Penile implants explained: risks, lifespan and what to expect
A penile implant is a device placed inside the penis during surgery to treat erectile dysfunction that has not responded to other treatment, or when a man prefers a definitive option. Implants are either inflatable or semi-rigid. Infection affects 2% to 3% of first implants in low-risk men at high-volume centres, and 76.8% of devices still work after ten years.
What types of penile implant are there?
Penile implants come in two classes. Inflatable implants have two or three pieces and are filled with fluid from a small pump in the scrotum to produce an erection, then emptied afterwards. Semi-rigid implants, which include malleable models, stay firm all the time and are bent into position by hand.
Patients may prefer three-piece inflatable devices for the more natural erection they give. Semi-rigid devices involve a simpler operation and are easy to use, but the penis stays firm and is harder to conceal. Satisfaction is generally higher with inflatable devices, although a semi-rigid implant can suit men with limited hand dexterity or when cost is a concern.
Who is a penile implant for?
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, including its benefits and risks.
"The benefits of prostheses include the ability to generate an erection sufficient for intercourse on-demand, for as long as is desired, and as frequently as is desired." Source 2, p. 29
Surgery is not performed while there is an infection in the body, on the skin or in the urinary tract. Spinal cord injury and low testosterone are linked with a higher risk of implant infection, and the two guidelines differ on whether diabetes still adds risk now that coated devices are used.
What are the main risks of a penile implant?
Infection and mechanical failure are the two main complications. After a first implant in low-risk patients at high-volume centres, infection affects 2% to 3% of men, and devices with an antibiotic or hydrophilic coating may lower this to 1% to 2%. An infected implant usually has to be removed.
Problems around the time of surgery are usually minor. Across published studies, swelling or bruising of the penis occurred in a mean of 3.4% of men, and these early problems were rarely serious. Less often, a cylinder moves into the head of the penis and needs surgical repair. This is called erosion and occurs in 1% to 6% of cases.
How long does a penile implant keep working?
A meta-analysis found that 87.2% of implants were still working at five years, 76.8% at ten years and 52.9% at twenty years. Design refinements have lowered mechanical failure, and the most commonly used three-piece devices show failure rates below 5% after five years. In a large database of men with a first implant, 11% needed a further operation, and about half of these operations were for mechanical failure.
Satisfaction is among the highest of any treatment for erectile dysfunction, at 92% to 100% in patients and 91% to 95% in partners, with appropriate counselling.
What does a penile implant not change?
An implant makes the shaft rigid, but the glans, or head of the penis, does not usually become rigid. It has no direct effect on sex drive and does not enhance orgasm or ejaculation, so a loss of desire is treated as a separate problem.
An implant is also best regarded as irreversible, because the penis is unlikely to respond reliably to other treatments if the device is ever removed. Counselling before surgery covers these points so that expectations are realistic, and men with realistic expectations before surgery report higher satisfaction afterwards.