The extender used in penile prosthesis surgery is an accessory that adjusts the implant length to the corpora cavernosa. Although it can contribute to small size refinements, its use must be judicious — and, in most cases, avoided — as it can compromise penile rigidity. Discover why!
The use of extenders during penile prosthesis placement has as its main purpose adjusting the prosthesis length to the corpora cavernosa. In some cases, upon noticing that the implant fell short of the adequate length, the surgeon may use extenders to adapt the prosthesis to the actual penile size.
Although they provide additional support to the penis’s internal structure, they can also over-tension tissues, increase the risk of surgical complications, impair healing, and compromise the optimal positioning of the prosthesis.
The decision to use or not use an extender during penile prosthesis placement must be evaluated with caution. Below, learn what the physician should consider to properly employ this resource in penile implant surgery:
What is the penile prosthesis extender?
The devices called penile prosthesis extenders are a kind of support that fits at the base of the prosthesis, complementing implant size.
The item’s purpose is to match the implant cylinder length to the corpora cavernosa inside the penis, whether for a malleable or inflatable prosthesis.
Attention: The penile prosthesis extender is different from the external penile extender
The penile prosthesis extender is used directly on the implant.
The penile extender is a device used directly on the penis’s exterior. It applies traction to the member and may be indicated in the early phases of Peyronie’s disease, erectile dysfunction, or even penile rehabilitation — provided it is prescribed by a physician.
In other words, it is not an alternative to the prosthesis extender, since it serves a different purpose.
In which cases is the prosthesis extender used?
The extender is not intended to increase or restore penile length.
Its function is purely technical: in some cases, during implant surgery, the surgeon finds that the corpora cavernosa are longer than the available prosthesis.
In this situation, a small extender can be used to adjust the implant to the internal length of the corpora cavernosa.
This adaptation prevents the glans from appearing disproportionate or drooping, contributing to a better aesthetic and functional alignment of the penis after surgery.
Although this scenario may occur in patients with penile retraction — such as in Peyronie’s disease, prolonged erectile dysfunction, penile disuse, or cavernous fibrosis — extender use is not aimed at treating these conditions and is not always necessary.
Definition of the prosthesis and extender
The size of the penile prosthesis and extenders is not predetermined. It is determined by the surgeon during surgery, based on measurements taken at the time of implantation.
Only after performing penile reconstruction, with tissue expansion and the penis’s new anatomy, is it possible to precisely measure the prosthesis size and decide on the need for extenders to fill the space.
Not every surgery requires an extender for penile implant
The penile prosthesis extender is not always necessary, and its indications must be carefully evaluated, since it can influence implant performance.
According to a study published in the Journal of Sexual Medicine, excessive extender use can compromise axial penile rigidity in inflatable prostheses. The study concludes that the ideal is to maximize the inflatable portion length of the cylinders and minimize extender use whenever the patient’s anatomy allows.
The study further notes that, in many cases, it is possible to implant a longer cylinder without extenders, which can contribute to better rigidity and stability, depending on anatomy and technique used.
Potential risks of extender use
Currently, surgeons should avoid extender use in patients undergoing penile prosthesis surgery.
The ideal is to properly size the prosthesis to avoid extenders, as they compromise vertical rigidity.
Lack of penile firmness
When adding extenders, particularly in inflatable implants, a non-inflatable area is introduced to the cylinder.
When the patient pumps the prosthesis to achieve an erection, the tip with the extender will not fill. In other words, this part will lack vertical firmness, and in some cases, penetration difficulty may persist.
In malleable prostheses, extender use must be evaluated with caution.
This is because the extender is made entirely of silicone, without the internal metallic structure that provides rigidity to the implant.
When an excessive number of extenders is used — especially at the base of the penis — the most resistant part of the shaft, which contains the metallic component, is reduced.
This reduction compromises the implant’s axial rigidity, which can make penetration during intercourse difficult.
Implant extrusion
Extrusion is a complication of penile prosthesis placement.
Extrusion can occur when the implant is oversized relative to the penis’s anatomy.
In other words, when the prosthesis is longer and/or more calibrous than ideal for that patient.
As a consequence, the patient may experience various complications: pain, swelling, glans drooping, infections, and other issues related to poor implant adaptation.
Improper extender use can increase the risk of penile prosthesis extrusion. This happens, for example, when the surgeon chooses a prosthesis size — plus extender — that exceeds the true length of the corpora cavernosa.
In this situation, the prosthesis tip ends up pressing excessively on the penis tip, favoring its migration (extrusion) over time. Therefore, extender use must be carefully evaluated, always considering the patient’s individual anatomy.
Alternatives to the penile prosthesis extender
To avoid extender use, it is essential for the operating surgeon to have all prosthesis sizes available in the surgical room.
Another major point is that the patient must have access to best urological practices.
One internationally established technique for severe Peyronie’s disease and erectile dysfunction — providing penile rigidity — is penile reconstruction combined with a prosthesis.
In this procedure, the surgeon addresses fibrosis and reconstructs penile dimensions using small geometric incisions in the tunica albuginea.
During penile reconstruction, it is crucial for the surgeon to have all prosthesis sizes available in the operating room. This allows, after measuring the corpora cavernosa, selecting the greatest length and girth compatible with the new dimensions achieved.
When the procedure is performed this way, in most cases, extender use can be eliminated or, when necessary, minimized.
The penile prosthesis extender is a device that can be avoided in certain penile reconstructions, when anatomical adjustment without the device is possible.
Discuss with your urologist and do not hesitate to seek guidance if you have questions.
Post-operative care and adaptation with extender
The post-operative recovery process for penile implants with an extender generally follows the same recommendations as conventional implants without extenders.
Proper hygiene, rest, antibiotic use, and gradual return to physical and sexual activities are part of the standard protocol, regardless of extender use.
The main difference lies in the potential long-term impacts. In both prosthesis types — malleable or inflatable — excessive extender use can compromise functional performance.
This happens because extenders are made entirely of silicone, without the internal structure that provides implant firmness.
In malleable prostheses, this lack of reinforcement reduces axial rigidity, especially at the base, which can cause the penis to bend or slip during penetration.
In inflatable prostheses, excessive extender use can impair implant stability, affecting erection efficiency and glans alignment.
Therefore, extender use must be guided by technical criteria, always aiming for a balance between aesthetics, functionality, and safety.
Ask your questions in person with Dr. Paulo Egydio
With experience in penile prosthesis surgery, Dr. Paulo Egydio is a reference in the field. He seeks to avoid extender use but also knows the right moment to employ them to offer a functional solution suited to the patient’s anatomical profile.
Get to know the EMC clinic, where the professional practices, and evaluate your penile retraction case with discretion, safety, and the surgeon’s expertise. Get in touch and find out whether the penile prosthesis extender can make a difference in your sexual life.
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