Impotence and Penile Implant Surgery: a permanent solution for erectile dysfunction
- dr Nikola StanojeviÄ
- Apr 19
- 7 min read
Penile prosthesis surgery: how do I know if I need an penile implant? How penile implant surgery treats erectile dysfunction?
Just mentioning a penile prosthesis causes uncertainty in men.
Despite common belief, the reason for implanting a penile prosthesis is not cosmetic surgery. Although it has a positive effect on aesthetics, the real role of the prosthesis is to ensure penile rigidity during sexual intercourse in men who have a serious functional problem with their penis.
The cause of the disorder may be a lack of firmness during erection, leading to the inability to have sexual intercourse. For enjoyable sexual relations, penile function is much more important than size.
If you experience repeated problems with erections, it certainly affects your sex life and your psychological stability, and there is no reason not to seek medical help. Penile implant surgery is 100% secure procedure for the treatment of erectile dysfunction.
If you are just learning about this topic, keep in mind that there are conditions where erections are perfectly preserved, yet a penile prosthesis is still necessary due to disorders in penile anatomy, such as Peyronie's disease.
What is a penile implant (penile prosthesis), what is it used for?
Sometimes, conservative treatment with pills or injection therapy can solve the problem, but in most cases, a penile implant is the most suitable solution, especially for older men with heart conditions who are prohibited from taking potency medications.
The placement of a penile prosthesis is the only permanent and safe solution for treating the most severe forms of male impotence.
In the following text, we will answer some of the most common questions men have about penile prostheses.
How do I know if I need a penile implant surgery?
Consult with a urologist-andrologist, a specialist in male sexual organs.
If you suffer from weakened erections, an implant may be a solution for you. However, keep in mind that there are other methods for restoring sexual function. A specialist doctor's assessment is crucial in the treatment process.
Lack of firmness may be caused by disproportionate penis anatomy. The ratio between length and width, for example, is very important and must be examined during a visit to a doctor specialized in erectile dysfunction.
When is a penile implant surgery indicated?
Whether a penile prosthesis is needed cannot be determined based on conversation alone. A detailed examination is mandatory.
Over the past 20 years, during which our team has been intensively involved in penile prosthesis surgery, we have met many men for whom the only solution was a penile implant. However, the decision to proceed with implantation was always made after a thorough clinical evaluation and depended on a number of factors.
The most precise way to determine the need for a penile prosthesis is a functional examination of the penis.
An expert urologist-andrologist administers an injection, after which a Doppler ultrasound examines the ability of the penile blood vessels to achieve an erection.
Penile implant surgery is considered when clinical treatment of impotence has failed or its effectiveness has diminished.
Men typically begin impotence treatment with medications and injections, but with limited results. Even when a good response to drug therapy is achieved, its effects weaken over time, the problem worsens, doses increase, and the ultimate effect declines. Therefore, it is crucial to pay attention to dosage and final outcomes when using these medications.
Surgery is done when a man cannot or does not wish to use medications and injections for impotence
The use of potency pills or vasoactive injections is not without side effects. Nasal congestion, headaches, or facial flushing are common and less serious adverse effects of drug therapy for impotence. Not all men experience these symptoms, but if you do, consult your urologist-andrologist to prevent the situation from worsening.
Another drawback that discourages men from this form of treatment is the discomfort associated with its use. Injections are administered immediately before sexual intercourse, interrupting the intimate moment between partners. Due to this awkwardness, men often try to hide their use of injections from their partners, which can lead to misunderstandings, such as suspicion of illicit substance use.
Penile implant is the only solution when penile fibrosis is associated with sexual dysfunction and impotence
After prolonged use of erection-inducing injections, men often notice fibrous scar tissue inside the penis (under the skin). Aside from causing pain, this scarring can lead to penile deformities, curvature, narrowing, or even shortening.
Reduced firmness of nocturnal and morning erections is one indicator that something is wrong. This can occur in conditions such as diabetes or prostate cancer, leading to fibrosis and even a reduction in penile size. Penile fibrosis also occurs in all cases of prolonged ischemic priapism.
When hormone therapy has not yielded successful results
One possible cause of impotence is low testosterone levels. Despite testosterone replacement therapy and normalization of testosterone levels, erectile dysfunction may persist.
In older men, testosterone therapy is not always advisable due to the high risk of prostate-related issues (prostate cancer, BPH).
When penile reconstruction is planned due to Peyronieâs disease
The internal scarring that forms in Peyronieâs disease can cause bending, narrowing, shortening, or even twisting of the penis. Delicate surgeries to restore the penisâs original shape and size are only guaranteed to succeed if a penile prosthesis is simultaneously implanted.
Implant surgery is done when an episode of ischemic priapism has led to permanent erectile loss
Priapism, an acute urological emergency requiring immediate medical attention, can have lasting consequences on a manâs sexual life.
Ensuring proper indications for penile prosthesis surgery
The text outlines situations where the only solution for erectile dysfunction is penile prosthesis implantation. This also represents a definitive, lifelong treatment for impotence.
Suppose your urologist-andrologist has recommended prosthesis implantationâwhatâs next?
There is no need for concern. If the procedure is performed with proper precautions in a specialized center, the treatment is safe and highly effective, with an exceptionally high satisfaction rate among men. The key to success is a thorough preoperative assessment of the conditions leading to impotence.
How will the prosthesis help? Is the procedure safe?
The implant will restore erections and provide the necessary support for normal penetrative intercourse. After implantation, men can confidently enjoy sex.
While the surgical procedure is moderately complex for the surgeon, patient needs remain the priority. Only an andrologist-urologist can define the procedural details, including precise evaluation of internal structures, vascularization, any penile deformities, and the degree of erectile dysfunction.
What does the surgery involve?
A few days before the procedure, an internist will examine you to confirm you are medically fit for surgery. On the day of the operation, you will be admitted to the hospital, and your doctor will once again explain all the details of the procedure and recovery.
Six hours before surgery, refrain from eating or drinking.
The procedure is typically performed under general anesthesia, but regional anesthesia is an option if preferred or medically advisable.
The surgery lasts about 60 minutes, after which you will wake up in your hospital room.
Discharge is expected within two days.
Your doctor will remain in close contact for daily check-ups, dressing changes, and postoperative monitoring.
Returning to work is possible after 7 days, depending on your job type. Strenuous physical activity can resume 4 weeks post-surgery.
Sexual activity may be resumed 4â5 weeks after surgery, as approved by your doctor.
What will I feel like after the surgery?
The scar after 6 weeks heals so that it is no longer visible. Touch, erogenous sensitivity, and the sensation during orgasm and ejaculation are completely preserved after a properly performed surgery.
After the adaptation period to the prosthesis, which is usually about 8 weeks, you wonât even notice that the prosthesis is implanted. You wonât feel that you have it, and when you need itâitâs there at any moment.
How does a penile implant work? Is the penis constantly erect?
The implant consists of two cylinders that are implanted into the cavernous bodies, the internal structure of the penis that normally fills with blood during an erection. The implants provide support to the penis for normal sexual activity.
Some men are concerned about the appearance of the penile prosthesis as well as the reaction it may cause in their partner. Donât worryâboth types of penile prostheses, when properly implanted, do not change the aesthetic appearance of the penis. The prosthesis is located in the center of the penis and cannot be seen.
Modern types of prostheses are divided into semi-rigid and inflatable, both types of prostheses solve the problem of erection loss.
The semi-rigid implant consists of two flexible silicone cylinders that can be bent as desired and keep the penis in a permanently extended state. The penis can be bent or straightened into a position suitable for penetration as desired. The inflatable implant represents a hydraulic system with two inflatable cylinders that are implanted into the corpora cavernosa and a control pump located in the scrotum behind the testicles. By activating the pump, the cylinders fill with fluid, thus creating a firm erection.
Is it possible to increase penis size with a penile prosthesis?
The prosthesis can restore penis size to what it was before the illness. Certain health problems such as Peyronie's disease, prostate cancer surgery, priapism, diabetes, or cardiovascular diseases can lead to loss of penis size. These conditions are usually associated with erectile dysfunction, which creates the need for penile implant placement.
For these men, the penile prosthesis itself solves the problem of erectile dysfunction, but not the problem of a reduced penis size. For this purpose, techniques for enlarging the internal structures of the penis are used to achieve the maximum possible size and diameter of the penis. Enlargement of penile tissue, not the prosthesis, leads to the restoration of the desired length and width of the penis. The limits of this procedure vary for each man, depending on the elasticity of the urethra, blood vessels, and nerves that run through the penis. Therefore, we come to the obvious conclusion: the prosthesis itself does not lead to penis enlargement.
Does the prosthesis reduce penis sensitivity? What happens with ejaculation?
The prosthesis itself does not reduce sensitivity, but the issue of sensitivity must be approached carefully. The nerves within the penis can be damaged by careless prosthesis placement. Nerve damage causes reduced penis sensitivity, difficulty achieving orgasm, delayed ejaculation, and decreased sexual satisfaction. Additionally, unprofessional destruction of the cavernous tissue where the prosthesis is implanted eliminates the possibility of achieving additional natural erection through the penile implant, of course with sexual stimulation.
When a man complains about lack of sensitivity, the so-called "cold penis," the prosthesis was most likely improperly implanted, destroying valuable tissue and thereby reducing blood flow through the penis. Therefore, pay attention when choosing your doctor.