About Penile Implants
Indications for Penile Implant Surgery
Types of penile implants | Semi-rigid penile implants
Inflatable penile implant – Three piece
Hybrid penile implants
About the inflatable penile implant
How does a penile implant get inserted?
After penile implant surgery, how does the penis and scrotum look and feel?
What makes a good candidate for internal penile pump?
Penile prosthesis innovations and advancements
Life expectancy of penile implants
About penile implants by Dr. Larish
Dr. Larish is an expert in penile implant surgery. He performs more penile implant surgeries than almost all general urologists. Penile implant surgery is a very precise procedure that requires the expertise and experience of a surgeon that is only acquired after performing many procedures.
Prior to private practice, Dr. Larish trained under the supervision of the most experienced penile implant surgeons in the field. He has taken this training to a higher level by combining all the skills he learned from multiple surgeons, and has developed his own unique surgical skills, which have been even further perfected through extensive experience in the operating room. In addition to his extensive experience and training, he stays on top of all the new, exciting developments and technology that has advanced penile implant surgery after he completed his training and continue to improve with research.
In addition to the experience of Dr. Larish, the experience of his operating room team is very important. Dr. Larish uses the same team of technicians and nurses when he performs penile implant surgery. This precise procedure requires the expertise of the whole team who have made it their routine in order to reduce the chances for infection and complications. It has been shown that reducing operating time also reduces the chance of infection. Whenever any foreign body is implanted into the human body there is a higher risk for infection. Dr. Larish’s and his team have the experience necessary to make the implant procedure go as fast and as smoothly as possible in order to reduce infection risk.
Another, less obvious advantage of performing so many penile implant procedures by Dr. Larish is the surgical instruments used. There are specialized and specific instruments that are only used for the penile implant procedure. These expensive instruments are not purchased and maintained by most operating rooms. Due to the high volume of surgery performed by Dr. Larish, it is cost effective for him to have his own set of instruments that are only used for his procedures.
Indications for Penile Implant Surgery
Impotence, or erectile dysfunction, can be treated with penile implant surgery. There are also other non-invasive treatments that your doctor will discuss prior to implant surgery. Through modern research and development, the implant procedure has become a safe and effective way to help patients realize that the can continue to have a fulfilling, sexually active life, even as they get older or suffer from medical conditions that lead to impotence.
There are many reasons men can become impotent and unable to gain, or maintain an erection including vascular disease (due to high blood pressure, diabetes, high cholesterol, heart disease, smoking, etc.), as a result of surgery (for prostate cancer, bladder cancer, colon cancer, etc.), obesity, congenital diseases (metabolic syndrome, Parkinson’s, multiple sclerosis), Peyronie’s disease, psychological disorders, and others.
After a thorough history and examination, we can assess whether or not a patient is a good candidate for penile implant surgery.
Types of penile implants
There are many types of penile implants available. Dr. Larish performs surgery with semi-rigid, inflatable and hybrid penile implants. In order to achieve the best results, Dr. Larish will conduct a detailed history and physical and relies on his vast experience, as well as listening to the concerns of his patients, to choose which type of implant will provide the best patient satisfaction. Dr. Larish will always discuss which type of implant he recommends and why during your preoperative consultation.
There are many variables to consider to find the best implant type. Some of these variables include: overall penis length and circumference, ratio of penis size to the various dimensions of the penis, ratio of penis size to scrotum, patient age, partner’s opinion and concerns, penis shape, previous penile surgery, penile deformities, erectile dysfunction etiology, and the overall medical state of the patient.
Some decision making about penile implants occurs in the operating room, after the surgery has begun. Dr. Larish takes very specific measurements prior to the final decision on which implant and what sizes to use. He will always discuss these decisions with the patient prior to surgery at their preoperative consultation.
Semi-rigid penile implants
The semi-rigid malleable penile implant is the simplest and least expensive penile implant currently available. It consists of two rods that are surgically implanted inside of the penis. These rods are coated with a smooth outer coating. They consist of a series of positionable segments that can be repositioned easily with manipulation.
The result of this implant is that the penis is permanently erect and bent downwards close to the body for concealment. When sexual activity is desired, the penis can be straightened and moved upwards. After sexual activity, it is again bent down and in close to the body.
Advantages so the semi-rigid implant include that it is the least expensive and the simplest implant procedure. The surgery can be done as an outpatient procedure and has the easiest and least complicated recovery period. Erection spontaneity is the easiest as there is no waiting time for the penis to become erect.
Precautions of the semi-rigid implant include that the penis remains erect at all times. The erection may be hard to conceal in certain clothing, especially tight clothing. The implant does not alter or enhance the width or length of the penis. Although the semi-rigid implant is the simplest and has the least complicated recovery period, like all surgery, it is not without risk of complications. Dr. Larish always discusses possible risks in his preoperative visit.
Inflatable penile implant – Three piece
The inflatable penile implant consists of two hollow tubes that are surgically inserted inside the penis. A small pump used to inflate the device that is inserted inside the scrotum. A reservoir that holds the fluid is inserted into the abdomen. The implant is inflated with fluid that is transferred from the reservoir in the abdomen into the hollow calendars inside the penis to create an erection. This is achieved by a compressing the pump in the scrotum several times. After sexual activity is concluded, the fluid is transferred back into the reservoir to allow the erection to go down.
Advantages of the inflatable penile implant include it allows the penis to be erect when sexually activity is desired, and flaccid at all other times. This ensures a more natural appearance to the penis when the implant is not in use. The inflatable implant also produces a more natural looking and feeling erection. There is very little waiting time as the cylinders fill up rapidly producing an erection once the pump is activated.
Inflatable penile implants come in two and three-piece configurations. The difference is the location of the reservoir where the fluid is maintained that will be pumped into the cylinders within the penis.
In the two piece configuration, the reservoir and pump are located together in the scrotum. In the three piece, the pump is in the scrotum and the reservoir is in the abdomen. Dr. Larish prefers the three-piece configuration as it has many advantages over the two piece.
The two piece has much less fluid in the combined pump and reservoir that creates a less rigid erection than allowed by the more fluid within the separate reservoir of the three piece. The pump in the two piece is smaller and more difficult to activate, especially in older individuals with hand arthritis. The three piece pump is larger and softer allowing it to inflate much easier. The three piece configuration also produces a much more natural looking and feeling erection. It is the only prosthesis that gives the penis a normal look and feel when both erect and flaccid. The two piece configuration produces an unnatural shape which gives the erect penis an abnormal appearance.
Hybrid penile implants
The Hybrid penile implant consists of two pre-filled cylinders that eliminate the need for a separate reservoir. The pump is also implanted into the scrotum. When sexual activity is desired, squeezing the pump causes the two pre-filled cylinders to expand in girth and produce a natural looking rigid erection. When sexual activity has concluded, the cylinders deflate and the erection goes down.
Advantages of the hybrid penile implant include it allows the penis to be erect when sexually activity is desired, and flaccid at all other times. This ensures a more natural appearance to the penis when the implant is not in use. The hybrid implant also produces a more natural looking and feeling erection. There is very little waiting time as the calendars fill up rapidly producing an erection once the pump is activated. The separate reservoir is eliminated making the surgery easier for the surgeon, and for the recovery, than the inflatable implant with a separate reservoir. This also is an advantage for patients whom have previous surgery of the abdomen or scrotum with scar tissue present.
About the inflatable penile implant
The inflatable penile implant consists of three components; the penile tubes, the reservoir, and the pump. While flaccid the fluid is stored in the reservoir. When an erection is desired, the pump is squeezed several times. This transfers the fluid from the reservoir into the penile tubes. The tubes enlarge and harden producing a rigid, erect penis. When sexual activity is concluded, the fluid is allowed to return from the penile tubes into the reservoir and the erection goes down.
There are many advantages of the inflatable penile implant. The inflatable penile implant has been in use and improved upon for the previous four decades. They last 10-15 years and are easy to replace when they fail. There is very high patient satisfaction with inflatable penile implants reported by patients and their spouses. The flacid and erect penis looks and feels natural. The penis performs naturally when in the erect state. The pump, reservoir and tubes are completely concealed within the body and virtually non-detectable eliminating self-consciousness and may not require disclosure if one decides not to divulge to a partner. The inflatable penile implant allows for spontaneous sexual activity with very little time required to inflate to achieve an erection. The procedure is safe and effective. It is covered by many insurance plans for the treatment of erectile dysfunction.
Additional benefits of the inflatable penile implant include the ability to make an erect penis longer and have increased width than prior to the implant surgery. Often men experience shortening and narrowing of the penis as a result of vascular disease, Peyronie’s disease, and surgery for cancer. The inflatable penile implant restores or even increase the penis size as compared to before implant surgery.
For men that experience premature ejaculation, the penile implant induced erection can be maintained after ejaculation, for as long as desired, in order to enhance the sexual experience of their partner.
How does a penile implant get inserted?
The penile implant surgery is performed in a hospital or surgery center setting. This is an outpatient procedure allowing the patient to go home the same day and not stay overnight in a hospital.
The procedure can be performed under local, epidural, spinal or epidural anesthesia depending on the patient and the decision of the surgeon and anesthesiologist.
The implant is inserted through a small incision in the scrotum. The incision is about an inch long in the center of the scrotum. The skin on the shaft of the penis is not incised like in previous older surgeries making recover easier and less painful. There scars are concealed in the scrotum below the penis allowing the best cosmetic outcome.
After penile implant surgery, how does the penis and scrotum look and feel?
There scars are concealed in the scrotum below the penis allowing the best cosmetic outcome. Most men report that they are completely unaware of the device components inside the penis, scrotum and abdomen. The penis looks natural both when flaccid and erect and the implant is completely concealed from view.
What makes a good candidate for internal penile pump?
All men whom suffer from erectile dysfunction due a physical problem and whom do not respond to well to less invasive erectile dysfunction treatments are candidates. This includes men that are tired of taking medications or have limited or inferior response to non-invasive treatments.
Candidates that suffer from physical conditions that cause permanent erectile dysfunction include penile atrophy, penile deformity, impotence due to vascular disease and complications of prior urological surgery.
Penile prosthesis innovations and advancements
Development in the technology of penile implant devices undergoes continuous advancement. There are multiple companies that produce the implant devices. These companies spend a significant amount of money and time doing research and development in order to advance the most recent generation of penile implants. Dr. Larish continually reads the latest literature on the subject of penile implants. He stays on top of all the recent developments and is helped by being involved with urology residents and their education. He is also continually educated by, and works close with the companies that produce the implant devices.
Life expectancy of penile implants
Like all mechanical devices, materials succumb to wear and tear and eventual material failure. It is difficult to predict the exact life expectancy of a penile implant, but based on experience, we like to say an implant put in today will likely last 10-15 years. There are patients in our practice that have implants that still function after 20 years. Of course, the wear and tear is based on the amount of times used and the more often one engages in sexual activity, the more the parts are moved. Additionally, the larger the implant device the more the times the pump is required to be squeezed and the more wear and tear induced to the pump and tubes.
Fortunately, upon failure of the device it does not produce increased risk to the health of the patient. The failed implant can be removed and a new device can be inserted. Often the space is maintained in the shaft of the penis allowing for easy insertion of the tubes resulting in less postoperative discomfort than the original surgery. With that said, the replacement surgery does take a bit longer for the surgeon to perform due to scar tissue from the previous surgery. There are only slightly increased risk of infection and problems healing due to decreased vascular supply.
Thanks to the research and development of modern penile implants premature failure is very rare, although there have been cases of this happening.