Is there a best age for a penile implant?
Neither the European nor the American guideline sets an age limit or an ideal age for a penile implant. Candidacy rests on whether other treatments have worked and on the man's preference. Age still shapes the discussion, because 76.8% of implants are still working at ten years and 52.9% at twenty, so a younger man is more likely to need a replacement.
What decides whether a man is a candidate for a penile implant?
The European guideline makes a strong recommendation for an implant when other treatments for erectile dysfunction fail or when the patient prefers it. The American guideline states that every man with erectile dysfunction should be told about the implant option, and that a man may reasonably begin with any treatment, however invasive.
Neither guideline lists age among its criteria. Implants have been used successfully in the general population and in many special groups of patients, and the decision is shared between the man, his partner where relevant, and the clinician.
How does age affect the long-term picture?
A meta-analysis found that 87.2% of implants were still working at five years, 76.8% at ten years, 63.7% at fifteen years and 52.9% at twenty years. A man who has an implant at a younger age therefore lives longer with the device and is more likely to need a further operation at some point.
When an implant is replaced, the operation can be more complex. After an infected device is removed, a delayed replacement carries a higher chance of penile shortening, a change in shape and loss of sensation.
Are there different options for younger men?
Erectile dysfunction is not limited to older men. In one study of men seeking help for new erectile dysfunction, one in four was younger than 40, and almost half of these young men had severe erectile dysfunction.
"In young patients with pelvic or perineal trauma, surgical penile revascularisation has a 60-70% long-term success rate" Source 1, p. 56
Arterial surgery of this kind is considered only for young men with a focal blockage of the pelvic or penile arteries and without widespread vascular disease or a leak in the veins of the penis. Surgery on the penile veins is not recommended, because its long-term results are poor.
How common is erectile dysfunction at different ages?
In a German study of men aged 30 to 80, the prevalence of erectile dysfunction was 19.2%, rising steeply with age from 2.3% to 53.4%. Because the condition becomes more common with age, many men considering an implant are older, but age alone does not change the guideline criteria. Erectile dysfunction is also linked with risk factors that build up over time, such as diabetes, high blood pressure and heart disease.
Satisfaction is high among implant patients in general, at 92% to 100% in men and 91% to 95% in partners, with appropriate counselling.