Penile implant surgery is indicated for patients with severe erectile dysfunction and for those who have impairment of penile function.
The penile implant can be a therapeutic option for men with erectile dysfunction who do not obtain a satisfactory response to conservative treatments or who have contraindications to the use of medications, after individualized clinical evaluation.
In addition, the penile implant may also be indicated for cases of penile function impairment associated with Peyronie’s disease.
Before undergoing the procedure, it is important that the patient understands what penile implant surgery is like, how recovery occurs, what care is necessary, and what results can be expected.
This information helps reduce anxiety and establish more realistic expectations regarding treatment.
Who needs penile implant surgery?
The penile implant is a treatment indicated in specific cases.
When is it indicated?
Penile implant surgery is indicated when conservative treatments for erectile dysfunction do not provide the expected results.
In addition, the procedure is also an alternative for men who have contraindications to medical treatment.
Another indication for penile implant surgery occurs in advanced cases of Peyronie’s disease, when the pronounced curvature compromises penile function, making sexual activity difficult or impossible.
When is it not indicated?
The relative contraindications to penile implant surgery concern preexisting conditions that do not prevent performing the procedure, but should be investigated before the procedure.
This assessment should be individualized and its objective is to verify whether the benefits outweigh the risks.
Learn about the relative contraindications of penile implant surgery and which actions should be taken by the physician:
Unrealistic expectations
When the patient believes that the penile implant will increase the size of the penis, it is important to provide preoperative counseling to clarify that the penile implant aims to restore erectile function, and not to increase penile length or thickness.
Low ability to understand or to operate the penile implant
Patients with cognitive impairment or significant limitation of manual dexterity may require additional guidance to understand how the penile implant works. The choice among the different models should result from an individualized assessment, taking into account the ability to handle it, the clinical context and the patient’s preferences.
Infections
Any type of infection must be treated before surgery to reduce the risk of contamination of the penile implant.
Uncontrolled cardiovascular diseases
Conditions such as severe hypertension, decompensated heart failure, unstable angina, uncontrolled arrhythmias and recent myocardial infarction require stabilization before surgery, to reduce the risks of cardiac and anesthesia-related complications.
Uncontrolled diabetes
High blood glucose levels impair the immune system and tissue healing, increasing the risk of infection. Therefore, surgery should be performed after glycemic control.
Use of anticoagulants and coagulation disorders
Anticoagulant medications and conditions that affect blood coagulation can increase the risk of bleeding during and after surgery.
Therefore, it may be necessary to temporarily adjust medication, discontinue use under medical guidance, or stabilize the coagulation problem to reduce risks.
How is penile implant surgery performed?
The procedure
- Type of anesthesia: The procedure is performed under general or spinal anesthesia – an anesthesia that blocks sensation in the lower part of the body, according to the medical team’s assessment.
- Average duration: It ranges between 60 and 120 minutes, depending on the type of penile implant and the complexity of the case.
- Incisions: The urologist makes a small incision at the base of the penis or in the region between the penis and the scrotum to access the corpora cavernosa.
- Positioning of the cylinders: After accessing the corpora cavernosa, the surgeon inserts the cylinders of the penile implant, components responsible for penile rigidity.
- Reservoir (when inflatable): In the three-piece inflatable penile implant, the reservoir that stores saline is implanted in the lower abdomen, remaining internal and not visible.
- Scrotal pump: In the inflatable penile implant, the pump is implanted in the scrotal sac. This component allows normal saline to move from the reservoir to the cylinders to produce an erection and to empty the system after sexual activity.
How long does the surgery last?
Penile implant surgery usually lasts between 60 and 120 minutes, depending on the type of implant, the technique used and the complexity of the case.
Revision procedures and surgeries in patients with penile fibrosis may take longer.
Length of hospital stay
The hospital stay after surgery is usually 24 hours, provided the patient has a good clinical recovery, can urinate adequately and with satisfactory pain control.
This period may be extended in situations such as urinary retention, pain that is difficult to control, bleeding, signs of infection, problems with anesthesia or when the patient has a comorbidity that requires a longer period of monitoring.
How to prepare for surgery? Step by step
1) Clinical assessment
Clinical assessment before surgery is important to choose the most suitable type of penile implant and the surgical strategy.
At this stage, the urologist analyzes the patient’s medical history, to identify the presence of preexisting conditions, ongoing medications, previous surgeries, and the cause of the erectile dysfunction or impairment of penile function.
A physical examination is also performed, and laboratory and cardiac tests may be requested to determine whether the patient is in suitable condition to undergo the procedure.
In addition, the evaluation consultation is an opportunity the patient has to clarify any doubts.
2) Preoperative tests
The preoperative tests allow identification and correction of conditions that can increase the risk of complications during or after the procedure.
These tests usually vary according to the patient’s age and health status, but generally include:
- Penile measurement: assesses penile anatomy and helps in choosing the type of penile implant.
- Palpation: allows identification of deformities, areas of fibrosis and other changes that may influence surgical planning.
- Pharmacologically induced erection: erection induced by a medication, intended to assess the presence of alterations in penile anatomy, which is especially important in patients with Peyronie’s disease.
- Rigidity test: verifies the quality of the erection and helps assess the degree of erectile function.
- Penile Doppler: imaging test that evaluates penile blood flow, helping to identify vascular causes of erectile dysfunction.
3) Medications that may need to be discontinued
Some medications may need to be temporarily discontinued or adjusted to reduce the risk of bleeding during and after surgery and other complications.
The anticoagulants and some medications for diabetes are examples that require assessment by the physician responsible for treating the underlying condition, to determine what adjustment will be necessary.
It is important to remember that the patient should never stop taking medications or make substitutions on their own.
4) Fasting and instructions on the day of surgery
The fasting instructions should be defined by the anesthesia team and may differ between solid foods and clear liquids. The patient must strictly follow the individualized instructions received before surgery.
In addition, the patient needs to sleep well, clean the genital area with antibacterial soap, and not shave the pubic hair, because this will be done by the physician in the operating room.
Another instruction for the day of surgery is to bring the preoperative tests.
5) Psychological preparation and expectations
Preparation for penile implant surgery also includes psychological counseling.
In this preparation, the urologist answers questions about how it works, the recovery period, the expected outcomes, and possible limitations of the penile implant.
This counseling is essential for reducing preoperative anxiety and aligning expectations, because some men may believe that the device increases penis size, whereas its purpose is to restore erectile function.
What is the postoperative course of penile implant surgery?
First 24 hours
- Follow-up appointment.
- Keep the dressing and follow the instructions on hygiene
- Avoid physical exertion and sudden movements.
First week
- Full-body bath the following day.
- Clean the dressing according to medical guidance.
- Relative rest, avoiding lifting heavy objects and strenuous activities.
First four weeks
- Gradually resume daily activities, as cleared by the urologist.
- Avoid strenuous physical exercise and sexual intercourse.
Activation of the penile implant
- In the inflatable penile implant, pump activation usually occurs between the fourth and sixth week after surgery, according to medical evaluation.
- The patient receives training to learn to inflate and deflate the penile implant before returning to sexual activity.
Adaptation to the penile implant
- Physical and emotional adaptation occurs gradually
- With clinical guidance and appropriate training, many patients can learn to handle the penile implant. Resumption of sexual activity depends on recovery, the type of device, and the medical assessment in each case.
When can I return to activities?
Work
Administrative activities or those requiring little physical effort are usually allowed between 7 and 14 days . The minimum time to resume activities that require intense physical exertion is between 4 and 6 weeks.
Physical exercise
Light walks may be allowed by the doctor after surgery, if the patient is in good clinical condition.
Higher-intensity exercises, such as weight training, are usually allowed between 4 and 6 weeks.
Driving
Generally, the patient can return to driving between 1 and 2 weeks, provided the patient is free of pain, is not using medications that impair reflexes, and can perform the movements safely.
In selected cases, penile implant surgery aims to restore erectile function and may have a positive effect on quality of life.
Sexual activity
Return to sexual activity is permitted between 4 and 6 weeks, after incision healing and, for inflatable penile implants, after activation of the device and training to learn how to inflate and deflate the implant.
What symptoms are expected during recovery?
Pain
It is common to feel some pain in the first weeks and the symptom is controlled with medications prescribed by the urologist.
Intense or progressively worsening postoperative pain should be reported to the physician to investigate the causes and begin treatment.
Edema
Swelling of the penis and scrotum is expected in the first days and tends to decrease gradually. Very marked swelling or swelling associated with redness should be evaluated.
Hematomas
Small purple spots may appear after penile implant surgery and disappear spontaneously. Cases of extensive hematomas require medical evaluation.
Sensitivity
Temporary changes in penile sensitivity are expected during recovery after a penile implant and usually improve over time. If this change in sensitivity persists it should be reported to the doctor.
Healing process
During the healing process it is common to notice slight tissue hardening and mild redness. However, if there is discharge, severe pain, fever or opening of the stitches, you should seek medical attention immediately.
What complications can occur?
Although complications may not occur in most cases, they remain possible risks of the procedure. Preoperative information should address the risks, preventive measures and the need for follow-up, according to each patient’s characteristics.
The most common include:
Infection
Infections are one of the most common complications, generally associated with contamination in the postoperative period.
Redness, severe pain, swelling, fever, and discharge are signs indicating the presence of infection and should be reported to the physician immediately.
Bleeding
Heavy bleeding may indicate a complication that requires immediate evaluation to prevent more serious problems.
Mechanical failure
Mechanical failures can occur over the years due to wear of the components of the penile implant, or due to improper handling.
Regardless of the cause of the failure, the urologist evaluates the need for revision or replacement of the penile implant.
Erosion
Erosion occurs when a component of the penile implant exerts pressure on the tissues and protrudes partially or completely outward. It is a complication that requires urgent medical evaluation to determine the appropriate management and reduce the risk of additional damage.
Persistent pain
Discomfort and some pain are expected in the postoperative period after a penile implant. However, persistent pain after the recovery period may be a sign of infection, erosion, or displacement of the implant.
What changes after surgery?
Erection
The penile implant replaces the physiological mechanism of erection.
To obtain penile rigidity it is necessary to position the implant upward, in the case of the malleable penile implant. In the inflatable penile implant, the erection is achieved by activating the scrotal pump.
Orgasm
The placement of a penile implant is not intended to directly treat orgasm. Sexual response may vary depending on physical, psychological, neurological, hormonal, and relational factors, which should be considered in the individual assessment.
Ejaculation
The penile implant is not designed to directly alter ejaculation. However, ejaculatory function may depend on preexisting clinical conditions, prior surgeries, and other individual factors, which should be clarified during the evaluation.
Fertility
The penile implant is not designed to treat fertility. The possibility of fathering a child depends on individual factors, including sperm production, ejaculation, prior surgeries and other clinical conditions. Patients with reproductive concerns should receive individualized counseling before the procedure.
When to see a urologist?
See a urologist for severe pain, redness, swelling, fever and discharge.
Medical evaluation is important to assess the causes of complications from penile implant surgery and to treat them appropriately.
Fill out the pre-assessment form to schedule your appointment with Dr. Paulo Egydio, a penile implant specialist.
Learn more:
- Penile enlargement with a penile implant
- Type of anesthesia and duration of penile implant surgery
- Types of inflatable penile implant: choosing the most suitable model
- Sex with a penile implant
- Penile implant price: current costs
- Erectile dysfunction and the penile implant: questions and treatments
