A penile prosthesis is another treatment option for men with erectile dysfunction. These devices are either malleable (bendable) or inflatable. The simplest type of prosthesis consists of a pair of malleable rods surgically implanted within the erection chambers of the penis. With this type of implant the penis is always semi-rigid and merely needs to be lifted or adjusted into the erect position to initiate sex. This type of implant is a good choice for men with spinal cord injuries and/or limited hand strength. Today, many men choose a hydraulic, inflatable prosthesis, which allows them to have an erection when they choose, and it's easier to conceal. It is also more natural.
A penile implant is usually used when there is a clear medical cause for ED and when the problem is unlikely to resolve or improve naturally or with other medical treatments. Sometimes a penile prosthesis is implanted during surgery to reconstruct the penis when scarring has caused erections to curve (Peyronie's disease).
Penile implant surgeries take about an hour and are typically done in an outpatient center. A man can resume sexual intercourse by 6 weeks after surgery.
The inflatable penile prosthesis consists of two attached cylinders -- a reservoir and a pump -- which are placed surgically in the body. The two cylinders are inserted in the penis and connected by tubing to a separate reservoir of saline. The reservoir is implanted under the rectus muscles in the lower abdomen. A pump is also connected to the system and sits under the loose skin of the scrotal sac, between the testicles.
This penile prosthesis is referred to as a 3-piece inflatable penile prosthesis, due to the three different components. A 2-piece inflatable penile prosthesis consists of only two components: the attached cylinders and the combined reservoir and pump unit. Instead of the reservoir being placed behind the groin, it is combined with the pump into one housing unit that fits comfortably within the scrotum. The advantage of a 2-piece prosthesis in that the surgery is shorter and less complicated and there is no device parts in the abdomen. The disadvantage of the 2-piece prosthesis is that the smaller reservoir may not result in adequate erections in some men.
To inflate the prosthesis, the man presses on the pump. The pump transfers saline from the reservoir to the cylinders in the penis, inflating them and causing an erection. Pressing on a deflation valve at the base of the pump returns the fluid to the reservoir, deflating the penis and returning it to the normal flaccid state.