Inflatable Penile Prosthesis for ED
Erectile dysfunction is extremely common as a man ages, and age related erectile dysfunction is almost always a progressive problem. At its earlier stages, PDE-5 inhibitors such as Viagra, Levitra, Stendra or Cialis will suffice. But as the problem progresses and becomes more severe, eventually these pills will no longer be reliable or work at all. When this occurs, and if a man retains the desire and motivation to have a usable erection, he must resort to more aggressive therapy. In our practice, the next step would be to learn injections into the penis with medicine that dilates arteries, or to use a vacuum erection device.
Shots for erections have been around for many years, and they are very effective. Vacuum erection devices have also been helpful. But for many men, even though they are willing to use one of these approaches, it simply is not a satisfactory solution. For these men, we offer to place a penile prosthesis. We usually will not consider someone for this surgery unless they have tried these other approaches first. But, for the right patient, an inflatable penile prosthesis can provide the highest degree of patient satisfaction of any modality.
An inflatable penile prosthesis is a hydraulic system that must be implanted surgically. We most commonly use the American Medical Systems (AMS) model 700, which is a three piece system. It consists of two cylinders which will fill the natural cylinders (corporal bodies) in the penis, a pump that will be located in the scrotum, and a water balloon, or reservoir, which is typically implanted behind the pubic bone. It is entirely internal, and inflates and deflates. The video below demonstrates how it would be inflated by the patient. In essence, when a man wants an erection, he pumps the pump in the scrotum approximately ten times. The pump forces water into the two implanted cylinders which then become rigid. The erection will have the same sensation as one would otherwise have, and the orgasm is unaffected. When finished, a button located on the side of the pump is pressed which allows the water in the cylinders to go back to the reservoir.
Unlike other methods used to achieve an erection, implanting an inflatable penile prosthesis (IPP) is surgery. There can be discomfort after surgery for up to four to six weeks, but after that it is ready to use. The procedure is typically done in a hospital, can be done as an outpatient, and the patient will likely miss a few days of work.
Risks of Inflatable Penile Prosthesis
The main complications seen with this procedure would be infection of any part of the system, which would require removal of the system, erosion of the corporal bodies, or mechanical malfunction which may occur up to 10% of the time over perhaps 10 years of usage. Implanting an IPP is a common procedure among insulin dependent diabetics. These patients may be asked to show that they can keep their hemoglobin A1c levels within a reasonable range prior to surgery in order to minimize infection. Other prophylactic measures that we employ are the extensive use of pre-operative antibiotics and showering twice a day on the days preceding the implant.