Today penile prosthetic implants are highly successful treatments for men with ED who do not respond, or who do not want to use, other forms of therapy for ED. Typically men who have penile implants have their sense of lot manhood restored. That restored sense of manhood, of being capable at any time, may be the most important outcome of prosthetic surgery.

Penile implants are inserted as simple outpatient surgeries in one hour or less with full recovery to intercourse in about 6 weeks. There are two types the semi-rigid or malleable and the inflatable device.

The first successful penile implant was developed in the late 1960’s in Los Angeles by one of my teachers at UCLA, Bob Pearman. The success of the implant became possible because of the invention of silicone® by Dow Corning a flexible plastic that is not rejected by the body. Non-inflatable Penile prostheses need to be flexible, not rigid, so that the penis can be comfortably located when the man is dressed and needed to be accepted by the tissues of the penis. That prosthesis was highly successful and for the first time allowed Urologists to treat men with ED. Prior to that time there were no successful ED therapies for men with physical and permanent causes of ED.

That first implant was soon improved upon with a more natural semi-rigid device (the Small-Carrion penile prosthesis) and in the mid-1970’s American Medical Systems introduced the first inflatable penile prosthesis. The inflatable penile prosthesis replicates a natural erection. It is a hydraulic, (i.e., fluid-based system) that at rest resembles the flaccid or non-erect penis and when inflated resembles a normally erect penis. Because prostheses are located within the body no one looking at the man with a prostheses can tell that it is place.

Through the next four decades technological advances have allowed penile implants to be modified and improved so that they can be considered to be as long-lasting, safe therapies for the treatment of ED. Unlike all of the other therapies for ED a man with a penile prostheses does not have to plan (by taking a pill, using a vacuum erection device, using injection therapy) to have sex- he is always able and ready.

How to choose semi-rigid or inflatable penile implant device

Because most insurers cover each device the choice is personal taste usually not financial.

The advantages of the inflatable penile implant device (IPP) are

· More natural non-erect to fully erect action

· More rigid erection

· More comfortable day to day

Disadvantages of the inflatable penile implant device (IPP)are

· Need to squeeze the scrotum to inflate and deflate the device

· More connections and material that have a higher failure rate than the semi-rigid device

The advantages of the semi-rigid penile implant prostheses are

· Simple design with low, long-term failure rate

· No need to pump up or inflate just bend the penis up

The disadvantages of the semi-rigid penile implant prostheses are

· Always erect

· Less rigid and stable erection

The primary surgical complication with either prosthesis is the possibility of infection in the near post-operative period. That rate is about 3%. To reduce the rate of infection as low as possible the man is given intraoperative antibiotics and one of the two companies that manufacturer the inflatable prosthesis now includes an antibiotic impregnated into the device. If a post–operative infection occurs the process almost always needs to be removed and a new device placed back a few months hence.

In my experience, as described in one of my published follow up studies (see future blog) , the best results of penile prosthetic implant surgery occur when both the man and his partner are fully informed before hand so that neither of them have unrealistic expectations of the outcome. Remember the partner is the recipient of the surgical outcome and should be fully educated beforehand. After surgery orgasm and ejaculation (if the man can ejaculate) should be the same. The penis will stay erect after orgasm. The penis is not so rigid that it will hurt the woman if she has a normal vagina. The penis will not be larger then when the man was functioning normally. Many women are afraid that their partner will desire to become the neighborhood stud and might be unhappy if he goes ahead. Frank, open preliminary can avoid each of these pitfalls and create a more satisfactory surgical experience.