Penile Implant Surgery

Every other treatment for this can be stopped. An implant closes the door behind it.

Tablets, injections and vacuum devices all leave the natural machinery intact, so a man can try one, abandon it and try another. Putting cylinders inside the erectile bodies replaces that machinery, so nothing that came before will work again afterward, which is the single most important sentence on this page and the one most often left out of the consultation.

The treatment that works, and the door that closes

An erection happens when two spongy cylinders running the length of the penis, the corpora cavernosa, fill with blood and stiffen inside their tough outer sheath. Tablets improve the signal that tells those cylinders to fill. Injections force the issue chemically. A vacuum device pulls blood in from outside. All three work on tissue that is still there, still capable, merely underperforming, and all three can be stopped tomorrow with nothing lost. An implant does something categorically different. The surgeon opens the sheath, dilates a channel through the spongy tissue along the whole length of each cylinder, and slides a device into the space, and that spongy tissue does not grow back, so removing the implant a year later leaves a man with neither the device nor the erections he had before it. Surgeons say this plainly among themselves and soften it for patients, which helps nobody. Understanding the trade beforehand is a choice. Discovering it afterward is a choice somebody made for you, and the difference shows up in every satisfaction study anybody has run.

None of that argues against the operation. It argues for arriving at it in the right order.

Men who reach an implant having exhausted tablets, injections and a vacuum device are overwhelmingly glad they did. Men who reach it in six weeks because a clinic offered a package and nobody mentioned injections write to somebody else two years later, and the difference lies entirely in what happened before the operation.

The words, the devices, and the plan of this page

Three device families exist and the vocabulary around them is worse than it needs to be. Here it is, once.

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Nothing on this page argues against the operation. It argues for arriving at it with the previous options genuinely tried, the length conversation genuinely had, and a surgeon who does enough of these to have opinions about the details.

Who this is actually for

Erectile dysfunction has a treatment ladder and an implant sits on the top rung, reached when the rungs below have been climbed and found wanting. Four groups arrive there regularly. Men whose nerves were divided or damaged during prostate surgery, where the tissue can no longer receive the signal whatever drug is given. Men with long standing diabetes, in whom the small vessels feeding the erectile bodies have failed, and men with severe Peyronie's disease, where scarring in the sheath bends the penis enough to prevent penetration. And men who respond to injections and cannot tolerate them, either because of pain, because of scarring at the injection sites, or because the ritual has become unbearable. Age on its own belongs on none of those lists. Fitness for an anesthetic and a clear head about what the device does matter, and the oldest man in a large implant series is routinely in his eighties while the youngest is in his twenties with a spinal injury.

Testosterone deserves a separate line. A man with genuinely low levels may respond to tablets that failed him before, and checking a morning blood test costs almost nothing compared with an operation that cannot be undone.

What the device does

The three piece device, in plain terms

Two cylinders lie inside the erectile bodies, running from just behind the head of the penis back to the bones of the pelvis. A small pump sits loose in the scrotum alongside the testes, where a man can find it with two fingers, while a reservoir of sterile fluid sits in the abdomen behind the pubic bone or in a space beside the bladder. Squeezing the pump a dozen times moves fluid from reservoir to cylinders and produces an erection that is firmer than a natural one and stays until it is released. Pressing a release valve on the pump sends the fluid back, and the penis returns to a soft state that looks and feels close to normal. None of this is visible from outside, no partner feels the mechanism, and airport security detects nothing. Fluid volumes run to around sixty five milliliters in a standard adult device, the pump takes roughly a dozen squeezes to fill the cylinders, and releasing takes one press held for a few seconds.

Choosing between the three

Most men who can have a three piece device should have one, and most surgeons will say so without being asked. The flaccid appearance is better, the erect state is firmer, and the mechanism is the closest thing available to switching between two normal states, so the other two exist for specific reasons and not as budget alternatives, which means a clinic that steers everybody toward the simplest device is telling you something worth hearing.

• Ask which device the surgeon implants most often, since familiarity with one system matters more than the badge on the box.
• Ask whether the cylinders come with an antibiotic or hydrophilic coating, which is now standard and worth confirming.
• Ask where the reservoir will sit, because after prostate or bladder surgery the usual space behind the pubic bone may no longer exist.
• Ask for the device name, the model and the serial number to be written on your discharge paperwork, since you will need them years later.

The operation itself

One incision does the whole job in most hands, placed either at the top of the scrotum where it meets the penis or in the crease below the pubic hair. Through it the surgeon opens each erectile body along a short line, dilates the channel inside with graduated instruments, measures the length from the pelvic bone to the tip with a device made for the purpose, and slides in a cylinder of that exact length with a rear extender if needed. The pump goes into a pouch made in the scrotum. The reservoir goes up through the same wound into the abdomen. Everything gets connected, tested by inflating and deflating several times on the table, and left partly inflated or fully deflated depending on the surgeon's habit, with ninety minutes covering a straightforward case. Two details separate a careful operation from a hurried one. The first concerns how long the skin preparation runs, since the bacteria that cause implant infections live in the follicles and a ten minute scrub reaches more of them than a two minute one. The second concerns how few people walk in and out of the room while the device sits open on the table.

Measurement is where the difference between surgeons lives. A cylinder one size too short leaves the head of the penis unsupported and floppy when the device is inflated, which is the deformity men describe as the tip drooping, and a cylinder one size too long erodes. Neither is fixable with anything other than another operation.

Sizing carries the whole craft here.

Antibiotics run before the first cut and the skin is prepared for longer than most operations require. Nobody shaves the area the night before, since that raises infection rates, and hair removal happens in theater with clippers.

Length, and the expectation nobody sets

Ask any implant surgeon which complaint their unhappy patients bring and length comes first, ahead of pain, ahead of mechanics, ahead of everything, and for years this was written off as a misperception, on the grounds that the device fills the erectile bodies completely and therefore cannot make anything shorter. Measurement studies settled that argument in the other direction. A review of the literature on this concluded that the loss of length and girth after prosthesis surgery is real rather than imagined, and that inconsistent measuring in the earlier studies had masked it.

What can be done before the operation

Several units now put men on a stretching program before surgery, using a traction device or a vacuum pump daily for several weeks, on the theory that tissue which has been lengthened takes a longer cylinder. Evidence for this remains thin and the studies are small. It costs little, it does no harm, and a surgeon who offers it has at least noticed the problem.

And during it

Careful measurement with the erectile body fully dilated, generous use of rear tip extenders, and in selected cases a technique that releases the sheath to gain a centimeter, each of which belongs to the surgeon and not to the patient, and each of which is a reason the volume question further down matters.

What to ask for, in one sentence

Ask to be measured, stretched, at the consultation, and ask for that number to be written down, because a number on paper is the only thing that will settle a disagreement over length a year later.

How long a device lasts

Implants are mechanical objects with moving parts, sitting in a warm wet environment, operated a few times a week for decades. They wear out. The honest figures come from a multicenter group that tracked device survival after a first implantation and reported 96 percent still working at five years and 60 percent at fifteen.

Read the fifteen year figure as a plan rather than a warning. A man implanted at fifty five has better than even odds of needing a second operation before he is seventy, and knowing that in advance is entirely different from discovering it.

What actually breaks

Tubing connections and the cylinder walls, mostly, producing a slow fluid leak that a man notices as an erection that will not hold. Pumps fail less often. Reservoirs rarely fail at all. Across 214 revision operations at four institutions, 65 percent were for mechanical failure, 19 percent for erosion or infection, and 16 percent were performed on devices that worked perfectly, either because the man was dissatisfied, because the tip drooped, or because scarring meant the cylinders needed upsizing.

What happens when it fails

A failed device gets replaced, and the replacement operation goes better than men fear. In that same series of 214 revisions, 93 percent produced a working device again, and the infection rate after revision came to 5.7 percent among devices that had no infection to begin with, provided the surgical space was washed out during the operation. That washout protocol matters, since revision surgery used to carry a much worse reputation and the difference is procedural rather than mysterious.

Replacement runs easier than the first operation in one respect and harder in another. The channels already exist, so dilation is quicker, while scar tissue has formed a capsule around everything, which distorts the anatomy and hides the planes a surgeon works in. Average age at revision was 66.

Infection, and what is done about it

How often, and how it declares itself

Modern series report infection in roughly one to three percent of first implantations, and one series of 146 two piece devices had a single device removed for infection across nearly five years, which is 0.7 percent. Diabetes with poor control, a revision rather than a first operation, and spinal cord injury all raise the figure. Infection announces itself as pain that increases instead of settling after the first two weeks, redness over the pump, fever, or a device that becomes fixed to the skin above it, and any of those inside three months means same day contact with the surgeon who put it in.

Why it is not simply taken out

Removing an infected device and waiting six months for the inflammation to settle produces a penis full of dense scar, shortened by several centimeters, into which a second device is much harder to place. So the preferred approach is salvage, meaning the old device comes out, the space is washed with a sequence of solutions, and a new device goes in at the same sitting, while one refinement reported from a tertiary center takes this further by placing the replacement outside the fibrous capsule that formed around the infected device, in the plane between that capsule and the sheath. Among 20 cases referred with an infected implant or an eroding pump, that space was found in 18, and one of those 18 became reinfected, which is 5.6 percent. Developing the plane added around ten minutes to the operation. Ask any unit you are considering what their salvage policy is, and ask it before the operation rather than after a problem, since the answer tells you whether they have seen enough of these to have a policy at all.

Satisfaction, and who is not satisfied

Implants score higher on satisfaction than any other treatment for erectile dysfunction, which surprises people who assume a mechanical solution must feel like a compromise. In a series of 146 men followed for an average of three years, the 101 who returned questionnaires used the device an average of five times a month, 88.9 percent were still using it, 91 percent found it easy to operate, 95 percent had little or no difficulty learning, and 84 percent rated the rigidity good or excellent. Overall satisfaction reached 85 percent among patients and 76 percent among partners, and 86 percent said they would recommend the device or go through the operation again.

Bring your partner to the consultation if you have one. Partner satisfaction runs consistently below patient satisfaction in every series that measures both, and the gap narrows when the partner heard the explanation firsthand instead of secondhand.

After prostate surgery

The largest single group coming to implant surgery are men whose erections did not return after the prostate was removed for cancer. Reviews of this situation reach a blunt conclusion, which is that penile rehabilitation programs have largely failed to deliver what was hoped, that nerve grafting and artery preservation lack supporting evidence, and that nerve sparing at the original operation and a prosthesis afterward are the only two approaches that reliably determine whether a man has erections. The prosthesis is third line by convention and carries the highest satisfaction rate of any option.

Timing repays attention. Waiting two years to see whether nerves recover is reasonable, and waiting five years is not, because erectile tissue that has gone that long without full erections shortens and scars, which makes the operation harder and the result shorter. Count the months against that clock.

One practical point applies to this group alone. The usual space for the reservoir behind the pubic bone has often been disturbed by the prostate operation, so a surgeon may place it elsewhere or choose a two piece device, and that decision should be made before you arrive and not discovered in theater.

Send the old operation note. It answers the question in a sentence.

Curvature, and straightening it

Peyronie's disease lays down a plaque of scar in the sheath, and because scar does not stretch the penis bends toward it during an erection, so where the bend is severe and erections have also failed, one operation can address both. After the cylinders are in and inflated hard, the surgeon bends the penis firmly against the curve for a timed period, which cracks the plaque and straightens the shaft. Surgeons call the maneuver modeling, and it sounds alarming described in words.

What that comparison showed

Device survival at five years came out the same in both groups, and the straightening held without anybody needing a further operation to correct residual curve. Maximum follow up in that series exceeded twelve years. One nuance sat inside the numbers, which is that among the modeled cases the two devices then on the market behaved differently over the longer term, suggesting that modeling itself may stress certain designs more than others.

What follows for you

Tell the surgeon the curve exists before the operation is booked, and ask specifically whether they model, since a unit that does not will either leave the bend or add a separate grafting procedure with its own risks.

Recovery, week by week

Expect more discomfort than the size of the wound suggests, because the erectile bodies have been stretched from end to end and they object for two weeks. Swelling of the scrotum and the shaft peaks around day three and looks worse than anything that follows, while most men go home the same day or after one night and return to a desk inside two weeks.

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Living with it

Sensation is unchanged, because the nerves carrying it run in the skin and along the top of the penis, nowhere near the cylinders. Orgasm carries on unchanged. Ejaculation continues where it was present before and stays absent where prostate surgery had already removed it. The device alters nothing in testosterone, desire or fertility.

Practical things nobody mentions

Carry the device card in your wallet, because an unexplained firm penis on a scan confuses radiologists and an implant record settles it in seconds. Tell any surgeon operating on your abdomen or bladder that a reservoir sits in there. Tell a urologist before any catheter goes in. Airport scanners detect nothing. Magnetic resonance scanning is safe with current devices, though the model should be checked. And the pump takes a few weeks to find without looking, after which most men stop noticing it entirely.

Choosing a surgeon, and what to ask

Why volume matters here more than usual

Implant surgery has a long learning curve concentrated in judgment more than in dexterity. Sizing, reservoir placement, deciding when to abandon dilation in a scarred body, and knowing when to model a curve are all things a surgeon learns by doing many of them, and since infection rates and revision rates both fall with experience, the effect is large enough to outrank the choice of device brand.

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If you are traveling for this

1. Settle who manages a complication at home before you fly, and get that in writing rather than in conversation.
2. Stay long enough that the highest risk window has passed, which in practice means at least a week and preferably ten days or more.
3. Take the device card, the operation note and the implant stickers home with you on the day of discharge.
4. Arrange the device teaching session before you leave, since learning to use a pump over a video call is a poor substitute.

Having this done in Istanbul

Write to us with what you have already tried and for how long, because that history decides whether this operation is the right next step or whether something simpler has been missed, and a urologist reads it and replies, at no charge and with no obligation, quite often suggesting that injections be tried properly first.

1. Your full medication list, since blood pressure and prostate drugs both interact with this problem.
2. Which tablets you tried, at what dose, how many times, and what happened.
3. Whether injections were taught in a clinic or handed over as a prescription, and what dose was reached.
4. Any operation on the prostate, bladder or bowel, with the date and the operation note if you have it.
5. A recent morning testosterone result, or a note that nobody has checked one.

Our team works in English, Arabic, French, Russian, Serbian, Romanian and Spanish, with interpreting arranged for other languages on request, and one coordinator stays with you from the first message through to discharge and afterward on WhatsApp once you are home. A companion sleeps in your room on a bed we provide, hotel nights either side of the admission and every airport and clinic transfer are arranged for you, and an invitation letter for a visa application goes out roughly ten days before you fly. Meals come halal, vegetarian or adjusted for diabetes, and there is a prayer room on the ward floor. We publish no figures on this page, because the cost turns on which device is used, whether scarring makes the operation longer, and how many nights the ward keeps you, and none of that is knowable before a urologist has read your history. A price quoted before that point is a number chosen to win an inquiry.

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Penile implant surgery FAQ

Seven questions arrive in almost every first message we receive.

References

1. Henry GD, Donatucci CF, Conners W, Greenfield JM, Carson CC, Wilson SK, Delk J, Lentz AC, Cleves MA, Jennermann CJ, Kramer AC. An outcomes analysis of over 200 revision surgeries for penile prosthesis implantation. A multicenter study. Journal of Sexual Medicine. 2012;9(1):309-315.
2. Lux M, Reyes-Vallejo L, Morgentaler A, Levine LA. Outcomes and satisfaction rates for the redesigned 2-piece penile prosthesis. Journal of Urology. 2007;177(1):262-266.
3. Chang C, Wang R. A review on penile length and girth issues in penile prosthetic surgery. Current Urology Reports. 2021;22(3):16.
4. Shaeer O, Shaeer K, Soliman AbdelRahman IF. Salvage and extracapsular implantation for penile prosthesis infection or extrusion. Journal of Sexual Medicine. 2019;16(5):755-759.
5. Castiglione F, Ralph DJ, Muneer A. Surgical techniques for managing post-prostatectomy erectile dysfunction. Current Urology Reports. 2017;18(11):90.
6. Wilson SK, Cleves MA, Delk JR. Long-term followup of treatment for Peyronie's disease. Modeling the penis over an inflatable penile prosthesis. Journal of Urology. 2001;165(3):825-829.