How long does a penile implant last?
Most penile implants keep working for many years. A meta-analysis found that 93.3% were still working at one year, 87.2% at five years, 76.8% at ten years and 52.9% at twenty years. Implants that stop working early usually do so because of mechanical failure or infection, and a further operation can replace the device.
Why do some penile implants stop working?
Mechanical failure and infection are the two main complications of implant surgery. Mechanical failure is most common with inflatable implants and usually happens when a component, most often the connecting tubing, ruptures and fluid leaks out.
"Numerous refinements in prosthesis design and materials over time have resulted in decreased failure rates." Source 2, p. 30
The most commonly used three-piece devices now show mechanical failure rates below 5% after five years. Infection usually appears within the first three months after surgery and usually requires removal of the device. After a first implant in low-risk patients at high-volume centres, it affects 2% to 3% of men, and 1% to 2% with a coated device.
How often is a second operation needed?
In a database of 7,666 men who had a first implant, 11% needed a further operation during follow-up. About half of these operations were for mechanical failure, and more than half of the mechanical repairs involved the pump, followed by the cylinders and the reservoir.
The two guidelines quote different long-term figures. The American guideline cites recent reports that 90% to 95% of men have a functioning implant ten years after surgery, while a meta-analysis cited by the European guideline found 76.8% of implants still working at ten years. The studies measured survival in different groups and in different ways, so the figures are not directly comparable.
What happens when a penile implant fails?
When infection is the cause, the device has to be removed and antibiotics given. In selected men without sepsis or severe local infection, a new device can be placed in the same operation after the area is washed out, and this succeeds in more than 80% of cases.
Otherwise the tissues are left to heal for six weeks to six months before a new implant is placed. This delayed replacement is a complex operation. Scarring can make it impossible to place a new device, and penile shortening, a change in shape and loss of sensation are more likely. No firm recommendation exists on how to proceed after removal, so the decision is made after a full discussion with the patient.
Does the type of implant change how long it lasts?
Inflatable implants, with their moving parts and fluid, are the type most affected by mechanical failure. Malleable implants contain no fluid, so leaks cannot occur, but no head-to-head studies have compared different devices or shown one implant type to be superior. Erosion, where a cylinder moves into the head of the penis, was less common with inflatable implants, at a mean of 2.5% across studies, than with malleable implants, at 4.1%.
Men who choose an implant report one of the highest satisfaction rates of any erectile dysfunction treatment, at 92% to 100%, and partners report 91% to 95%, with appropriate counselling.