Penile Implant / Inflatable Penile Prosthesis for ED
Watch Dr. Engel’s Presentation on Incontinence and ED
Erectile dysfunction is extremely common as a man ages, and age-related erectile dysfunction is almost always a progressive problem. At its earlier stages, PDE-5 inhibitors such as Viagra, Levitra, Stendra, or Cialis will suffice. But as the problem progresses and becomes more severe, these pills will eventually no longer be reliable or work at all. When this occurs, and if a man retains the desire and motivation to have a usable erection, he must resort to more aggressive therapy. In our practice, the next step would be to learn injections into the penis with medicine that dilates arteries or to less commonly use a vacuum erection device.
Shots for erections have been around for many years and are very effective. Vacuum erection devices have also been helpful. However, for many men, even though they are willing to use one of these approaches, it simply is not a satisfactory solution. For these men, we offer to place a penile prosthesis. We usually will not consider someone for this surgery unless they have at least tried or seriously considered these other approaches first. But, for the right patient, an inflatable penile prosthesis can provide the highest patient satisfaction of any modality.
AMS 700 Inflatable Penile Prosthesis
An inflatable penile prosthesis is a hydraulic system that must be implanted surgically. We commonly use the American Medical Systems (AMS) model 700, which is a three-piece system. Now this is sold by a company called Boston Scientific. There is a competing company with far less market share called Mentor, but Dr. Engel has always preferred the Boston Scientific prostheses. One can also ask for a prosthesis that does not inflate, called a malleable prosthesis, but nearly every patient would prefer a three-piece inflatable prosthesis. It consists of two cylinders that will fill the natural cylinders (corporal bodies) in the penis, a pump that will be located in the scrotum, and a water balloon, or reservoir, which is typically implanted imperceptibly either behind the pubic bone or behind the abdominal muscles. It is entirely internal and inflates and deflates. The video below demonstrates how the patient would inflate it. When a man wants an erection, he pumps the pump in the scrotum approximately ten times or less. The pump forces water into the two implanted cylinders, which become rigid. The erection will have the same sensation as one would otherwise have, and the orgasm is unaffected. When finished, a button on the side of the pump is pressed, which allows the water in the cylinders to return to the reservoir.
Unlike other methods to achieve an erection, implanting an inflatable penile prosthesis (IPP) is surgery. There can be discomfort after surgery for up to four to six weeks, but after that, it is ready to use. The procedure is typically done in a hospital as an outpatient, and the patient will likely miss a few days of work. Soreness in the scrotum will be the last thing to resolve, and generally, our patients will meet with the same representative of Boston Scientific that was in the operating room for their actual surgery to learn how to use the device and to ask questions and be supported in the future.
Risks of Inflatable Penile Prosthesis
The main complications seen with this procedure would be infection of any part of the system, which would require removal of the system, erosion of the corporal bodies, or mechanical malfunction, which may occur up to 10% of the time over perhaps ten years of usage. Implanting an IPP is a common procedure among insulin-dependent diabetics. These patients may be asked to show that they can keep their hemoglobin A1c levels within a reasonable range before surgery to minimize infection. Other prophylactic measures that we employ are the extensive use of pre-operative antibiotics and showering twice daily on the days preceding the implant.
All patients are instructed to take any return of pain, redness, or problems with their urination very seriously and to only let us manage that. All of these may be the first signs of infection and erosion. These days, if an infection does happen, it has been shown that instead of simply removing the device completely, we can immediately reinsert a malleable prosthesis in the corporal bodies in the penis yet still avoid repeat infection. Often, patients will still be happy with the malleable device alone, but if not, this act allows us to implant a three-piece device more easily later. However, we can only do this if the patient presents to us right away when a problem is noticed, so this is repeatedly stressed.
Patients should always consult with us before having other surgeries that could injure the device as well.
