotence

When a man has erectile dysfunction (ED), he cannot achieve or maintain a firm erection. ED also is called "impotence." About one in every ten men has ED or some degree of impotence.

Most ED has a physical cause. Diseases such as diabetes or prostate cancer and its treatment, injury, and the side effects of drugs can reduce or prevent blood flow and nerve impulses to the penis. Only about 10% of impotence has a psychological cause.

Penile implants (often called "internal penile pumps") are one of several ED treatment options. Doctors began doing penile implants in the early 1970s. Since then, nearly 300,000 men have received penile implants. About 20,000 men choose penile implants each year to treat impotence.

There are three types of penile implants. All are totally concealed within the body and provide an almost immediate erection to enhance romantic spontaneity.

• 3-piece inflatable implants (about 75% of penile implants.)
• 2-piece inflatable implants (about 15% of penile implants.)
• Semi-rigid malleable (positionable) rods (about 10% of penile implants.)

Long-term clinical data shows penile implants to be highly effective and reliable. Studies also find a very high degree of satisfaction by both users and their partners.

Penile implants often follow a failure or poor treatment experience with Viagra or another therapy. As with all surgical procedures, there is a slight risk of infection. And although penile implants are highly reliable, malfunctions can occur over time. Reliability and inflation control, however, have significantly improved over the past few years.

General considerations for penile implants

Penile implants require a simple surgical procedure to place and totally conceal the prosthesis.

An inflatable penile implant is a small, self-contained medical device that is implanted entirely within the body. It is not visible. Two cylinders are inserted side-by-side into the corpora cavernosa in the shaft of the penis. During a natural erection, the corpora fill with blood. After a penile implant, when a man desires an erection, he uses the device to transfer fluid to the cylinders. The cylinders expand, enlarging or "erecting" the penis.

For malleable or "positionable" penile implants, the urologist places bendable rods into the penis. The man then gently bends his penis to achieve an erection.

Among other advantages, penile implants are the one option for treating physical ED that best preserves romantic spontaneity.

Doctors normally recommend starting men with a less-intrusive treatment such as Viagra. If this fails, then penile implants may be the logical next step.

The cost of penile implants (including device, medical procedure, and after-care) usually ranges from $15,000 - $35,000. Most insurance plans, including Medicare, cover penile implants and procedures. There may be some level of co-pay for the patient. However, most men who choose a penile implant have failed previous ED treatment. Most gladly pay a small portion of the cost of the procedure to regain their ability to achieve an erection.

Three-piece inflatable penile implants

Three-piece penile implants are the most technologically advanced device. They are totally concealed within the body. Urologists consider the 3-piece inflatable implant to be the "gold standard" of penile implants.

Placement. During placement of the device, the patient usually is under general anesthesia. A skilled urologist trained in prosthetic urology performs the simple procedure. The procedure generally is on an outpatient basis, commonly called a "23-hour stay."

Using a small incision, the urologist positions inflatable cylinders in the corpora cavernosa. A small pump is positioned in the scrotum and a reservoir is placed deep in the abdomen. The reservoir is filled with saline solution. The device is completely hidden and unobtrusive.

Recovery time. It commonly takes about four to six weeks to regain sexual function. Patients can resume sexual activity after physician consultation.

How it works. Gently squeeze the concealed pump in your scrotum several times. This moves the saline solution from the reservoir into the cylinders. As the cylinders fill, the penis becomes erect and firm.

To end the erection, simply press a "deflation site" on the pump. Deflating the cylinders transfers the fluid back to the reservoir and the penis becomes flaccid.

Advantages of three-piece penile implants

• Most closely resembles the process and "feel" of a natural erection.
• Simple, fast inflation preserves sexual spontaneity.
• Erection feels full.
• When deflated, the penis feels soft and flaccid and appears full and youthful.
• Totally concealed.
  

Disadvantages and risks of three-piece penile implants

• Requires some manual dexterity to inflate.
• More mechanical parts than other penile implants.
• Complications can occur, including infection and device malfunction.

Two-piece inflatable penile implants

Two-piece inflatable penile implants are fluid-filled internal penile pumps. The two-piece system includes cylinders and a small pump. This makes it a slightly more complex device compared to malleable or "positionable" penile implants.

Placement. During the procedure, the patient usually is under either local or general anesthesia. The procedure generally is on an outpatient basis, commonly called a "23-hour stay."

A skilled urologist trained in prosthetic urology performs the procedure which usually takes 45 minutes or less. Using a small incision, the urologist positions inflatable cylinders in the corpora cavernosa. A small pump is positioned in the scrotum. The device is completely concealed and unobtrusive.

The pump inflates the cylinders by transferring fluid within the system. A simple deflation technique then transfers fluid to return the penis to a flaccid state.

Recovery time. It takes about four to six weeks to regain sexual function. Patients can resume sexual activity after physician consultation.

How it works. Gently squeeze and release the concealed pump in your scrotum several times. This transfers the fluid in each cylinder to the cylinder shaft. Your penis will then become erect.

To end the erection, gently bend your penis down for 6-12 seconds (as illustrated here.) This transfers fluid back into the reservoir.

Advantages of two-piece penile implants

• Small inflation pump provides comfort and ease.
• Simple, fast inflation preserves sexual spontaneity.
• Fast and easy one-step deflation.
• Easier to conceal than a malleable implant.
  

Disadvantages and risks of two-piece penile implants

• Requires some manual dexterity to inflate.
• More mechanical parts than malleable penile implants.
• Complications can occur, including infection and device malfunction.

Malleable (Positionable) Penile Implants

This is the simplest of the penile implants.

Placement. Most skilled urologists will do the procedure on an outpatient basis, also called a "23-hour stay."

The surgeon gently places two bendable, "positionable" rods into the penis. The rods have an outer coating of silicone and inner stainless steel core or interlocking plastic joints. These enable the man to place the penis in either the erect or flaccid position.

Recovery time. It takes about four to six weeks to regain sexual function. Patients can resume sexual activity after physician consultation.

How it works. For intercourse, the man places his penis in the erect position. As he does so, the rods inside his penis bend. To conceal the penile implant, the man bends his penis down. He can bend the device in more than one place to create the desired erection.

Advantages of malleable penile implants

• Easy to use.
• Generally the simplest surgical procedure for ED.
• Few mechanical parts mean less chance of malfunction.
• Least expensive penile implant.
  

Disadvantages and risks of malleable penile implants

• The penis always has some degree of rigidity and may be difficult to conceal under tighter-fitting clothes.
• Complications can occur, including infection and device malfunction.