Male Erectile Dysfunction | Reconstructive Urology

Erectile dysfunction is a common condition that affects more than 30 million men in the United States. Also known as impotence, erectile dysfunction is the inability to have a satisfactory erection for sexual activity. There are many different types and causes of erectile dysfunction. Indiana University School of Medicine Department of Urology faculty provide personalized treatment for erectile dysfunction through the school’s partnership with IU Health.

Common causes of erectile dysfunction include cardiovascular disease (heart disease), diabetes, hypertension, radical prostatectomy surgery for prostate cancer, prostate radiation treatment, pelvic trauma and spinal cord injuries.

Treatment

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  A small needle is inserted into the side base of the penis and medication is directly injected into the erectile chamber of the penis. These medications vasodilate, or increase the blood flow to the penis.





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  A number of prescription medications are available to improve blood flow to the penis and encourage erections. Oral drug therapy is generally the first option for men experiencing impotence. Some men who take nitrate medications for heart disease may not be candidates for oral medications despite being healthy enough for sexual activity.





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  MUSE is the trade name for prostaglandin suppository, a small pellet which is inserted in the opening of the urethra at the end of the penis. This medication absorbs into the tissue and allows an increase in blood flow to the penis.





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  A cylinder is placed over the penis and pump is used to create a negative-pressure vacuum which draws blood into the penis, creating an erection. A stretchable constriction band is placed around the base of the penis to prevent blood draining out and thus maintaining the erection.

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  The penile implant may serve as a very satisfying, long-term solution to erectile dysfunction which does not respond to the above alternative therapies. The vast majority of implants are inflating-deflating types which employs a pump which is surgically placed into the scrotum. This type of implant allows for a hard, rigid erection which is fully controllable suitable for sexual intercourse at any time. This erection can be safely maintained for as long as desired. The inflatable penile implant provided full cosmetic concealment yet creates exceptional rigidity for sexual activity.

Inflatable Penile Prosthesis Surgery

The penile implant is a minimally invasive surgical solution for men with erectile dysfunction who do not respond to oral pills, injections or vacuum pumps. This unique solution allows spontaneity without risk of medication side effects. This surgical option has been used for male erectile dysfunction for more than 40 years. Since its development in 1973, more than 500,000 penile implants have been placed in men in the United States.

This procedure involves the placement of two soft plastic cylinders side by side into the shaft of the penis. A reservoir is inserted under the abdominal wall and filled with sterile water. This reservoir retains the fluid until the patient wants to inflate the cylinders to create an erection. A small pump is placed in the scrotum and is used to inflate or deflate the cylinders on demand. The pump moves the fluid between the penis cylinders and the hidden reservoirs. The surgery is performed through a small incision in the middle of the scrotum and generally takes 45 minutes.

Frequently Asked Questions

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  The implant surgeries are generally performed under one
  hour. They are scheduled as outpatient procedures with the vast majority of
  patients returning home the same day. 





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  The vast majority of men will undergo general anesthesia for
  this procedure, although a small majority will elect a spinal anesthetic.





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  Depending on individual recovery, most patients are
  encouraged to start cycling and using their device as soon as possible, which
  can be anywhere from 2-4 weeks. There is generally a formal, post-operative visit at two months to assess healing and provide counseling
  regarding proper use of the device once the healing has been accomplished.





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  A penile prosthesis provides a straight, hard erection for
  sexual intercourse. The sensation to the penis will be preserved. Sexual
  function and orgasm will be unaffected. If a patient has had a prostatectomy or
  other prostatic surgery and does not ejaculate, they will not ejaculate after a
  prosthesis either. Penile implants only improve erection quality. They do not
  improve reproductive function.





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  Once placed, the penile implant is completely concealed an undetectable. No one will know unless they are told.





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  Many men will attempt use of oral phosphodiesterase tablets
  such as sildenafil and tadalafil. Additionally, penile injections with
  vasodilators can be used along with vacuum assist devices and intra-urethral
  suppositories. Penile implant surgery is generally used when conservative
  measures have failed or have been unsuccessful.





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  On average, an implant device will last 10-15 years with
  reasonable use. Many will last forever. Each implant comes with a lifetime
  warranty for replacement should the device fail. A replacement can be placed in
  the future if the device fails. 





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  In general, the only risk is a one percent chance of infection, which
  would require removal of the device. This risk is at the time of placement and
  not a long-term risk.





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  Patients who have an implant should expect to have bruising
  and swelling after the procedure. This is common and normal. It is very
  important to ice the scrotum, elevate and maintain limited activity. We leave
  the implant in a partially inflated position to prevent scar tissue formation
  around the implant cylinders. Therefore, it is normal to have a partial or full
  erection for a number of weeks after the procedure. Showering is allowed, just
  towel dry the incision. No tub baths or swimming until the incision is healed.
  All sutures will dissolve and skin glue is used. There is nothing that needs to
  be removed from the wound post-operatively. 





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  Pus coming from the incision, hives, high fevers, trouble
  urinating or redness extending over the abdomen could be concerning signs or
  symptoms which we encourage patients to contact their doctor immediately.

Male Erectile Dysfunction Faculty Experts

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 | Articles by EMC doctors about diseases, diagnosis and treatment

Erectile dysfunction (formerly the term impotence) is the persistent inability to achieve and maintain an erection sufficient for successful intercourse

Surgical treatment of ED is indicated in case of failure of conservative measures.

In our clinic, all types of surgical interventions that are used for this problem are successfully performed. The correct and individual approach to each clinical situation is important. Proper diagnosis in the preoperative period allows you to choose the best way to solve the problem of erectile dysfunction of a particular man.

There are 3 main types of surgical treatment for ED:

Various methods of restoring adequate penile blood flow have become popular since the late 1970s. However, indications for them, in recent years, due to a deeper study and understanding of the mechanisms of erection, have significantly narrowed, and their effectiveness does not exceed 40-50%.

The most effective surgical method for restoring penile rigidity is penile prosthesis. The effectiveness of the application of penile prosthesis reaches 95%.

We use the most modern penile implants from the world’s leading manufacturers, which, along with vast surgical experience, guarantees excellent postoperative results.

You can return to an active sexual life as early as 6 weeks after the operation.

Hydraulic prostheses are the gold standard in penile prosthesis, as they mimic a normal erection as much as possible. This is especially true for three-component implants, consisting of 2 cylinders, a pump and a reservoir, which are a closed system by connecting with special connectors.

Normal erection is a hydraulic phenomenon, which was taken into account when creating these phalloprostheses. During an erection, blood fills the cells of the cylinder, which occupy most of the cavernous bodies. When the prosthesis is activated, the penis takes on a natural shape. This is achieved by intermittent pressure on a pump that is implanted in the scrotum. Fluid from a reservoir located in the prevesical space enters the cylinders in the cavernous bodies, and tumescence (erection) occurs. Detumescence is achieved by pressing a special button on the pump, which returns the liquid to the reservoir.

The erection obtained with the use of these prostheses is close to natural, since the rush of fluid resembles the circulation of blood in the cavernous bodies when the penis is in an excited state.

Key points to remember:

1. Penile prosthesis is the ultimate solution to erection problems.

2. The entire operation is performed in most cases from one surgical approach, after which there are no postoperative scars.

3. We preserve the cavernous tissue as much as possible, simply install an “assistant” that allows you to achieve a full erection. Those. the residual erection is also maintained.

4. Sensitivity and all sensations in most cases remain at the preoperative level.

5. The mechanism of ejaculation practically does not suffer, and the reproductive function is completely preserved.

6. Lifetime warranty on the implant from the manufacturer.

7. A penile prosthesis fits in your body just as naturally as a hip or knee prosthesis. It is up to you to tell your partner about it or not.

Treatment of erectile dysfunction in St. Petersburg. Penile prosthesis

Erectile dysfunction – inability to complete sexual intercourse due to lack of sufficient erection. This ailment may be associated with psychological, vascular, neurological or hormonal disorders. But usually, if we are talking about a severe form of erectile dysfunction that requires a penile prosthesis, it is the result of spinal injuries and surgical treatment of oncological diseases of the pelvic organs. Every second man aged 40-70 has erectile dysfunction.

It is better to ask for help urologist . The specialist will not only conduct a complete diagnosis of erectile dysfunction, but also offer the best treatment option, in particular, if there are indications, a penile prosthesis operation. It is based on the implantation of specially sized devices that fully imitate the erection of a healthy man.

Penile prosthesis – is a guaranteed way to treat severe erectile dysfunction in men. It allows not only to have sexual intercourse at any time, but also to enjoy all the sensations of it without loss of erection and the appearance of a feeling of fear. The installed prosthesis does not affect the ability to achieve orgasm and urination in any way.

There are currently many different penile prostheses in the world.

Manufacturers of implants for penile prosthetics offer models of different design features, trying to make them as functional and organic as possible.

One-piece “memory” prosthesis

This implant consists of cylinders of high strength and flexibility, inside of which there is a metal spiral made of special alloys. The structure is surgically implanted into the cavernous bodies of the penis. It is necessary to bring the penis into an erect state manually, and after sexual intercourse, the penis is also lowered manually.

This prosthesis is characterized by increased reliability and ease of use, while the risk of mechanical failure is minimal. One-piece prostheses with a “memory function” are well suited for overweight men (who cannot reach the scrotum with their hand), as well as men with problems in coordinating hand and arm movements.

Note that the surgical treatment of erectile dysfunction using this type of prosthesis is a fairly simple and inexpensive process. However, these implants also have disadvantages: an unnatural appearance of the penis at rest, as well as a feeling of discomfort in the patient due to the rigid state.

Two-piece prosthesis

In this case, the prosthesis consists of two cylinders that are implanted in the cavernous bodies of the penis, while at the base of the cylinders there is a reservoir with saline, and a special pump (pump) is implanted in the scrotum.

A few clicks on this pump are enough to force fluid from the reservoir into the cylinders and bring the penis into a state of erection. After completing intercourse, a man needs to bend and hold the penis in this position until it relaxes.

Three-piece prosthesis

A three-component prosthesis is considered the most technologically advanced and the best to date. It consists of 2 cylinders, which during the operation are implanted in the cavernous bodies of the penis, as well as a pump (pump) placed in the scrotum and a special reservoir with sterile saline, which is hermetically located behind the bosom.

To bring the device into operation, you need a slight pressure on the pump. After that, the liquid from the reservoir will fill the cylinders with a solution, and the penis will reach an erection. After intercourse, the patient also needs to press the pump to bring the implant to rest.

The main advantage of using two- and three-piece prostheses is their secrecy from the partner, since all components are located inside the body. The penis at rest has its own physiological proportions and it is impossible to visually determine the presence of a prosthesis.

However, with phalloprosthesis with 2- and 3-component implants, the risk of their breakage is higher, since the prosthesis itself consists of several components. For men suffering from articular, vascular and neurological diseases, these types of prostheses may also be contraindicated due to the physical impossibility of performing a series of manual manipulations to bring the device into operation. Note that a three-component prosthesis is considered the most modern and technologically advanced – it looks organic and is quite easy to use.