What are the different options of penile implants?

DEAR DOCTOR K:

Can you discuss penile implants? I haven’t had success with other treatments for erectile dysfunction.

DEAR READER:

Medications, injectable drugs and devices such as vacuum pumps can effectively help most men who cannot get or maintain an erection. In particular, the three different pills for erectile dysfunction (ED) are effective about 70 percent of the time. Have you talked with your doctor about increasing the dose of the medicines you have taken? And has your doctor done tests to determine the cause of your erectile dysfunction?

If these treatments haven’t helped you, consider a penile implant (also called a penile prosthesis). Penile implants allow you to have an erection at any time — and maintain it for as long as you want.

Broadly speaking, there are two types of implants:

  • Inflatable implants. Three-piece implants consist of a fluid-filled reservoir in the abdomen, a pump with a release valve in the scrotum and two inflatable cylinders in the penis. Squeezing the pump transfers fluid from the reservoir into the cylinders, causing an erection. Pushing the release valve drains the fluid back into the abdominal reservoir. In two-piece implants, fluid-filled reservoirs are in the rear portion of the cylinders; the pump is in the scrotum. Bending the penis returns the fluid to the reservoir.
  • Semirigid, or malleable, rods. As the name implies, this type of implant consists of bendable rods. The rods are bent upward to have sex and pointed down to conceal the penis under clothing.

Most patients choose an inflatable device because the penis looks more natural than with semirigid rods. One downside to inflatable implants is the risk of mechanical trouble that may require surgical repair. Most devices last 10 years or longer.

Malleable devices have pros and cons, too. They are easier to manipulate than inflatable implants and are simpler to insert surgically. But because the rods always remain firm, their presence is harder to conceal.

Here are illustrations of penile implants and a detailed list of advantages and disadvantages of each type:

Penile implants compared

Three-piece inflatable implant

PA0113-27

Advantage

  • Acts and feels more like a natural erection than semirigid models.

Disadvantages

  • Requires more manual dexterity than other implants.
  • Possibility of leakage or malfunction.
  • Most expensive type of implant.
  • Requires the most extensive surgery of all implants.

Comments

  • The inflate/deflate device is implanted in the scrotum. Squeeze pump to inflate, and press the release valve to deflate.
  • The fluid reservoir is implanted in the abdomen.
  • Lock-out valve can prevent unintended inflation.

 

Two-piece inflatable implant

PA0113-28

Advantages

  • Penis looks more natural in erect and flaccid states than with the semirigid implant.
  • Easier to operate than the three-piece implant.
  • No abdominal incision.

Disadvantage

  • Possibility of leakage or malfunction.

Comments

  • Squeeze and release the pump several times to move fluid into the penile cylinders. Bending and holding the penis causes the cylinders to soften.
  • The penis does not deflate as fully as with the three-piece implant.

Semirigid (malleable) implant

PA0113-29

Advantages

  • Easy to use, especially for those with limited dexterity.
  • Requires the least extensive surgery.
  • Fewest parts, so less chance of malfunction.
  • Least expensive type of implant.

Disadvantages

  • Constantly firm.
  • Somewhat harder to conceal than inflatable implants, but new designs make this less of a concern than in the past.

Comment

  • For intercourse, lift the penis and make the rods as straight as possible.

You and your partner are more likely to be satisfied with the results if you know what to expect from a penile implant. If possible, meet with the doctor together before surgery. Make sure you understand the risks and benefits of the procedure and how the device works.

In the days before pills were available for erectile dysfunction, a number of my patients tried penile implants. They were uniformly skeptical when first presented with the idea, but most were glad they tried it. Since then, the devices have become even smaller and easier to use. Still, I haven’t recommended one of these devices in a decade, because simpler approaches have worked.