Penile Implants

Penile implants can be an excellent choice to fix erectile dysfunction when all other, more conservative methods, have failed.

They are considered the so called “end game” of erectile dysfunction.

Basically, there are two types of penile implant available, a malleable penile implant and an inflatable penile implant.

The malleable implant is sometimes referred to by patients as “the bendy implant”. This is because it consists of two flexible rods that are inserted into the penis. This then makes the penis in the erect state, permanently. When there is a desire for sexual intercourse the penis is bent upwards into the desired position. After sex, the penis is then bent to the side or downwards. The advantage of this penile implant is that it is very easy to use. You simply bend it up and down as you wish. The surgery for the malleable implant is also less time than the inflatable and the recovery is a little bit quicker.

The inflatable implant is perhaps the favoured choice for many men. This is perhaps due to the natural appearance of the penis when it is in the flaccid state, it is not permanently erect as with the malleable penile implant. It consists of three parts, all linked together. There is a small pump which is located in the scrotum. A reservoir which is located in front of the bladder and two chambers within the shaft of the penis itself. When sexual intercourse is desired, the pump is activated by a few presses which sends fluid from the reservoir into the two chambers in the penis. This then pumps up the penis shaft to achieve a form erection strong enough for sexual intercourse.

When sex has finished, it is a matter of squeezing a value located at the top of the pump to send the fluid back into the reservoir and enabling the penis to return to a natural flaccid state.

The surgery needed to place this implant takes around two hours under general anaesthetic and the recovery is a little longer compared to the malleable implant. Most Patients are back to successful sexual activity at around six to eight weeks.

One of the key questions most patients ask about penile implants is, are they safe?

It should be remembered that a penile implant is a foreign body and therefore prone to complications. Most patients who have penile implants do not experience complications but it is important to be aware of them.

Perhaps one of the worst complications soon after placing an implant is infection. If the infection reaches the implant, then the device has to be removed because antibiotics may not be enough to clear the infection. If the device has to be removed, then this would mean an additional surgical procedure. Usually, a period of time must elapse before the implant can be replaced. In most cases, this is between six and twelve months. Infection of a penile implant is a rare occurrence but one that patients should be made aware of.

Both malleable and inflatable penile implants are placed under general anaesthetic. Generally speaking, malleable implants take less time in theatre than an inflatable one. General anaesthesia is always taken seriously by the medical team and a series of pre-operative tests will be undertaken to assess your suitability for surgery. Your medical file will be reviewed by the Anaesthetist to ensure that you are fit and well enough for the operation. General anaesthesia itself carries risks. As part of your assessment the Doctors will review any medication that you may be taking and advise you when to take these ahead of your surgery date, or in some cases, when to stop taking them in such medications as warfarin or aspirin, which thin the blood.

Penile implant surgery is carried out under general anaesthetic. In most cases, the surgery takes around two hours for the penile inflatable implant. The Malleable implant probably a little less at around 1.5 hours.

Patients are usually admitted to the hospital around two hours before the operation is due to start. This gives the medical team the opportunity to carry out some routine tests and settle you into the hospital. The Surgeon and Anaesthetist would normally come and see you prior to the operation starting.

After the surgery has been completed there will be a period of recovery. In most cases, this will be two to three hours before you will be ready to be discharged. Someone will need to collect you from the hospital and if your procedure is an overnight stay in the hospital, you are normally discharged on the following morning.

Penile implant surgery is carried out under general anaesthetic. The procedure itself is painless as you are asleep throughout the procedure. In the post-operative period, you should expect some pain and discomfort. In the first week after surgery, apart from antibiotics, you will also be given pain relief medication to help you through the first week. You should expect the scrotum to be quite swollen, bruised, and sore. This is normal and it will settle down gradually over the first few weeks after the surgery. Because of this swelling and bruising you will not be able to use the pump to generate the erection in the case of the inflatable implant. The scrotum will be too sore to palpate it. Patience is needed at this time and when the swelling and bruising subsides you can use the pump without any pain.

Following your penile implant surgery, you should arrange to take some time off work. In most cases, one to two weeks should be fine. In the first weeks, you can expect some bruising and swelling of the scrotum. This takes several weeks to subside in most cases. The scrotum will be sore to touch, and it might be that you cannot inflate the device for several weeks until this settles. You should also avoid contact sports and gym activity for six weeks. Once the bruising and swelling has settled you will be able to start practicing inflating and deflating the device. In the case of the malleable implant, this will be putting the penis into the erect position and down to the side again, into the position when not engaging in sexual activity. Allow yourself at least six weeks for the recovery process and don’t expect too much of yourself in the first few weeks. Remember that recovery takes time and not all patients recover at the same rate.

At Moorgate Andrology we only have Urologists who are registered on the general medical council specialist register for urology.

This is your reassurance of being under the treatment and care of a specialist in genital surgery and procedures.

In terms of penile implant surgery our Urologist is Dr Nenad Djakovic. He has many years of experience in the placement of both malleable and inflatable penile implants. He has placed implants from well known manufacturers such as AMS, Rigicon and Coloplast, which are some of the best known.

Dr Nenad Djakovic offers both in hospital consultation and assessments and also on zoom video. Zoom video appointments are very popular with patients who do not live in or around London.

Most experts agree that a penile implant will last for at least ten years, but many do last much longer than that.

We see patients who have implants that have lasted beyond 20 years with no functional problems whatsoever.

Of course, implants can fail and parts can wear out which would require the implant to be changed. In such cases, further surgery would be required to remove the device and place a new one.

In some cases, it may require just a minor adjustment of the same implant, such as the repositioning of the pump in the scrotum, if this becomes dislodged.

Other potential complications that may require removal of the implant are infection. This tends to happen quite soon after the implant has been placed and is not a complication because of the implant itself. Infection following penile implant surgery is not common and most patients do not experience an infection.

Many manufacturers offer a warranty with the implant device itself, which is a great comfort and reassurance to patients.