Penile prosthesis revision or maintenance may be necessary when the device loses effectiveness, whether due to mechanical failure or wear associated with the passage of time.
Before undergoing surgery to place a penile prosthesis, a man may wonder whether the benefits will be long-lasting, since no one wants to undergo surgical interventions frequently. This assessment can contribute to a safer, more informed decision.
Although it is an effective treatment, the penile prosthesis can indeed require revision or maintenance over time. Still, it is not possible to determine how long the treatment will be effective in each case.
The need for revision or maintenance of the prosthesis depends on the type of device implanted, since each model is associated with a specific failure rate. The type of surgery performed and proper handling of the prosthesis are also relevant factors.
Below, clear up your questions about the topic.
When Is Penile Prosthesis Revision Needed?
Maintenance or penile prosthesis revision can be considered when the device stops functioning as expected, after urological evaluation of the cause and the patient’s clinical conditions.
Pain or lack of rigidity during erection are reasons to evaluate the situation.
How long does a penile prosthesis last?
In general, penile prostheses last many years without any problems. It is more common for surgeries performed longer ago to require revisions, but in rare cases, during the first sexual experiences after surgery, the man may already notice that something is wrong.
Durability of the inflatable penile prosthesis
According to a systematic review with meta-analysis published in the journal Urology in 2022, involving 20,161 patients, the median device survival time is approximately 20 years, with:
- 5 years after implantation, the device was still effective in 87.2% of cases;
- 20 years after implantation, the device was still effective in 52.9% of cases.
Durability of the malleable or semirigid penile prosthesis (malleable)
The malleable or semirigid penile prosthesis is generally more durable than the inflatable penile prosthesis over time.
In a 2020 literature review published in the Journal of Visualized Surgery, the researchers concluded that:
- Five years after implantation, the malleable or semirigid penile prosthesis remained functional in 88.8% of cases.
- Ten years after implantation, it remained functional in 84.3% of cases.
It is important to emphasize that, despite the risk of replacement over time, both the inflatable penile prosthesis and the malleable or semirigid penile prosthesis continue to be a recommended treatment in selected cases, including refractory erectile dysfunction and Peyronie’s disease.
Factors that influence the durability of the penile prosthesis
The need for penile prosthesis revision or maintenance depends mainly on the implanted model. Inflatable penile prostheses are more likely to require revision or replacement for mechanical failure than malleable or semirigid models.
Also influencing durability are the quality of the implant materials, the type of surgery performed, the anatomical characteristics of the patient’s penis, and daily usage habits.
Model and material quality
In the malleable or semirigid penile prosthesis, materials are designed to withstand repeated mechanical stress: the core may include durable metal alloys such as Nitinol, silver or stainless steel, while the silicone coating contributes to greater anatomical comfort.
The design of malleable or semirigid models aims to allow positioning of the device during usual use. Durability and performance may vary according to the model, implant characteristics, clinical conditions and manner of use. When study data are presented, they should be accompanied by the appropriate reference and interpreted in the context of the populations evaluated, without extrapolation to all cases.
By contrast, the inflatable penile prosthesis is manufactured with high-strength silicone, and its components (scrotal pump, reservoir and cylinders) are designed for continuous use but, due to its complexity, may present mechanical failures, pump blockage or saline leakage.
Both types of prostheses may include antimicrobial coatings aimed at reducing the risk of infection, one of the main causes of early implant replacement.
Type of surgery
There are different approaches to placing the penile prosthesis. In some cases, the penile implant is performed in isolation. However, when there is curvature, thinning or associated deformity, such as in Peyronie’s disease, penile reconstruction may need to be performed beforehand.
Surgery with penile reconstruction is not limited to placing the prosthesis. The technique aims to address deformities that can compromise penile rigidity and alignment.
Therefore, it is important that the procedure be evaluated by an experienced surgeon. This expertise allows determining when the patient requires an associated reconstructive approach, according to each anatomy and the treatment objectives.
The surgeon’s experience is also important for postoperative follow-up and for guidance related to the device and sexual activity.
Patient anatomy
Penile anatomy is one of the elements considered when planning the implant and defining the surgical strategy, always according to the individualized assessment of the patient.
In cases of longer penises, for example, it is necessary to use prostheses with a compatible diameter, because very thin cylinders may not be sufficiently firm, which increases the risk of buckling during sexual intercourse.
When the penis is thin and cannot accommodate an implant with a larger diameter, penile reconstruction may be indicated.
This procedure is performed with relaxing incisions in the tunica albuginea, the inner layer of the penis. The incisions relax the tissue, allowing the penis to expand to accommodate a wider penile prosthesis.
Patient habits
Usage and care habits can also influence the need for maintenance of the penile prosthesis.
In the case of the malleable or semirigid penile prosthesis, the way the patient positions the penis inside their underwear or the position they sleep in can affect the device’s integrity over time. Ideally the penis should be positioned to the side or downward, and the patient should avoid sleeping on their stomach.
With an inflatable penile prosthesis, applying excessive force to operate the pump or to handle the cylinders can accelerate wear of the components.
When to seek urological evaluation for penile prosthesis revision or maintenance
Although not very common, the penile prosthesis can fail.
Whenever there are signs that the penile prosthesis has stopped functioning as expected, it is important to seek specialist evaluation. In some cases, surgical revision or replacement of the prosthesis may be necessary, depending on the type of implant and the cause of the problem.
Evaluation of changes in the functioning of a penile prosthesis should be performed by a qualified urologist, who can assess the device, the presenting symptoms, and the appropriate follow-up or treatment options for each case.
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