Introduced in the early 1970s, erectile dysfunction (ED) surgery involves implanting a prosthesis in the penis, and is generally only considered as an option after other, less invasive erectile dysfunction treatments have been considered.
While effectiveness and satisfaction rates are high, the surgery is by far the most invasive and permanently-altering of all erectile dysfunction treatments, and it comes with a number of potential complications. Sales of penile prostheses dropped following the introduction of oral medication for erectile dysfunction, but in more recent years they have increased, beyond their pre-Viagra levels.
Penile implants should not be confused with cosmetic surgeries that claim to enlarge the penis. Implants are not designed to increase the length or girth of the penis; they are designed to provide an erection. In some cases, the size of the erect penis will appear shorter than before the surgery.
How Erectile Dysfunction Surgery Works
There are different types of penile implants and different ways of performing the surgery, but all surgeries involve inserting some sort of penile prosthesis into spongy tissue of the penis. There are two main types of penile implants; one is malleable but semi-rigid all the time, while the other is inflatable. The inflatable penile prosthesis tend to be preferred by both recipients and doctors. Once implanted into the penis, the inflatable implant is made erect by different mechanisms, including squeezing a bulb or pressing a button that is inserted in the scrotum.
How Effective are Penile Prosthetic Implants?
If by effective we mean giving a man an erection when he wants, penile implants have been shown to be highly effective, and have low rates of mechanical failure. When men are asked about satisfaction, several studies report high satisfaction. In a five-year study of men who experienced erectile dysfunction following radical prostatectomy, 12% found that penile implant surgery didn't help at all, 18% said it helped somewhat, and 63% said it helped a lot. Of those men who found penile implant surgery worked for them, 47% said it produced erections firm enough for intercourse. In a more recent four-year study of 80 patients with erectile dysfunction, 90% reported never having problems with their prostheses and being satisfied with the results, and 79% said that the surgery resulted in improvements in their sexual life.
Complications and Side Effects
Surgery to insert penile implants permanently changes the anatomy of the penis, and as such, once an implant is inserted, erections without some sort of treatment or aid are impossible. For this reason, erectile dysfunction surgery should only be performed when other treatment options have been explored.
The most significant problems with penile implants are infection (which seems to occur in 2-3% of patients), mechanical failure, and the device moving out of place. If for any reason the device needs to be removed, it can result in scarring as well as loss of penile length. If the physical reaction to the removal of the device is significant, it's possible that another device will not be able to be inserted.
Bettocchi, C., Palumbo, F., Spilotros, M., et. al. "Patient and Partner Satisfaction after AMS Inflatable Penile Prosthesis Implant" Journal of Sexual Medicine Vol. 7 (2010): 304-309.
Lightfoot, A.J., Rosevear, H.M., Kreder, K.J. "Inflatable Penile Prostheses: An Update" Current Opinion in Urology Vol. 20, No. 6 (2010): 459-464.
Penson, D.F., McLerran D., Feng Z, et. al. "5-Year Urinary and Sexual Outcomes After Radical Prostatectomy: Results From the Prostate Cancer Outcomes Study". Journal of Urology Vol. 173 (2005): 1701–5.