Treatments and surgeries

Penile implant for erectile dysfunction

Treatments and surgeries

Penile implant for erectile dysfunction

Overview of the procedure

A penile implant is a medical device that gets surgically inserted into the corpus cavernosum (the penis’ erectile tissue). Since the prothesis is inserted in the genitals, it can’t be seen from the outside. This implant is made up of inert biomaterials that the human body accepts well in most cases, much like pacemakers, breast protheses and testicular protheses.

A penile implant is an effective treatment option for men with severe and irreversible erectile dysfunction. It can help men who have difficulty achieving or maintaining an erection, as well as those who cannot gain an erection at all. It can also help men whose erections are not firm enough for sexual intercourse.

There are three types of penile implants:

  • Three-piece inflatable penile implants
  • Two-piece inflatable penile implants
  • Malleable penile implants (also called a semi-rigid or concealable implants)

Make sure you get all your questions answered prior to having the procedure. To initiate the process, schedule a consultation with Dr. Marois to discuss your needs.

How does a penile implant work?

A penile implant is an excellent option for the right candidate, as long as he has realistic expectations. There’s no age limit for the procedure. A person with a penile implant can have an erection whenever he chooses and maintain his erection for as long as he desires, without the use of medication or an external device. This allows for the sort of spontaneity in one’s sexual life that’s forfeited with other treatment options.

Who’s a good candidate for a penile implant?

Any man with erectile dysfunction who hasn’t responded to other medical treatments (such as intracavernous injections or drugs like Sildénafil, Tadalafil and Vardenafil) is a candidate for a penile implant.

The most common indications for penile implant procedures are cardiovascular disorders and diabetes. Men who developed erectile dysfunction following a radical prostatectomy are also candidates for the procedure.

Who performs penile implant surgeries?

Fewer than 10% of urologists regularly perform penile implant surgery. Dr. Marois is a urologist who has been professionally trained for all three types of prostheses and who has been performing these procedures for a number of years.

Does a penile implant impact sensation in the penis or effect orgasms?

A penile implant simply corrects erection problems. It allows a man to achieve a firm erection that enables him to engage in sexual activity. The presence of a penile implant does not affect sensation during sexual intercourse, nor does it impact the orgasm. If a man has normal feeling in the penis prior to the procedure, he will generally experience all the same sensations after. However, the procedure won’t cause a person without normal feeling in his penis to regain feeling.

Moreover, a penile implant neither improves nor diminishes a man’s ability to have an orgasm. It’s simply, an effective treatment option for men suffering from erectile dysfunction. The cost of the procedure is generally covered by a person’s medical insurance.

Is a penile implant the same as a penile pump?

A penis pump usually refers to a vacuum erection device (VED), which is different from a penile implant. While some patients refer to their penile implant as a penile pump, these are in fact two very different treatments for erectile dysfunction. One is an inflatable penis implant, while the other is an external vacuum pump.

How are the three types of implants different?

Three-piece inflatable penile implant
This implant is made up of penile implants, a pump and a fluid reservoir. It is considered the ideal type of penile implant for the majority of men. Our clinic uses the three-piece AMS 700™ inflatable penile prosthesis. It has two inflatable cylinders that are inserted into the shaft of the penis, the pump is inserted in the scrotum, and the fluid reservoir is inserted in the groin region.

To gain an erection using the AMS 700™, the man or his partner gently squeezes the pump in the scrotum several times. This causes the inflatable cylinders in the shaft of the penis to inflate. The device permits a man to have an erection at any time. To deflate the cylinders, it is a simple matter of applying constant pressure to the pump.

Compared with other implants, the three-piece AMS 700™ inflatable penile prosthesis offers firmer erections. It also allows the penis to soften more when flaccid. In addition, the pump is smaller and therefore less perceptible in the scrotum. It is the implant that feels the most natural, whether the penis is flaccid or erect. A person must have a certain amount of dexterity to use the implant and be able to learn its operation.

All inflatable implants may potentially leak or malfunction, which would necessitate that the surgical procedure be performed again. It’s also possible for the cylinders to become deformed, which may necessitate a remodelling procedure.

Two-piece inflatable penile implant
This implant is made up of a penile implant and a pump. Unlike the three-piece implant, there is no fluid reservoir. Only a small amount of liquid is transported into the cylinders when pressure is applied to the pump. Erections are easier to achieve with a two-piece inflatable penile implant. The implant is deflated by bending the penis downward.

This type of implant is sometimes suggested when inserting a fluid reservoir would be difficult due to a past surgery. A two-piece inflatable penile implant is also ideal for men who have limited dexterity in their hands. Compared with the three-piece implant, the penis hangs less naturally when flaccid. The AMS Ambicor is a two-piece inflatable penile implant without a fluid reservoir. Compared with the three-piece implant, the erection it generates is less stiff. In addition, the pump is larger and may be visible in the scrotum.

All inflatable implants may potentially leak or malfunction, which would necessitate that the surgical procedure be performed again.

Malleable penile implant (semi-rigid or concealable implant)
This type of implant has an easy-to-use non-inflatable protheses. It’s stiff and doesn’t inflate or deflate. The man or his partner simply bends the penis upward to create an erection and downward to return his penis to a flaccid state.

While this implant has its advantages (in particular, its ease of use), it also has its drawbacks. Notably, it can be somewhat uncomfortable. Since the implant is always in place, it can at times be inconvenient. It corresponds to a permanent erection.

However, this implant is the easiest to surgically insert and the most affordable. It can be a good option for men who’d likely benefit from simplicity and ease of use. In particular, the semi-rigid penile implant is a preferred option for people with limited dexterity.

What considerations must be factored into your choice of penile implant?

Your doctor can help you choose the most appropriate penile implant for you. Though your satisfaction with the result of the procedure is important, certain factors and limitations need to be taken into account. You and your doctor must discuss the following things when determining which implant is right for you:  
  • Overall size of the penile implant
  • Your age and your partner’s age
  • The size of the scrotum and its size relative to that of the penis
  • All previous abdominal surgeries you’ve had, such as prostate or bladder surgery
  • Any deformities in the groin area
  • Sources of concern in the area of the pelvis
  • History of implant use
  • Whether or not you’re circumcised
  • Your body type
  • Your overall health
  • Any indication of penis curvature or penile fibrosis

Are penile implants visible? Will other people be able to tell that I have a penile implant?

A penile implant is inserted beneath the skin of the penis, at the interior of the shaft. When the implant isn’t being used and isn’t inflated, no one will be able tell that you have it. It does not protrude from your pants when it’s deflated. When the implant is inflated prior to sexual activity, the penis appears to stiffen in the same manner as a natural erection. Visually, one cannot distinguish between a natural erection and one generated by a penile implant.

What risks and complications are involved with the surgery?

In the majority of cases, the surgery proceeds without a problem. Nevertheless, every surgical procedure involves a certain amount of risk and the potential for complications to arise. Some of these relate to your general health and to the use of anesthesia. Complications that are directly linked to the surgery itself are rare, but possible.

The main risk is that of infection. Infections can occur earlier (in the days following the procedure) or later (sometimes several months or years after). The risk of infection is increased by certain medical conditions such as: diabetes; a history of pelvic radiotherapy or pelvic trauma; urethral injury following pelvic trauma; acute or chronic urinary, sinus, dental or other infections and certain neurological conditions.

In the event of infection, antibiotics are typically insufficient, and the penile implant may need to be removed during a second surgery involving anesthesia. In most cases, it’s possible to insert a new implant several weeks or months after an implant has been removed following an infection. A second implant surgery is more difficult and carries a non-negligible risk of infection occurring once again.

Another potential complication is that, a hematoma could develop. However, it can be surgically removed or may be absorbed by the body if it’s small.

In the medium or long term, a mechanical issue with the implant could arise, necessitating its complete or partial surgical replacement. About 60% of implant patients need a second surgery after having a penile implant in place for 15 years. In some cases, despite the proper functioning of the implant, the individual experiences a lack of sexual satisfaction related a soft or sensitive glans or to a decrease in the length of the erect penis. Every surgical procedure carries a certain amount of risk, and individual variations aren’t always foreseeable.

What is the satisfaction rate of patients and couples following a penile implant?

An individual’s satisfaction with his penile implant is typically measured about a year after the operation. In general, patients and their partners are more satisfied with the results if they were well-informed about the implant in advance and had realistic expectations. The support of the partner is also important.

Regardless of the type and model of the device, couples report high levels of lasting satisfaction with penile implants. Some patients, particularly those with a history of Peyronie’s disease, those who had a radical prostatectomy and those who are obese, experienced varying degrees of insatisfaction. More than 90% of patients are satisfied with penile implants as a treatment for erectile dysfunction. In comparison, 51% are satisfied with ED medications and 40% with intracavernous injections. Patients should expect a decrease in the size of the penis once the cylinders have been inserted into the intracavernous tissue.

Why aren’t penile implant procedures more common in Quebec?

Despite its high rate of efficacy, low rate of complications and high degree of patient satisfaction (90%), penile prostheses remain an uncommon treatment option in Quebec. In comparison, the procedure is five times more common per capita in the United States. And while 30,000 to 50,000 procedures are performed annually worldwide, only 200 of them are performed in Quebec.

A greater number of patients could benefit from this treatment if information, indications, decisions and support were provided by doctors and sexologists. Moreover, the option of a surgical procedure should not be proposed too late to patients with erectile dysfunction, as the esthetic and functional results depend on the size of the implant.

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Preparing for a penile implant

No additional examinations are required before the procedure apart from the usual blood and urine tests. The antibiotic prophylaxis is routinely administered beforehand. The surgery is done at the Centre Métropolitain de Chirurgie in Montreal.

Dr. Marois will inform the patient beforehand about the various types of implants, discussing their advantages, drawbacks, risks and limitations.

Dr. Marois will make the final decision about which penile implant to use, as technical constraints that cannot be foreseen before the procedure may influence the choice. The urologist may, for example, have to insert a two-piece implant rather than a three-piece implant or may be unable to insert an implant of any kind.

Post-operative instructions for a penile implant

What can you expect following a penile implant procedure?

The recovery from a penile implant surgery is not necessarily difficult. The majority of patients will experience some pain in the groin area for several days. Dr. Marois will provide you with specific instructions on how to care for your incisions, when you can use the implant and what to expect in terms of recovery.

The nurses will explain in detail what you can expect at every stage in this process. The majority of men find that their recovery takes time and is uncomfortable, but that the benefits of the operation make it worth the short-lived inconvenience.

The first 48 hours

Many men require time to recover in the hours directly following the surgery, as the anesthesia takes time to wear off. Though you’ll likely be able to go home the same day, some patients need to remain overnight at the hospital.

During the first 48 hours, you should limit your activities and give your body time to heal. This means lying on your back as often as possible. However, you should also try to walk for about 15 minutes three times per day for better mobility following the recovery period.

Dressings are usually removed 48 hours after the procedure, and the catheter is typically removed the day of the procedure. Generally, you’re sent home the day of the surgery or the day after. A nurse may come to your home a few days after the procedure for post-operative care of your incision and dressing. Alternatively, this care can be self-administered. Painkillers and antibiotics are prescribed at discharge.

The first week

A post-operative checkup is scheduled a week after the procedure to ensure satisfactory healing of the patient and proper functioning of the implant.

Most patients are able to return to work a week after the procedure, but they need to continue to limit their activities for as long as it takes to completely heal. After the first three days, you can take several baths a day. This will help reduce pain in the groin area. Warm water can be beneficial, but you must refrain from aggravating the wound. Your doctor will tell you how to care for the incision.

It can take up to 14 days for your swelling to completely subside. As the swelling goes down, the pain will diminish and you’ll have greater mobility. Generally, the stitches get absorbed within 14 days following the operation.

After a month

A second post-operative visit occurs four weeks after the operation to ensure satisfactory healing of the patient and proper functioning of the implant.

The implant will be activated during this visit. However, patients are advised to not have sexual intercourse with penetration until after the sixth week following the surgery. Over the course of one or multiple visits, you’ll learn how to use the implant in a way that optimizes your satisfaction.

Intense physical activity should be avoided for about a month after the surgery.

To enable proper healing, you must abstain from sexual activity and avoid using the implant in the six weeks following the procedure. However, healing times can vary, so always follow your doctor’s instructions.

After a year

Our follow-up protocol is to examine the patient at 3 months, 6 months and 12 months after the surgery.

What to do in the case of an emergency or intensifying pain

Call the office Dr. Marois’ office or call emergency services if there’s an intensification of pain, abnormal discharge from the incision, swelling in

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