What Is a Penile Implant?
This surgical procedure is usually covered by insurance, including Medicare.
Benefits of Implants
Many men choose an implant over medical treatments, as they offer the following benefits:
- An erection that is rigid and satisfying for sexual activity.
- The ability to be spontaneous in their sex lives.
- The ability to predict and control how long the erection lasts and how often they can use it.
- Lack of “paraphernalia”. In other words, the erection should be natural, not associated with devices or other impediments.
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Types of Penile Implants
There are several different types of implants. Your provider will help you decide which implant is the best option for you.
One-piece implants use flexible or semirigid cylinders. Some describe the flexibility like that of a goose-neck lamp. This implant is rigid enough for sex, but soft enough to be concealed easily in your clothing.
Benefits: least expensive type of implant, fewer mechanical parts to fail
Downsides: least natural erection, no antibiotic coating; worst rigidity; worst flaccidity
Good for: men with poor hand function or men with buried penis who need a prosthetic to hold on a condom-style catheter
Two-piece cylinders are made of cylinders and a pump. The pump is hidden in your scrotum. Pumping fills the cylinders with fluid to give you an erection.
Bending your penis allows the fluid to move out of the cylinders, so your penis can become flaccid.
Benefits: excellent rigidity; no need to place any parts in the pelvis or abdomen
Downsides: no antibiotic coating; not as good flaccidity; not good for very thin men; not good for larger penises due to poor flaccidity
Good for: men who have extremely complex pelvic issues that make placement of a three-piece implant (see below) less desirable such as men who have had certain pelvic crush injuries or those with complex vascular reconstruction – very few men fall into this category.
Three-piece implants are the most commonly used devices. They consist of a pair of cylinders in the penis, a pump placed inside your scrotum near your testicles, and a reservoir of saline. Squeezing the pump in your scrotum moves the saline into the cylinders, creating a rigid erection that feels natural.
Implants remain inflated as long as you desire, even after climax. When you’re ready, you’ll hit a deflate button on the pump that returns the penis to a flaccid, soft state.
Benefits: excellent rigidity and flaccidity; total control over the erection; antibiotic coatings are available
Downsides: need for placement of reservoir in your pelvis/abdomen
Good for: most men with erectile problems, including those from prostate cancer, diabetes, vascular disease, spinal cord injury, pelvic trauma, transplant patients, and others
Frequently Asked Questions
Does the Implant Work Well?
Yes, very well. Satisfaction rates for patients and their partners in most studies is well above 90 percent.
Çayan S, Aşcı R, Efesoy O, Bolat MS, Akbay E, Yaman Ö. Comparison of Long-Term Results and Couples' Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation. J Sex Med. 2019 Jul;16(7):1092-1099.
Does My Insurance Pay for It?
Most insurances companies, including Medicare, cover the device and surgery. For those without insurance, we have specialists who can work with you on costs and payment.
Who Should Do the Surgery?
As with other specialized surgeries, you should be careful about who you choose to perform it. Penile implant surgery requires specialty training and expertise. Make sure you’re confident in your surgeon’s abilities and experience.
What Are the Risks?
As with any surgical procedure, there are potential risks. The greatest risk is infection. Just like having a knee or hip prosthesis, having a penile implant means there is a “foreign body” in place and an infection can be quite serious (just like with a hip or knee). However, the risk of infection is typically fewer than one percent in most patients.
If you someday need an MRI, implants are safe. It is important to tell other health care providers that you have an implant. For example if you are having a dental procedure, you will likely need additional antibiotics.
What Can I Do to Avoid Infection?
Infection rates with modern implants are quite low, around one percent. One of the great advances of modern implants is the use of coatings that hold in antibiotics to prevent bacteria from getting on the device.*
There are, however, certain conditions that do increase the risk of infection, which include the following:
- Spinal cord injury
- Diabetes (especially if the blood sugars are consistently high)
- Re-do surgery or surgery in the setting of extensive scarring
- Taking chronic steroids, such as prednisone
Our team uses many techniques to minimize infection in patients, both before the operation and during the operation. It is critical that surgeons are very meticulous in technique and are aware of the many things that can be done to prevent infections.
* Dick B, Tsambarlis P, Reddy A, Hellstrom WJ. An update on: long-term outcomes of penile prostheses for the treatment of erectile dysfunction. Expert Rev Med Devices. 2019 Apr;16(4):281-286.
Do I Need to Stay in the Hospital?
The procedure may be done as an outpatient (where you go home from the hospital the day you have surgery) or with an overnight stay. If done as an outpatient, you will need to return to clinic the next day so we can remove the dressings.
What Is My Expected Recovery Time?
Everybody heals at different rates, so recovery times can vary between patients. Generally, you will likely begin to feel better after the first week.
How Active Can I Be After Surgery?
There are some restrictions following your surgery, specifically, no heavy lifting (nothing over 15 lbs) for the first four weeks and no rigorous exercise. You can resume normal day to day activities as you feel up to it.
Many men ask if they can ever return to their favorite activities such as bike riding and running. Yes! You can return to those activities after you are fully healed.
Will I Have to Have My Stitches Removed?
No. The sutures we use are dissolvable and are made to stay in for a long time. Your sutures will likely dissolve over four to eight weeks.
Is Bruising and Swelling Normal?
Yes. As with any surgery, there will be bruising and swelling. We will prescribe post-operative pain medication for you and you may use an ice pack to help with swelling.
When Can I Begin to Use My Device?
Your provider will teach you how to use your implant at your two-week follow-up appointment. We will give you physical therapy instructions to inflate it for a certain amount of time each day.
You may not be feeling 100 percent by this time, but the earlier you can begin your physical therapy the better your ultimate function and size will be.
Depending on how quickly you are healing, you may be able to resume sexual activity. The average time to resume sexual activity is between four to six weeks.
What Will the Penile Implant Look Like After Surgery?
Once healed, your implant will be completely undetectable. It is fully concealed in the body and no one will know unless you tell them.
Will the Implant Affect Penis Size?
A penile implant is not intended to add length to the penis. Most implants expand in length and girth in order to achieve the maximum size of the patient’s natural erection.
The sizing is done during surgery and customized to each patient. Some men do experience some penile shortening, although it can be subjective. For example, men who have had erection problems for a long time might not accurately recall their earlier penis size.
What Will the Penile Implant Feel Like for Me and My Partner?
A man’s erection after implant surgery looks and feels very natural. The penile implant does not change your sensation or ability to climax. The implant is replacing the erectile tissue that does not function anymore.
Does a Penile Implant Affect Urination?
No, the implant will not affect urination since the urethra is separate from where the penile implant cylinders are placed.
Are People Ever Dissatisfied?
When a man has had ED for a long time, the penis shrinks and scars. This is similar to a weightlifter who stops working out and the muscles shrink. For this reason, the penis is often shorter than it was when he was younger. This loss of length is the most common cause for dissatisfaction.
Does the Device Ever Fail?
These devices are mechanical, so eventually they will fail. With modern devices, they usually last 10–15 years and may last even more than 20 years. When they fail, an additional surgery is required to replace the device (very similar to the original surgery).
Meet Our Patients
The first time he experienced ED in his mid-50s he thought it was just a fluke, which was a reasonable assumption to make. More than half of men experience episodic erectile dysfunction at some time in their life from things like stress, too much alcohol, or as a side effect of medication.