Erectile dysfunction surgery: Outcomes and more

There are several treatment options for erectile dysfunction. Surgical treatment could be an option if medications and pump devices have not worked. The most common surgical treatment is a penile implant.

Most doctors will begin treatment for erectile dysfunction (ED) with medications. If these do not work, a doctor may recommend other therapies, such as ED injections or penis pumps.

If these therapies do not provide a satisfactory outcome, a doctor may begin to discuss surgical options.

The most common ED surgery is a penile implant. Most of these devices are designed to inflate for erection and deflate for a flaccid state.

Vascular reconstruction surgery is another surgical option, but surgeons rarely perform it.

This article discusses surgical treatments for ED, the risks, benefits, outcomes, and more.

ED treatment aims to provide a person with an erection sufficient for sexual intercourse.

Surgical intervention for ED can have good outcomes. According to the American Urological Association, penile implants have the highest rates of success and satisfaction among ED treatment options.

However, medications are usually the first-line treatment for ED. They also have good results for many people. A doctor may recommend surgery for cases of ED that do not respond to medications.

Surgery is a last resort, however, and a person should consider it carefully.

Two types of surgery are available: penile implants and vascular reconstruction.

Penile implants are the main surgical procedure for ED. Doctors usually only recommend vascular reconstruction in specific cases of trauma to the penis or pelvis.

A healthcare professional might recommend any of the following lifestyle strategies in addition to medication or surgical intervention:

• quitting smoking
• limiting or stopping alcohol use
• increasing physical activity
• maintaining a moderate body weight
• stopping recreational substance use

This section explains the types, benefits, and risks of penile implants.

Types

Penile implant surgery is an irreversible procedure. It involves a surgeon placing a rod, usually silicone rubber, into a person’s penis to create a rigid state.

There are two types of implants. One is a malleable, semi-rigid device, and one is inflatable. Additionally, there are two styles of inflatable devices.

Malleable implants

Malleable implants are simple to implant and operate. They are single pieces of silicone rubber that a person can mold with the hands to make the penis more or less erect.

Malleable implants are only semi-erect devices, so the penis will not be fully erect or flaccid. These devices could also interfere with urination. It may be difficult to conceal them.

Malleable implants are usually the best option for people who want an implant that is simple to use.

Inflatable devices

Two-piece inflatable devices are a pair of cylinders attached to a scrotal pump.

Surgeons place the two cylinders inside the penis and position the pump within the scrotal sac. This makes it discreet yet easily accessible for a person to use.

A person can inflate this device for intercourse and then partially deflate it to allow some appearance of a flaccid penis.

Three-piece inflatable devices comprise two cylinders that surgeons place inside the penis, a scrotal pump, and a reservoir for saline that fits inside the body.

Because they provide the best rigidity for an erection, three-piece inflatable devices make up about 85% of the U.S. market.

Benefits

People usually tolerate prostheses well. They also have a high satisfaction rate, greater than 90% in the United States.

They allow for unplanned, repeated erections, so people can use them whenever they desire. Additionally, they can last for 10–15 years on average.

Risks

Infection remains the most significant risk of penile implant surgery.

However, infection rates are still low. Infection rates are less than 2% among people who receive implant surgery for the first time from an experienced surgeon.

Another risk is that a person may not be satisfied with the physical results. Many people dislike their penis length after surgery, but counseling and mental preparation can help a person come to terms with the changes.

Learning to operate the device also takes time, so a person must practice patience.

Vascular reconstruction aims to restore blood flow to the penis by reconstructing any damaged blood vessels.

Doctors usually only recommend it for young males with damage to the arteries from injury or congenital abnormalities.

Some conditions, such as high blood pressure or diabetes, can cause ED due to insufficient blood flow to the penis. Doctors do not recommend vascular reconstruction surgery in such cases.

This section discusses the types, benefits, and risks of vascular reconstruction.

Types

Vascular reconstruction can involve the arteries, called arterial reconstruction, or the veins, called venous reconstruction.

Surgeons may opt for venous reconstruction if any of the veins that carry blood to the penis are damaged.

Surgeons may opt for arterial reconstruction in older adults with arterial occlusive diseases, where the arteries narrow.

However, doctors mainly only recommend these surgeries in rare cases of healthy young males whose blood flow is interrupted by physical trauma.

Benefits

The long-term results of this type of surgery vary considerably. It is a high risk procedure.

However, it can work for otherwise healthy young males with damaged blood vessels. Additionally, if it works, it avoids the need for medications, injections, devices, or prostheses.

Risks

The most significant risk with this surgery is an overflow of blood to the blood vessels of the penis, called glans hyperemia. Sometimes, this can cause ulcers.

Other potential complications from surgery include:

• infection
• hematoma
• blood clots

Surgery is generally an outpatient procedure, so a person can go home to recover.

Some pain may occur. Doctors may prescribe pain medication or over-the-counter pain relievers to use after surgery.

Postoperative symptoms, such as bruising, swelling, and localized discomfort, may last for several weeks. A person should limit physical activity for 1 month following the surgery.

It may take around 4–6 weeks for a person to recover after surgery. If there is swelling or pain, the person may need to wait longer before having sex.

According to a 2020 research review, more than 90% of people who receive penile implants are satisfied with the results. These results may vary depending on the specific device.

However, it is a costly procedure. It is generally only available after all other treatment options have proved to be unsuccessful.

Individuals and their partners generally report satisfaction with the results of surgery. It may take some time to learn to use the device.

When considering any surgery, reaching out for support and information can be helpful.

A few organizations that provide help, support, and information include:

• ED Cure
• American Urological Association
• Urology Care Foundation

This section answers some frequently asked questions about erectile dysfunction surgery.

How much does erectile dysfunction surgery cost?

Many insurance plans have coverage for ED surgery, as well as Medicare.

Insurance providers will want to know that the person has tried all other treatment options first and had no success.

They may also ask for documentation from the doctor that:

• ED is due to physical, and not psychological, reasons
• ED has been present for a certain amount of time
• the person has tried all nonsurgical options

Without insurance coverage, surgery costs vary from $17,000–$25,000. This factors in the cost of the surgeon, surgery center, anesthesiologist, and other fees.

With private health insurance, these prices should be significantly lower.

Medicare does cover penis implants under Part B, which covers outpatient procedures. The deductible for 2023 is $226. The individual is responsible for 20% of all approved charges for the procedure. A Medicare supplement policy (Medigap) will usually cover this amount.

Is erectile dysfunction surgery painful?

Surgeons will perform the surgery while the patient is under general anesthesia. This means the patient will be unconscious and not feel any pain during surgery.

However, a person should expect some pain after the procedure. Some doctors will prescribe pain medication to ease the discomfort. After 1–2 weeks, over-the-counter pain medication may suffice.

Discomfort and pain should decrease within a few weeks.

When a person has tried medication and other treatments for ED, a doctor might recommend surgery for a penile implant.

In rare cases, doctors may recommend another surgery, called vascular reconstruction. This is mainly reserved for rare cases of healthy young males who have experienced physical trauma.

There are two types of penile implants. One is malleable but relatively rigid and does not allow the penis to become fully erect or flaccid.

The other, more popular type is an inflatable device. It allows the penis to inflate and deflate to an erect or flaccid state.

Penis implant surgery is an outpatient procedure. Private insurance and Medicare usually cover it. A person should expect some pain for a few weeks.

A person may be able to resume sexual activity 8 weeks after ED surgery. However, people should avoid sex and speak with a doctor if they experience pain or discomfort after 8 weeks.

Erectile dysfunction surgery: Outcomes and more

There are several treatment options for erectile dysfunction. Surgical treatment could be an option if medications and pump devices have not worked. The most common surgical treatment is a penile implant.

Most doctors will begin treatment for erectile dysfunction (ED) with medications. If these do not work, a doctor may recommend other therapies, such as ED injections or penis pumps.

If these therapies do not provide a satisfactory outcome, a doctor may begin to discuss surgical options.

The most common ED surgery is a penile implant. Most of these devices are designed to inflate for erection and deflate for a flaccid state.

Vascular reconstruction surgery is another surgical option, but surgeons rarely perform it.

This article discusses surgical treatments for ED, the risks, benefits, outcomes, and more.

ED treatment aims to provide a person with an erection sufficient for sexual intercourse.

Surgical intervention for ED can have good outcomes. According to the American Urological Association, penile implants have the highest rates of success and satisfaction among ED treatment options.

However, medications are usually the first-line treatment for ED. They also have good results for many people. A doctor may recommend surgery for cases of ED that do not respond to medications.

Surgery is a last resort, however, and a person should consider it carefully.

Two types of surgery are available: penile implants and vascular reconstruction.

Penile implants are the main surgical procedure for ED. Doctors usually only recommend vascular reconstruction in specific cases of trauma to the penis or pelvis.

A healthcare professional might recommend any of the following lifestyle strategies in addition to medication or surgical intervention:

• quitting smoking
• limiting or stopping alcohol use
• increasing physical activity
• maintaining a moderate body weight
• stopping recreational substance use

This section explains the types, benefits, and risks of penile implants.

Types

Penile implant surgery is an irreversible procedure. It involves a surgeon placing a rod, usually silicone rubber, into a person’s penis to create a rigid state.

There are two types of implants. One is a malleable, semi-rigid device, and one is inflatable. Additionally, there are two styles of inflatable devices.

Malleable implants

Malleable implants are simple to implant and operate. They are single pieces of silicone rubber that a person can mold with the hands to make the penis more or less erect.

Malleable implants are only semi-erect devices, so the penis will not be fully erect or flaccid. These devices could also interfere with urination. It may be difficult to conceal them.

Malleable implants are usually the best option for people who want an implant that is simple to use.

Inflatable devices

Two-piece inflatable devices are a pair of cylinders attached to a scrotal pump.

Surgeons place the two cylinders inside the penis and position the pump within the scrotal sac. This makes it discreet yet easily accessible for a person to use.

A person can inflate this device for intercourse and then partially deflate it to allow some appearance of a flaccid penis.

Three-piece inflatable devices comprise two cylinders that surgeons place inside the penis, a scrotal pump, and a reservoir for saline that fits inside the body.

Because they provide the best rigidity for an erection, three-piece inflatable devices make up about 85% of the U.S. market.

Benefits

People usually tolerate prostheses well. They also have a high satisfaction rate, greater than 90% in the United States.

They allow for unplanned, repeated erections, so people can use them whenever they desire. Additionally, they can last for 10–15 years on average.

Risks

Infection remains the most significant risk of penile implant surgery.

However, infection rates are still low. Infection rates are less than 2% among people who receive implant surgery for the first time from an experienced surgeon.

Another risk is that a person may not be satisfied with the physical results. Many people dislike their penis length after surgery, but counseling and mental preparation can help a person come to terms with the changes.

Learning to operate the device also takes time, so a person must practice patience.

Vascular reconstruction aims to restore blood flow to the penis by reconstructing any damaged blood vessels.

Doctors usually only recommend it for young males with damage to the arteries from injury or congenital abnormalities.

Some conditions, such as high blood pressure or diabetes, can cause ED due to insufficient blood flow to the penis. Doctors do not recommend vascular reconstruction surgery in such cases.

This section discusses the types, benefits, and risks of vascular reconstruction.

Types

Vascular reconstruction can involve the arteries, called arterial reconstruction, or the veins, called venous reconstruction.

Surgeons may opt for venous reconstruction if any of the veins that carry blood to the penis are damaged.

Surgeons may opt for arterial reconstruction in older adults with arterial occlusive diseases, where the arteries narrow.

However, doctors mainly only recommend these surgeries in rare cases of healthy young males whose blood flow is interrupted by physical trauma.

Benefits

The long-term results of this type of surgery vary considerably. It is a high risk procedure.

However, it can work for otherwise healthy young males with damaged blood vessels. Additionally, if it works, it avoids the need for medications, injections, devices, or prostheses.

Risks

The most significant risk with this surgery is an overflow of blood to the blood vessels of the penis, called glans hyperemia. Sometimes, this can cause ulcers.

Other potential complications from surgery include:

• infection
• hematoma
• blood clots

Surgery is generally an outpatient procedure, so a person can go home to recover.

Some pain may occur. Doctors may prescribe pain medication or over-the-counter pain relievers to use after surgery.

Postoperative symptoms, such as bruising, swelling, and localized discomfort, may last for several weeks. A person should limit physical activity for 1 month following the surgery.

It may take around 4–6 weeks for a person to recover after surgery. If there is swelling or pain, the person may need to wait longer before having sex.

According to a 2020 research review, more than 90% of people who receive penile implants are satisfied with the results. These results may vary depending on the specific device.

However, it is a costly procedure. It is generally only available after all other treatment options have proved to be unsuccessful.

Individuals and their partners generally report satisfaction with the results of surgery. It may take some time to learn to use the device.

When considering any surgery, reaching out for support and information can be helpful.

A few organizations that provide help, support, and information include:

• ED Cure
• American Urological Association
• Urology Care Foundation

This section answers some frequently asked questions about erectile dysfunction surgery.

How much does erectile dysfunction surgery cost?

Many insurance plans have coverage for ED surgery, as well as Medicare.

Insurance providers will want to know that the person has tried all other treatment options first and had no success.

They may also ask for documentation from the doctor that:

• ED is due to physical, and not psychological, reasons
• ED has been present for a certain amount of time
• the person has tried all nonsurgical options

Without insurance coverage, surgery costs vary from $17,000–$25,000. This factors in the cost of the surgeon, surgery center, anesthesiologist, and other fees.

With private health insurance, these prices should be significantly lower.

Medicare does cover penis implants under Part B, which covers outpatient procedures. The deductible for 2023 is $226. The individual is responsible for 20% of all approved charges for the procedure. A Medicare supplement policy (Medigap) will usually cover this amount.

Is erectile dysfunction surgery painful?

Surgeons will perform the surgery while the patient is under general anesthesia. This means the patient will be unconscious and not feel any pain during surgery.

However, a person should expect some pain after the procedure. Some doctors will prescribe pain medication to ease the discomfort. After 1–2 weeks, over-the-counter pain medication may suffice.

Discomfort and pain should decrease within a few weeks.

When a person has tried medication and other treatments for ED, a doctor might recommend surgery for a penile implant.

In rare cases, doctors may recommend another surgery, called vascular reconstruction. This is mainly reserved for rare cases of healthy young males who have experienced physical trauma.

There are two types of penile implants. One is malleable but relatively rigid and does not allow the penis to become fully erect or flaccid.

The other, more popular type is an inflatable device. It allows the penis to inflate and deflate to an erect or flaccid state.

Penis implant surgery is an outpatient procedure. Private insurance and Medicare usually cover it. A person should expect some pain for a few weeks.

A person may be able to resume sexual activity 8 weeks after ED surgery. However, people should avoid sex and speak with a doctor if they experience pain or discomfort after 8 weeks.

Treatment of erectile dysfunction with local negative pressure (LOD-therapy)

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Urologists

LOD-therapy in urology for men is the impact on the penis with high negative pressure through a special device. This technique became widespread at the beginning of the 20th century, but its principle has remained unchanged today.

Vacuum decompression can be used as an independent method of treatment for erectile dysfunction, and as part of a combined treatment on the AELTIS apparatus for the complex therapy of copulative disorders of the male reproductive system.

Treatment involves acting on the spongy tissue of the penis, which fills with blood when the pressure around it decreases, after which an erection occurs. Vacuum exposure provides a rush of blood not only to the penis, but also to the prostate gland. The task of such therapy is to ensure a full flow of blood to the genitals, stimulation of lymph circulation and blood circulation. In the penis of a man, metabolic processes are restored, so the effect of the treatment comes very quickly. Such therapy has proven its effectiveness and safety for many years, so today this method is very relevant and in demand.

The LOD therapy device is a special flask attached to a pressure release mechanism. The genital organ is placed in a flask, the latter is pressed tightly against the pubis. Negative pressure is created by activating the air pumping mechanism.

As a result, during the treatment procedure, a pronounced erection occurs, which is directly observed by the patient, which also leads to a psychological improvement in his self-awareness. The method of local negative pressure (LOP) treatment itself is most indicated for various clinical variants of the syndrome of vascular insufficiency of the erection component. During the LOD session, more oxygen-rich arterial blood flows to the cavernous bodies of the penis than in the normal state. When blood enters an organ placed in a pressure chamber, intensive diffusion of oxygen into the tissues occurs with the help of blood flow. This helps to increase the exchange area for gases and nutrients, improve the function of plasma membranes, transport oxygen in interstitial spaces and intensify metabolism. All these processes improve trophism and contribute to the elimination of degenerative changes in the vascular apparatus of the cavernous bodies, as evidenced by the sufficient stability of the results obtained.

Treatment of erectile dysfunction with phototherapy

The second equally important method of treating erectile dysfunction is the use of phototherapy, including light therapy. In modern medical practice, phototherapy methods have taken a strong place among the widespread methods of physiotherapy. The basic principle of treatment is that there is a pronounced photoactivation in a biological object at the molecular, cellular, tissue, organ and system levels. At the same time, the following therapeutic effects are achieved: biostimulating, analgesic, anti-inflammatory, decongestant, and many others. However, the most important achievement of phototherapy today is considered to be the normalization of blood flow components, such as blood viscosity, microcirculation parameters, immunocompetent elements, secondary processes, and others.

LOD therapy in Kutuzovsky medical center: advantages

Kutuzovsky medical center uses a technique based on the combined therapeutic effect on the penis of local negative pressure (LOP) with a powerful LED matrix emitter (SDM) of the red range.

The method of influence consists in alternating the rarefaction and rest phases (pneumopulses) in the flask according to special automatic programs, which also control the frequency and power of the SDM radiation.

Photomodified blood acquires the properties of superfluidity (blood viscosity decreases by 2-3 times) and easily penetrates into small and distant capillaries, which, with an adequate dosage, improves the trophism of the vascular apparatus of the penis and prostate. During the procedure, the baro-, chemo-, thermo- and photoreceptors of the penis are simultaneously irritated, the impulses from which enter the spinal cord and brain, causing the activation of the activity of the spinal centers of erection and ejaculation, as well as the response of the central nervous system. Positive effects are fixed and realized in normal sexual life.

Due to the difference in pressure and increased inflow of arterial blood, in the cavernous bodies of the penis, the vast majority of arterioles and capillaries, which previously did not function, open and fill with blood. In addition, the blood flow and microcirculation in the periprostatic space and the prostate gland are reflexively increased. Thus, there is a restoration of blood circulation and microcirculation in the penis, prostate, the transmission of nerve impulses in the spinal center of erection and ejaculation and peripheral nerve pathways is normalized.

As our many years of experience show, for a more pronounced effect, in addition to LOD-therapy, we can recommend electro-laser stimulation of the muscles of the perineum on the AELTIS device, which allows you to train and strengthen specific muscles that increase not only erection, but also the overall sexual potential of a man. In parallel, the patient is offered a simple set of special exercises for self-fulfillment.

LOD therapy, both as an independent technique and in combination with other described physiotherapeutic effects, has its own indications and contraindications, but, of course, this is the safest and completely non-invasive method of treating erectile dysfunction, which suits most patients.

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Treatment of erectile dysfunction – Clinic “Own Doctor Krasnoyarsk”

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Our clinic uses a local photodecompression apparatus PHOTOLOD

Combination of action

• Combined rarefaction of air in a flask around the penis in the form of pneumatic impulses
• Monochrome blue and infrared

Produced an active effect on erogenous zones and nerve endings , the mechanisms of psychosexual arousal are restored, sexual functions are normalized and increased, libido and erection stability are improved.

Preparation before the procedure:

Not required

How is the procedure performed?

• The mechanism of action of the local negative pressure of the apparatus creates in the working flask an alternation of rarefaction (erection) cycles in the flask and pauses without rarefaction according to special programs. In rarefaction cycles, blood rushes into the penis in a powerful stream, causing a full erection. The walls of the vessels move apart, adhesions are eliminated, the blood supply to the penis improves, and the cavernous bodies overflow. During the procedure, the mechanisms of psychosexual arousal are restored, sexual function is increased, libido and erection stability are improved.
• Phototherapy . In rarefaction (erection) cycles, a powerful flow of light energy is created in the working flask. Blue and infrared radiation range promotes the production of reactive oxygen species (ROS) in the blood, has antibacterial, anti-inflammatory and immunomodulatory effects, normalizes metabolic processes, improves blood microcirculation and its oxygen capacity , reduces the pathogenicity of microorganisms and increases their sensitivity to antibiotics.

Benefits:

• High treatment efficiency due to combination of therapeutic factors
• Comfort and no discomfort for the patient
• Possibility of individual selection of optimal procedure parameters for each patient

Contraindications:

1. Acute inflammatory diseases of the urethra and prostate
2. Cardiovascular insufficiency
3. Local diseases (phimosis, paraphimosis, varicose veins of the spermatic cord, hydrocele, inguinal-scrotal hernias)
4. Malignant tumors
5. Severe mental disorders
6. Alcohol intoxication

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