Implants can treat ED when other methods fail or result ineffective. Erectile dysfunction is caused by vascular insufficiency due to illnesses such as atherosclerosis, diabetes mellitus, and cigarette smoking; neurogenic disorders such as spinal cord damage; surgery or radiation.
Genetic factors and Liver illness due to heavy alcohol consumption. Men with physiological ED are the most likely suited for a penile implant, but if sex therapy hasn't worked for them, men with psychogenic ED may also benefit. A penile prosthesis may be placed during surgery to restore the penis when Peyronie's disease scarring causes erections to bend.
A penile prosthesis does not affect the feeling of the penile skin or a man's ability to achieve orgasm. Ejaculation is not harmed. The prosthesis has excellent satisfaction ratings; generally, 80%-90% of men are delighted with the outcomes and can have satisfactory intercourse.
SEMI-RIGID OR MALLEABLE IMPLANTS are the most basic and are made of silicone rods. They are rigid enough to facilitate entry yet flexible enough to bend. Each rod may have a steel cable or coiled wire going through the center.
These implants are inexpensive because they are essential and easy, with no intricate pieces. The penis is raised into place, i.e., the rods are straightened, to commence intercourse. Because the penis is always semi-erect, it may be more noticeable and must be disguised behind tight pants. The length and breadth of the penis cannot be enlarged with these implants, as in a natural erection.
INFLATABLE (HYDRAULIC) IMPLANTS are slightly more complex, consisting of two hollow cylinders of silicone or polyurethane available in one, two, or three pieces. The one-piece device comprises a pump on one end and a reservoir on the other. The complete apparatus is implanted in the penis. To achieve an erection, you pump the front of the cylinder, letting the saline solution from the reservoir flow into the hollow rods.
This causes the rods to expand and straighten, resulting in an erection. You may deflate the device at the end of the intercourse by bending the penis down for a few minutes, forcing the fluid to return to the reservoir.
A pump and reservoir are inserted in the scrotum in the two-piece implant. Only the pump of the three-piece device is implanted into the scrotum, while the reservoir is placed in the abdomen.
Inflatable implants have the benefit of more closely mimicking natural erections. The male controls when and for how long the erection occurs. There may also be some improvement in the breadth and length of the penis. When the penis is deflated, it becomes softer and more natural. These inflatable implants are best suited to more dedicated persons seeking a more natural erection.
A tiny cut between the penis and scrotum may be created. Following selecting the right implant size, the doctor inserts the implant components into the two chambers (corpora cavernosa) of the penile shaft, which usually fills with blood during an erection.
Unless the implant necessitates the installation of a reservoir and pump, the procedure is complete. Typically, the penis is taped to the abdomen until the incision heals, and a tube or catheter is placed to drain the bladder.
Although it requires surgery, implants are the last chance for most men who have been carefully studied and unsuccessfully treated with all other choices. They represent a newfound faith in their capacity to perform. After 6-8 weeks, light exercise may be permitted.
Dr. Dhir is a pioneer in penile implant surgery in India and has performed hundreds of these in the last 25 years or more as the Director of Alpha One Andrology Centre in New Delhi.
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Penile implant surgery is performed when conservative treatments are not successful. Men who have been diagnosed with organic erectile dysfunction and have failed to respond to oral PDE5 inhibitors (such as sildenafil or tadalafil) or intracavernosal injection, or have not used vacuum erection devices are suitable candidates.
The most likely candidates are men who have developed ED due to a radical prostatectomy (surgery to remove the entire prostate gland), pelvic radiation, injury to the spinal cord, or significant vascular damage as a result of severe diabetes. Patients who have Peyronie's disease and erectile dysfunction due to a deformity that makes sex impossible may also gain from an implant, as it can be inserted at the same time as the deformity is corrected.
Men who are not suitable candidates are those with active urinary tract or genital infection, uncontrolled diabetes with poor wound-healing history, or major cardiovascular disease which renders general anaesthesia unsafe. Dr. Anup Dhir performs comprehensive pre operative evaluations to determine individual suitability prior to any surgical plan.
Usually, pre-operative preparation starts two weeks before surgery. Certain blood-thinning drugs (such as aspirin, ibuprofen) and supplements (Fish oil, Vitamin E) are discontinued to minimize the risk of bleeding. For diabetic patients, blood glucose should be well controlled for the 4-6 weeks before surgery, as this increases the risk of infection.
Smoking is a strong risk factor for impaired wound healing and the smoking of any type is strongly recommended to be avoided for at least four weeks prior to surgery. Genital area is shaved and cleaned the day of the procedure. If general anaesthetic is being used, the patient should be asked to fast for 6-8 hours before the operation.
Surgery is done under spinal or general anaesthetic and will last between 45 and 90 minutes. Depending on the type of implant chosen, an incision is made at the base of the penis where it meets the scrotum or just below the head of the penis.
The two chambers of the corpora cavernosa are carefully dilated to allow the implant cylinders to fit into. With inflatable implants the pump goes into the scrotum and the fluid reservoir into the lower abdomen. The incision is closed with absorbable sutures with all components connected before the cut is sutured. For the first 24 hours a urinary catheter is used to drain the bladder.
Most patients will be discharged within 24-48 hours of surgery. Hospitalization is brief. There is no external scarring after the procedure.
The first week will include rest and some swelling along with pain that is controlled by a prescription pain medication. Most men can switch from heavy work to light daily work in 7-10 days.
After 4-6 weeks, exercise is slowly re-introduced. Sexual activity is usually allowed by the 6-week timeframe when the surgeon deems that sufficient healing has occurred at a follow-up visit. With the inflatable implants, patients learn in follow-up appointments how to use the pump before they try to use the implant on their own.
Patients typically become fully comfortable with the device within 2-3 months after swelling has subsided and body tolerance to the implant.
Today's penile implants last a long time. Most patients will have functional life of 10 to 15 years with inflatable devices from established manufacturers, although some last much longer. However, malleable implants, which do not contain any mechanical parts, are likely to last even longer. However if a component breaks, revision surgery can remove and replace the affected component.
Risks are associated with surgery, as with any surgical procedure. Infection in about 1-3% of patients is the most important complication, but is more common in men who have poorly controlled diabetes. Most contemporary implants are coated with antibiotics and this risk is minimized. Mechanical failure (which is extremely rare with existing equipment) could necessitate revision surgery. It is uncommon for implant parts to erode or migrate.
The implant will not cause any sensation, orgasm or ejaculation. The device will not affect urination.
Oral medications (sildenafil, tadalafil) are effective for many men but can become ineffective over time, and are unsuitable for men with severe vascular or neurogenic ED and will require some planning. Penile injections are effective, but require the man to inject himself prior to sexual activity, a practice which is difficult for some men to maintain.
The Shockwave therapy and PRP (P-Shot) treatments are suitable for mild to moderate ED and function by enhancing natural erectile function. These treatments are not likely to be effective in men with severe or end-stage ED who have irreversible vascular or neurological damage. The implant completely avoids the malfunctioned mechanism and provides stable and consistent erectile function whenever it is desired.
The patients' satisfaction rate regarding penile implants is one of the highest of all ED treatments and has been reported to be between 80% and 95% in studies of patients and partners.
No. When the inflatable implant is deflated, the penis looks and feels natural. If the malleable implant is placed in the downward direction, the implant will not be visible. Often, the partners do not realize that an implant is in place.
The actual implant will not grow the penis to a length or circumference that is larger than the penis's natural erect size. Long-term ED sufferers might find that the penis size is somewhat smaller than what they can remember from previous years, as over time, disuse can lead to some changes in penis tissues. The surgeon chooses a size implant that will fit the person's anatomy.
Yes, but it doesn't go like that. If prostate surgery is in the near future, it is usually recommended to address the prostate surgery first, and then to go for implant surgery. When properly managed, there is no interference with future urological procedures by the implant.
Most men are cleared for sexual activity at the six-week follow-up appointment. Dr. Anup Dhir will confirm healing is adequate before giving clearance. Rushing this timeline increases complication risk and is not advised.
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