When Do Men Need Penile Implant Surgery?
The process of medical care for any illness always runs its unique course. You may have run out the options of conservative care with behavioral modification with medications. If so, then naturally you would ask, “what is the next step for my care?” Likewise, for erectile dysfunction, the men with ED and their family would ask, “When and how may or should I have penile implant surgery?” “What will my penis look like before and after penile implant surgery?”.
All the concerns about penile implant surgery comprise the key points of this article. After reading it, you will gain sufficient insight on if penile implant surgery is for you and what you may expect before and after surgery. The following aspects are what I will address for you:
- What have you gone through before reaching the time to discuss penile implant surgery?
- How much do you already know about erectile dysfunction (ED)?
- Is penile implant surgery the best option for you? Do you need it?
- Meaning of penile implants. How many kinds of penile implants do we have? Which one is best for me? What is the cost of penile implants?
- What would you expect after penile implant surgery?
- Do you need a long-term follow-up after a successful penile implant?
So, let us begin our discussion. Read on…
What have you gone through before reaching the time to discuss penile implant surgery?
Understandably, the list of what you have done includes:
- having a detailed history + physical examination + some testing as needed.
- you have a reasonable understanding of the causes, diagnosis, and treatment for your erectile dysfunction.
- you failed to respond to conservative care with behavioral modification and medication.
Is penile implant surgery best for you? Do you need it?
Surgery is always considered as the last resort of medical care. It comes after all other options have failed.
At the time of exploring and discussing surgery, you have to consider if the proposed surgery is essential or optional for you. In principle, life – survival, should come first. That is essential and a must to have if you want to live on.
To address the issues on if penile implant surgery is best for you or not, let us peruse the article on “What is Sexuality and How May Erectile Dysfunction (ED)-Impotence Affect Male Sexuality? “. After reading it, you should be able to answer the above two questions to suit your best interest of health and life at this time.
At the end, you would be the one to decide if penile implant surgery is best for you. At this moment, I would need to remind you that oftentimes what we like best is not what we need. And what we need is oftentimes not what we like. This is the critical decision-making moment, which the doctor will help you if you permit her/him to do so.
Besides, it is helpful to know: In life and medicine, perfection will never be, but perfecting would be. In other words, nothing can be perfect. But at most or at best, only be reasonable under the circumstance.
What is the penile implant, how many kinds of penile implants do we have? Which kind is best for me? What is the cost of penile implants?
A penile implant is a device or prosthesis which your urological surgeon will insert into the paired cylinders of the penis. They are called corpora cavanorsa and are responsible for penile erection.
How many kinds?
Currently, three kinds of the penile prosthesis are available:
- Semi-rigid – malleable or bendable, penile prosthesis
- Company: American Medical Systems as AMS-Malleable 600 and Mentor Corp. As Acu-Form.
- Structures: a pair of 2 bendable malleable Fcore rods inserted into erection chambers.
- Advantage: low mechanical failure; easy to insert.
- Disadvantage: constant penile erection although most are concealable, penis always appears erect – firm at all times.
- Patient selection: for those with poor hand ability to inflate/deflect – poor manual dexterity.
From American Medical Systems. Claimed to be concealable to a great degree.
- 3-piece inflatable penile prosthesis as shown below.
- Company: American Medical Systems as AMS-AMS-700… and Mentor Corp. as Titan or alpha-1.
- Structures: a hydrodynamic system with a pair of 2 inflatable cylinders inserted into erection chambers, a pump device to the scrotum, and a reservoir of 65 or 100c c to the space between the pubic bone and the bladder or beneath the rectus muscles of abdominal wall.
- Advantage: make penile length and girth closest to normal erection, but never be as long as that at a younger age, or most natural appearance at flaccid state (no erection).
- Disadvantage: highest mechanical failure; more difficult to insert, but still very low under experienced hands.
- Patient selection: for those with good hand ability to inflate/deflect – good manual dexterity.
from American Medical Systems
2-piece inflatable penile prosthesis
- Company: American Medical Systems as Ambicor.
- Structures: hydrodynamic system but with a pair of 2 inflatable cylinders inserted into erection chambers and a pump device with a much smaller reservoir to the scrotum, .
- Advantage: easy to insert with less local complications; penis always looks full.
- Disadvantage: increased risk of mechanical failure, but still very low under experienced hands.
- Patient selection: for those with good hand ability to inflate/deflect – good manual dexterity but with an expected dense scar in the pelvic cavity and abdominal wall from prior surgery or radiation.
- Self-contained inflatable penile prosthesis
- you might have heard about this, but it has become historical item and replaced by the above.
Which is best for me?
For about 95% of my patients, I implanted inflatable penile prosthesis through an infrapubic incision. Provided their physical and mental state and hand handling ability are adequate to learn how to operate the pump device for initiating and ending erection. If not, malleable is the choice.
So, nothing is perfect or best, but just reasonable.
What is the cost of penile implants? At mentioning the cost of penile implant surgery, some patients may feel offended. Because they contended they have good health insurance coverage and/or they have money. But my professional experience compelled me to remind my patients of the surgery-related cost. Why? Because some patients might just have used the implanted penile prosthesis very rarely like not more than 1-3 times in 1-3 years, and occasionally the patients even told me that they do not know how to operate the pump. Despite being taught before surgery (at least what I would expect).
Fortunately, I have had NO patients after penile prosthesis run into such professional ordeal of wasting resources. How much is the cost of implanting penile prosthesis? It may run between $15,000 to $30,000 or more depending on where it is done and who is doing it for you. As you can see, spending that amount of money for optional need is not what ordinary people can afford. This is especially so if they make no good use of it. So, you may want to think twice before proceeding with penile implant surgery.
What would you expect before and after penile implant surgery?
Before surgery, you were evaluated and counseled on the reason for a penile implant. On the potential complications during and after surgery, and how you will be followed. The key points are:
- Penile implant is the last resort of care for ED;
- the possible anesthesia-related complication may rarely occur despite going through a comprehensive risk evaluation;
- surgery-related complications like bleeding, local swelling, infection, etc. may occur though very rarely.
- know how to operate the pump device to inflate and deflate the cylinders of the penile prosthesis;
- Make sure the sexual partner to have the same preoperative counseling as to assure penile implant is what they need and like. I would stress enough the importance of this step of care.
After going through extensive pre-operative evaluation and counseling as outlined above, you should have a clear expectation from receiving penile implant surgery such as:
- The penile length and girth will be decided right on the surgical table. As the surgeon measures the penile chambers, and will not be as long as those at your younger age; this is a reality.
- The pump will be on right side of the sac (scrotum) if you are right-handed and vice versa.
- Make sure to continue practice on how to operate the pump. Since how you feel the device at the office will differ from what you will palpate and hold the pump inside the sac.
- Follow the postoperative instructions and see the surgeon timely as appointed. If there is anything happening to you not as expected and as instructed, ask your surgeon right away.
That is the needed realistic understanding. Are you ready for such surgery?
How is the surgery done?
Under a strict aseptic control, a team of penile implant specialists will work as shown here.
This surgery can be done by making only one or two small incisions with the so-called infrapubic incision. Or penoscrotal incision at surgeon’s preference. Personally, I exclusively use infrapubic incision of about 2-2.5 inch long. Through this incision, I can reach the penile chambers(corpora cavernosa). For the paired cylinders of the prosthesis and the space between the pubic bone and the bladder. Where the pump device will sit or reside there permanently. I prefer this approach because that was what I was trained to do (at the University of Michigan Medical Center). And it has worked so well for me and my patients with almost no complications.
What is the long-term satisfaction after penile implant surgery?
For most patients, they are able to operate the pump within 8 weeks comfortably. But still, expect the need to practice how to inflate and deflate the prosthesis as closely instructed. Overall, some 90-95% of the patients would be happy with what they got after proper preoperative counseling stressing realistic expectation. Namely, they like how they feel themselves and how they sense during sexual intercourse. But, remember: the best one is still what we got at birth.
According to American Medical Systems, Patients and Partners Are Satisfied10 with. An AMS three-piece inflatable penile implant allows you to be spontaneous again. It also puts you back in control of your erectile function.
Many patients and partners are highly satisfied with the penile implant.
- 92% … Patients reported sexual activity with the implant to be excellent or satisfactory.
- 96% … Partners reported sexual activity with the implant to be excellent or satisfactory.
- 95% … Patients reported no change or better orgasm following the surgery.
- 98% … Patients reported satisfactory or excellent erections following the surgery
Penile implant surgery is a very safe procedure for the men with ED after proper evaluation and counseling before surgery. With an emphasis on their realistic understanding of what they may expect during and after the surgery. Its related complication is extremely low. Its outcome is excellent, and its satisfaction rate is very high. This is usually so provided they are properly evaluated, counseled, and selected.
For more related information, go to https://www.webmd.com/erectile-dysfunction/penile-implants-for-erection-problems ; https://www.webmd.com/erectile-dysfunction/guide/penile-prosthesis#1;
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