What are the drawbacks of a penile prosthesis?
The main drawbacks of a penile prosthesis are the risks of surgery, infection in 2% to 3% of first implants at high-volume centres, mechanical failure over time and the fact that the choice is best regarded as irreversible. Satisfaction is still among the highest of any treatment for erectile dysfunction, at 92% to 100% of patients.
What complications can happen around the time of surgery?
Early problems after implant surgery are usually minor. Across published studies, swelling or bruising of the penis occurred in a mean of 3.4% of men, injury to the erectile tissue in 2.3%, being unable to pass urine in 2.0%, injury to the base of the erectile tissue in 1.5% and injury to the urethra in 1.2%.
"These AEs were rarely serious and generally resolved with supportive care or minimal intervention" Source 2, p. 29
Most men have some pain after surgery, which in the experience of the AUA guideline panel resolves completely within one to three months. Rarely, placing the reservoir has injured nearby pelvic structures such as the bladder, bowel or blood vessels.
How serious is infection after a penile implant?
Infection is a serious complication. It usually appears within the first three months after surgery and usually means the device has to be removed. 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%.
Some groups carry a higher risk, including men with spinal cord injury, who had infection in up to 16% of cases in published series, and men with low testosterone. When infection occurs, a new device can sometimes be placed in the same operation after a wash-out, which succeeds in more than 80% of cases.
Can the device wear out or move?
Mechanical failure is most common with inflatable implants and usually happens when the connecting tubing ruptures and fluid leaks. The most commonly used three-piece devices show mechanical failure rates below 5% after five years, and 76.8% of implants are still working at ten years.
Erosion happens when tissue at the tip of the penis weakens and a cylinder moves into the head of the penis, which then needs surgical repair. It occurs in 1% to 6% of cases. Loss of blood supply to the glans has been reported in about 1.5% of patients, and both problems are more likely with significant vascular disease, such as diabetes.
What are the longer-term trade-offs?
An implant is best regarded as irreversible. If the device is ever removed, the penis is unlikely to respond reliably to other treatments for erectile dysfunction.
Some men feel the penis is shorter after surgery. In one study, 72% of men reported a shorter penis, yet measurements before and after surgery were statistically indistinguishable. Shortening is more likely after a delayed replacement, which is needed when an infected device is removed and the tissues are left to heal first. The glans does not usually become rigid, and an implant does not enhance orgasm or ejaculation.