Just for men (and the partners who love them): penile implants

by Jeanine Barone

When other treatments for impotence are ineffective, unsatisfactory or cumbersome, men turn to implants. Whether impotent because of diabetes, radiation therapy, prostate surgery or another physical cause, a surgical implant can help men regain the ability to perform in the bedroom and to have greater control over their erection.

Implants come in two main categories. The simplest, called a semi-rigid or nonhydraulic implant, consists of a pair of silicone rods. They are bendable, yet stiff enough to maintain intercourse. Some varieties contain a steel cable or coiled wire running through the center of each rod. To initiate sex, the penis is simply lifted to position the rods straight out. Of all the implants, these are the easiest to use, have the fewest moving parts, and are the least expensive. However, the penis is always semi-erect and has to be tucked into the briefs; under tight clothing, it may be visible. Unlike with a natural erection, neither the length nor width of the penis will improve. Yet, some men don't mind these limitations.

The second, more complex, type of implant is a pair of hollow, inflatable (hydraulic) cylinders that come as a one-, two-, or three-piece unit. These devices, made of silicone or polyurethane, are best suited to men who are highly motivated and have good dexterity.

The one-piece, or self-contained device, is a neat little package with a pump at one end and a reservoir at the other. The entire unit is housed in the penis. To get an erection, you simply pump the front of the cylinder, allowing saline solution to move out of the reservoir into the hollow rods. By bending the penis down for a few seconds after intercourse, the erection softens as fluid returns to the reservoir.

In the two-piece implant, a pump and reservoir are placed in the scrotum. With the three-piece device, only the pump is inserted in the scrotum; the reservoir is placed in the abdomen. It's this latter, very complex implant that most closely mimics a natural erection. When stiff, the penis is firmer than with the other implants, and when flaccid, it's softer and easier to conceal.

When using a three-piece inflatable, all a man has to do is squeeze the pump forcing fluid from the reservoir through the connecting tubes to fill the penile cylinders, producing an erection. With pump in hand, a man has control over when and how long he'll have an erection. To some extent, both the length and width expand, as they do in a natural erection. Pressing a release valve in the scrotum (at the base of the pump) sends the fluid back to the reservoir; the penis softens as it normally would.

No one implant is good for every man. A urologist can provide you with all the various options based on an array of factors, including your specific anatomy and needs.

These procedures, which can cost $10,000 to $15,000, are typically performed under general, spinal, or epidural anesthesia. Depending on the implant, the operation takes from 30 minutes to two hours. The urologist will decide precisely where to make the incisions based on the type of device inserted.

A small cut may be made either under the head of the penis or between the penis and scrotum. After deciding on the appropriate implant size, the doctor places the implant components in the two chambers (corpora cavernosa) in the shaft that would normally fill with blood during an erection. That's the end of the surgery, unless the implant requires the additional placement of a reservoir and pump.

In that case, an incision is made in the scrotum to insert the pump and another cut is placed in the abdomen so that the reservoir can be positioned at the base of the pelvis. The penis is usually taped to the abdomen until the incision heals and a tube or catheter will be inserted to drain the bladder.

You might go home from the hospital the same day. Or you might stay in up to a week depending on the type of implant, anesthesia and whether there are complications. Post-operative pain can last for one to two months -- your urologist will suggest appropriate pain medication.

As the incision heals, the hard ridge of tissue that forms will eventually fade away. You'll probably see your urologist several times after the surgery and then at six-month or yearly intervals thereafter. You'll be instructed to call the office if you develop worsening pain, swelling, redness, or problems with urination.

Expect to resume your normal every-day activities over the course of three to six weeks, though some men return to work after a few days. Your urologist will probably tell you to avoid strenuous physical activity for four to six weeks post surgery. Don't even think about a test-run sex session until you're all healed up, which can take 4 weeks or longer. The doctor will tell you when it's safe --otherwise you risk pain and infection.

None of the implants affect your ability to ejaculate or have an orgasm. Rarely, some men end up with persistent pain or a loss of sensation in the penis. Many men are surprised to learn that with an implant their erection does not appear as it once was; it's often shorter or it may not be as rigid. Also, the unerect penis isn't quite as relaxed as it used to be. But these outcomes generally depend on the type of implant used and how well you heal.

No surgery is without its risks, and that includes implant procedures. In a very small percentage of cases, the wound can become infected. While implants have gotten more reliable over the years -- tubing is kink resistant and the connectors and reservoir are seamless - a variety of problems can still arise.

About 5% of the malleable or semi-rigid implants fail, while 10% of the three-piece hydraulics malfunction over five years. In general, the more complex the implant, the greater the likelihood there will be mechanical problems. The fluid can leak out and, though saline solution presents no medical risk, a second operation is necessary because without saline, the implant won't inflate.

Sometimes the reservoir or pump may protrude through the skin. Occasionally, the unit will auto-inflate or deflate without warning. Or the healthy tissue adjacent to the implants may break down. Men should accept that there's a chance they might need to undergo a second operation either to remove the implant or have another one inserted. It's hard to say how long an implant will last, because, as with any medical device, there's ongoing wear and tear.

Silicone penile implants, though solid and not gel-like, carry the same risks inherent in silicone breast implants. There have been reports that silicone particles, shed from the implant, can migrate to other parts of the body. But, there are little data to confirm silicon-related health problems associated with these devices.

Think carefully about an implant, because they are generally irreversible. The penile chambers are permanently altered by the device, making it unlikely that natural erections could ever return. Despite the risks, more than 80% to 90% of patients are satisfied with their decision to get an implant. For many men, implants mean a renewed confidence in their ability to perform.