Penile Implants Best For Young
Penile implants are effective and practical for only a small section of men with erectile dysfunction.
As prosthetic devices inserted into the penis to help men get an erection, penile implants work best for young men who have had some kind of traumatic groin injury, but for older men dealing with normal age-related ED they are not suitable and have a poor success rate.
They require complicated surgery, with a risk of infections or device breakdown, and are usually only used when there is a clear medical cause for ED (spinal cord injury, side effect of radical prostatetectomy or bladder surgery for example) and when the problem is unlikely to resolve or improve naturally or be suited to other erectile dysfunction treatments. They are also considered fairly invasive treatments.
Penile Implant Future Like Knee Replacement?
That is the state of the surgical art at the moment. However erectile dysfunction specialists like Dr Drogo Montague see a time coming when penile implants for erectile dysfunction could be as accepted and as effective as replacement knees and hips for arthritis are today.
Because erectile dysfunction is a “progressive disease” Dr Montague predicts a day is coming when ED will be treated like osteoarthritis, another age-related problem. Men may start out using an oral treatment (drugs or pills) and then as ED gets more severe will eventually need to bring in the heavy artillery.
Penile implants will be equivalent to hip and knee replacements, he suggests. Erectile dysfunction treatment will evolve similar to how arthritic joints are treated; at first with NSAIDs (non-steroidal anti inflammatories) taken as oral pills, but then as pain increases and function is further impaired treatment moves on to joint injections, arthroscopic surgery and finally knee and hip replacements.
“Implant surgery is big business in the United States,” he says. “I think that this is what’s going to happen to ED.”
Different Types of Penile Implant
What men want most is an erection that is as close to the natural thing as possible. Of the two types of penile implants available, the inflatable comes closest to doing that, while the non-inflatable type of inserted rods remains permanently rigid and is harder to conceal.
And of the inflatable types available, the 3-piece with large-volume abdominal fluid reservoirs mirrors a natural erection best because the device can alternate between erect and deflated states.
The 3-piece types have improved considerably over the last decade and for young men who have suffered pelvic injury they can be successful as a treatment for erectile dysfunction caused by injury.
Choosing Which Implant is Right for You
Penile implants are really only suitable for men who have not found a suitable solution from all other forms of erectile dysfunction treatment (pills, suppositories, vacuum pumps or erectile injections) and want to pursue further options.
You will need full briefing by a urological surgeon to work out what type of implant will suit you best.
Simplest and least expensive type of penile implant
The simplest type of penile implant (also known as non-hydraulic because it contains no pump) consists of two malleable rods inserted within the erection chambers of the penis.
This non inflatable type of penile implant leaves the penis permanently semi-rigid and when sex is desired is simply lifted into an erect position. It cannot be easily worn with jeans or gym gear, and most men want a more natural feeling process.
Three non inflatable penile implants are available at this time, according to Cornell Urology - the AMS Malleable 650, Mentor Acu-Form prosthesis and TIMM Medical Dura-II devices.
Advantages and Disadvantages of the Non Inflatable Penile Implant
- Easy to use - You simply bend it up for an erection. Down when not in use.
- Good option for men with limited hand use due to arthritis or other conditions.
- Totally concealed in body - but most men don’t like having a permanent erection
- Has an abnormal feel and appearance.
- Causes deterioration and thinning of penile flesh over the long-term.
- Most amount of pain and discomfort after the operation. The penis has to accommodate a constant erection.
The 2-Piece Inflatable Penile Implant
Consists of a cylinder and a combined reservoir-pump unit. The cylinder is inserted into the penis and connected by tubing to the reservoir unit, inserted with the pump into the scrotum.
To inflate and create an erection, the man presses on the pump which then transfers fluid from the reservoir to the cylinders in the penis. Pressing on a deflation valve at the base of the pump returns the fluid to the reservoir, deflating the penis and returning it to the normal flaccid state.
The AMS 2-piece device (Ambicor), is the only 2-piece in production at present.
Advantages and Disadvantages of the Two-Piece Inflatable Penile Implant
- Easy to use - You simply pump it up for an erection and it deflates when not in use.
- Suitable for men with limited dexterity, but be warned - the pump is small and difficult to inflate.
- Because only a small amount of fluid is transferred into the cylinders to obtain an erection, it does not provide as good an erection as the 3-piece penile implant
- All parts are implanted inside the body, but having a partial erection is very othersome for most men.
- Has an abnormal feel and appearance. The cylinders have an unnatural shape and make the penis look like a broom with a square head.
- Causes deterioration and thinning of penile flesh over the long-term.
The 3-piece Inflatable Penile Implant
Very similar to the 2-Piece inflatable but it has two cylinders, not one, which are inserted into the penis, while the reservoir is implanted under the groin muscle and the pump sits between the testicles, tucked into the scrotum. Requires more complicated surgery to put the reservoir unit in place.
Two major companies make five different models of the 3-piece inflatable penile implants. AMS manufactures three devices: the AMS 700CX prosthesis, AMS 700CXM device, and AMS Ultrex. Mentor manufactures the Alpha I and the Alpha I Narrow Base devices.
Advantages and Disadvantages of the 3-Piece Inflatable Penile Implant
- Like the 2-Piece - Easy to use - Pump it up for an erection and press the release valve to deflate.
- Easier to inflate than 2-piece device, with a larger softer pump.
- Creates a better erection because a larger amount of fluid is transferred into the cylinders
- Erection deflates to normal softness after sex
- Only implant that looks normal when penis is erect and when flaccid. Many single patients report that the partner does not realize that the penis has an implant in it.
- Risk of wear on penile flesh much reduced.
- Totally concealed in the body.
- Most complicated surgery requiring a lot of medical experience
- Because the penis deflates and doesn’t remain semi-rigid patient have the least amount of pain after surgery.
(Advantages and Disadvantages information from Advanced Urological Care)
How Does Sex Feel with a Penile Implant?
Penile implant manufacturers are striving to produce devices which make erections as natural as possible because men have increasingly high expectations of the procedure.
Sex with a penile implant is:
- Similar to a natural erection
- Erect penis length is shorter than normal - about 1–2 cm (.25 to .75 in) loss - though newer models are fixing this
- Ejaculation and orgasm as normal
- Skin sensation as normal
- Natural erection reflex is destroyed by a penile implant. If removed, man may never have natural erection again.
Possible Complications of Penile Implant Surgery
About 85 per cent of men still have the original implant ten years after surgery, but about 15 per cent experience complications or infections which require the removal of the implant at least temporarily.
- The most common side effects of penile implant surgery are:
- Uncontrolled bleeding after the surgery possibly leading to re-operation
- Infection – low grade infection possible for up to a year after surgery
- Scar tissue formation
- Erosion (tissue around the implant may break down) requiring removal
- Mechanical failure leading to re-operation and removal
Customer Satisfaction Rates with Penile Implants
Penile implants have the highest satisfaction rates of all treatment options for erectile dysfunction, according to published reports.
Two different studies record satisfaction rates amongst men of more than 85 percent, with their partner’s approval of the device ranking at between 70 and 76 per cent.
Pain, appearance and the need for a repeat operation were reasons for loss of satisfaction.
In another follow up 70 per cent of men with penile implants reported having sex on a regular basis, compared with only 41 per cent of men using penile injections. The greatest satisfaction was between 6 and 12 months after surgery.