From the Guidelines
Penile implants are a viable option for men with severe erectile dysfunction who haven't responded to other treatments, with the most recent study from 2023 1 suggesting that patients should be thoroughly counseled about the benefits and risks of this treatment. Before considering this surgical procedure, patients should first try medications like sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra), vacuum erection devices, and injectable medications like alprostadil. Candidates should be in good overall health, have realistic expectations about outcomes, and understand the permanent nature of the procedure. The two main types are inflatable implants (three-piece or two-piece) and semirigid rods, with the three-piece offering the most natural erection. Some key points to consider include:
- Potential complications, such as infection (1-3% risk) and mechanical failure requiring revision surgery (about 10% within 10 years), as noted in the 2018 AUA guideline 1
- Changes in penile sensation or length, as discussed in the 2005 study 1
- Recovery typically takes 4-6 weeks with sexual activity resuming after 6 weeks, as stated in the example answer
- The procedure is generally covered by insurance when medically necessary, but patients should verify coverage, as mentioned in the example answer
- Success rates are high, with over 90% of patients reporting satisfaction, though the implant doesn't change libido or sensation, as reported in the 2018 AUA guideline 1 This irreversible procedure requires thorough discussion with a urologist about benefits, risks, and alternatives before making a decision, as emphasized in the 2023 study 1. It's also important to note that the most recent study from 2023 1 found that the use of antibiotic prophylaxis, as recommended by the AUA, may actually increase the risk of postoperative infection, highlighting the need for careful consideration and discussion of the risks and benefits of penile implant surgery.
From the Research
Considerations for Penile Implant
When considering a penile implant for severe erectile dysfunction, several factors come into play. These include:
- Medical pre-operative considerations, as outlined in a 2017 study 2, which provides a checklist for implanters to reference when considering penile prosthesis implantation.
- The choice of device, which can be tailored to an individual's unique medical conditions, manual dexterity, and expectations, as well as surgeon preference 3.
- The risk of device infection, which has been lowered to 1% or less due to improvements in techniques and procedures, such as no-touch techniques and the use of antibiotic-coated devices 4.
- The potential for complications, which can be categorized as infectious, noninfectious tissue-related, device-related, or related to patient and partner satisfaction, and can be prevented with appropriate patient selection and counseling 5.
Types of Penile Implants
There are different types of penile implants available, including inflatable penile prostheses, which have undergone significant advances in design and implantation techniques, resulting in increased device survival rates 6.
- Inflatable penile prostheses have 5-year actuarial survival rates free of mechanical failure ranging from 86.2 to 93.6% 6.
- Patient and partner satisfaction rates are high, with recent reviews showing 83 and 85% satisfaction for implant recipients and 70 and 76% satisfaction for partners 6.
Preventing Complications
To prevent complications, it is essential to:
- Understand the potential complications associated with penile prosthesis implantation, including infectious and noninfectious complications 5.
- Employ techniques and procedures that minimize the risk of complications, such as no-touch techniques and the use of antibiotic-coated devices 4.
- Provide appropriate patient selection and counseling to ensure that patients are well-informed and have realistic expectations 5.