Penile implant – effectiveness and high patient satisfaction
Penile implants are an effective solution for patients struggling with erectile dysfunction, especially those for whom previous treatments have proven ineffective. Due to the risks of surgical treatment and irreversible results, this is the third and final line of therapy. However, it is worth noting that it has a very high patient satisfaction rate:
Patient satisfaction with hydraulic implants
Patient satisfaction with semi-rigid implants
No other method of treating erectile dysfunction achieves such high levels of satisfaction.
Accurate diagnosis and cooperation with the patient
Due to the fact that erectile dysfunction can have various causes, qualification for surgical treatment must be based on a thorough assessment of the patient’s condition.
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Basic diagnostics
Thorough assessment of clinical and mental condition, as well as a sexological interview, physical examinations and laboratory tests.
Supplementary diagnostics
Includes, for example, assessment of nocturnal physiological erections, colour Doppler examination of the penis during pharmacological erection, cavernosometry, cavernosography, selective angiography, etc. It is not absolutely necessary before surgery – it is recommended rather to dispel diagnostic doubts or in complicated cases.
The decision on the purpose and methods of further treatment is made by the patient together with the attending physician and, if applicable, the partner – so that the chosen option best meets the man’s expectations.
Experience in numbers – penile implants in the practice of Dr Anna Bonder-Nowicka
Thanks to her extensive surgical experience and international internships, Dr Anna Bonder-Nowicka is a recognised specialist in the field of penile implants.
Penile implants: benefits, limitations and potential complications
Penile implants are not new – they have been used in the USA since the 1970s, although they had their drawbacks and limitations. Nowadays, they are used more and more often due to the enormous technological progress of recent years, which has made the currently implanted devices safe, durable, reliable and much more resistant to infection. It is estimated that the vast majority of implants currently implanted will function flawlessly for over 20 years.
The most important thing in the decision-making process regarding surgical treatment is to have realistic expectations! After the operation, natural, spontaneous or pharmacologically or mechanically assisted erections will not be possible – an erection can only occur thanks to the implant. Implantation may cause a slight shortening of the penis, scarring or bending. No implant will make the penis bigger! Its final length will be the same as it was on the day of the operation.
Patients with diabetes, spinal cord injuries and reduced immune response are particularly vulnerable to infectious complications, so they will often require additional preparation before surgery. If the implant becomes infected, damaged or moves outside the corpora cavernosa, it will need to be removed. Replacement of the implant is usually possible and safe, but requires another procedure. Even after the best possible surgery, the patient may experience swelling, subcutaneous haemorrhages, discomfort, a feeling of pressure and pain – as after any implant procedure, e.g. dental. A full return to sexual activity will not happen immediately – it may take several weeks for the tissues to heal, for the implant to be activated, and for the patient to get used to the new situation.
Contraindications for implant placement include active urinary tract or genital skin infections and a previously confirmed allergy to antibiotics.
Semi-rigid and hydraulic penile implants
Penile implants are a solution for men with severe erectile dysfunction, allowing them to regain control over their sexual activity. There are two main types of implants available: semi-rigid and hydraulic, each with unique features and advantages. The choice of the right implant should be made in consultation with a doctor, taking into account the individual needs of the patient.
Semi-rigid implants
One option is a semi-rigid implant – usually a silver core covered with a hydrophilic coating. It has several advantages, including low cost, ease of use for patients with reduced hand function, and an extremely low risk of mechanical damage and infection. Its operation is as simple as possible because the penis is rigid and elongated at all times. To have intercourse, all you need to do is straighten it. However, for this very reason, it is not suitable for patients with a short penis – it is difficult to fold it so that it is not noticeable under clothing. The disadvantages of a semi-rigid implant also include the risk of chronic pain and possible erosion (i.e. the implant piercing through the skin), which mainly occurs in patients with spinal cord injuries.
Hydraulic implants
Hydraulic implants enable erections by filling them with fluid. The fluid can come from a separate reservoir (three-piece implant) or from a small reservoir placed in the scrotum (two-piece implant). The latter are currently used to a limited extent because they do not expand in circumference like three-piece implants and, moreover, their design does not provide men with sufficient rigidity. All these needs are met by the three-piece hydraulic implant, which is the most popular choice worldwide. It consists of an expandable implant, a fluid reservoir placed in the abdomen and a pump implanted in the scrotum. Between the components of the system there are valves that prevent spontaneous filling – it remains under the complete control of the man. The implant is made of durable materials that allow the penis to lengthen and widen in circumference when activated, thus the risk of penis shortening after surgery is very low.
The course of the operation and return to sexual activity
The implant is inserted through surgery – an anaesthesiologist consultation will be necessary before general anaesthesia, and a consultation with the attending cardiologist or imaging tests of the urinary tract may also be required. It will be necessary to perform the recommended laboratory tests and provide documentation of previous surgical/oncological treatment. If a urinary tract infection is suspected, it must be treated in advance.
Immediately before the operation, prophylactic antibiotics will be administered by intravenous drip. The operation is performed under general anaesthesia and usually lasts 60-90 minutes. After waking up, the patient is taken to the recovery room where their condition is closely monitored and painkillers and anti-infective drugs are administered. After several hours, the drain can usually be safely removed and the patient can be discharged home. At this stage, the implant is inactive.
Only after 3-4 weeks, when the tissues have healed, is the implant activated – this is done by the doctor during a follow-up visit. From this point on, the patient activates the implant daily for another 3 weeks (so that the tissues expand) and can gradually return to full sexual activity.
Patients with implants do not need to worry about undergoing magnetic resonance imaging or passing through metal detectors – they are completely safe. After the implant is inserted, the patient can remain sexually active for as long as he wishes, regardless of the circumstances that originally caused severe erectile dysfunction. His sensations will be the same, he may even ejaculate and become a father (if his prostate has not been removed or his sympathetic nerves damaged). He does not need to take medication in advance or measure the time needed for it to take effect. He does not need (and cannot!) give himself injections or use pumps. When he wants to have sex, he can simply activate the implant and focus solely on feeling pleasure.
