Contents
When is a cavernous body implant/penile prosthesis necessary?
A hydraulic erectile tissue implant is the best solution for severe erectile dysfunction. This treatment can be considered if:
- The erectile dysfunction is caused by physical damage
- Medication and injections no longer help
- Treatment with medication is not tolerated
The three -piece inflatable penile prosthesis (IPP) is the gold standard for natural-looking erections. The procedure is safe and patients are very satisfied with the results (Citation: 1, 2)
These implants give men back their quality of life – with a natural-looking erection, discreetly and functionally.
Special feature
They are also suitable for treatment if the erectile dysfunction has persisted for a very long time and the penis has become smaller as a result. They can then restore the original length in both the flaccid and erect state.
If patients are also overweight, a reduction of the fatty tissue on the lower abdomen (suprapubic fatty tissue) can be useful to enhance the visual effect (Citation: 3)
What are the main causes of severe erectile dysfunction ED?
The most common causes are
- Circulatory disorders of the penis
- Induratio Penis Plastica (Peyronie's Disease)
- Radical prostate removal
How common is erectile dysfunction after prostate surgery?
After radical prostate removal, around 50% of men develop severe erectile dysfunction (Citation: 4).
Can circulatory disorders cause erection problems?
Vascular problems in the penis lead to reduced blood flow and can therefore lead to erection problems of varying degrees of severity.
Can induratio penis plastica (Peyronie's disease) cause ED?
Yes, this condition causes hardening of the penis, which can lead to severe erectile dysfunction.
When is a penile prosthesis the right treatment?
Is it possible to immediately assess whether a penile prosthesis is necessary?
The decision to have a penile prosthesis should be made by a specialist doctor. This doctor must have experience both in the treatment of severe erectile dysfunction and in the operation to implant a penile prosthesis. As a tertiary medical center, we are often consulted for evaluation.
Does surgery have to be performed immediately after prostate surgery?
Even severe erectile dysfunction after prostate surgery does not require immediate surgery. Erectile function can still improve in the first 24 months (Citation: 5, 6).
Important: In our experience, further serious problems with the penis can arise during this waiting period. It must therefore be decided on an individual basis whether surgery should be performed earlier.
When is the right time for a prosthesis for Peyronie's disease?
The penile prosthesis is also the gold standard for induratio penis plastica with ED (Citation 1). The right patient selection by an experienced doctor is crucial.
Patient satisfaction is usually high – regardless of whether induratio penis plastica (Peyronie’s disease) is present in addition to ED (Citation: 2, 7).
Warning: If you wait too long, a complex grafting method often has to be performed in addition to the prosthesis. This reduces patient satisfaction (Citation: 7).
Does medication still help with vascular problems?
Here too, an experienced doctor is important for the assessment. PDE-5 inhibitors (tablets) can even help with moderate vascular erectile dysfunction and improve spontaneous erections (Citation: 8).
Only if these medications no longer help or are not tolerated should a penile prosthesis be considered.
Is there a test to check whether the penile prosthesis is the last option?
What does a SKAT injection show?
A SKAT injection can be used to test whether the blood flow in the penis is sufficient for an erection. This injection opens all vessels to the maximum.
What the test shows:
- Vascular erectile dysfunction can be clearly demonstrated
- Nerve damage after prostate surgery cannot be detected, but it is very likely if the vessels are functioning.
- Damage to the erectile tissue caused by induratio penis plastica (Peyronie's disease) is not recognizable. In this case, the physical examination findings are decisive and an ultrasound of the penis should also be performed.
Why is an experienced doctor important for test evaluation?
In the case of nerve damage and damage to the erectile tissue, a very experienced doctor is needed to assess the test result correctly.
Do you have any questions? Our doctors will be happy to advise you on all aspects of penile prostheses and erectile tissue implants.
How are penile prostheses constructed?
Three-piece penile prostheses are the gold standard for safety and patient satisfaction (Citation: 1, 2). These implants consist of three main parts:
The three components:
- Two cylinders - are inserted into the natural erectile tissue
- A pump - located in the scrotum to trigger an erection
- A reservoir - is placed in the lower abdomen, inserted through the same incision
What special features do modern penile prostheses have?
These implants have important properties:
- Different sizes for optimum fit
- Antibacterial surface to protect against infections
- Natural erection and relaxation function
- Barely visible components in the body
How does the implantation operation work?
What type of intervention is this?
The procedure is usually performed on an outpatient basis under general anesthesia. Only a single, small incision is made between the penis and scrotum.
What happens during the operation?
The process step by step:
- 1. tissue-sparing insertion of the implant components through a single incision
- 2. placement of the pump in the scrotum
- 3. insertion of the reservoir via the same access
- 4. closure of the skin - later almost invisible
How long does recovery take after the operation?
The healing phases:
- 1 day stay at the hotel required
- 3-4 days: physical rest necessary
- After a few days: return to everyday life possible
- 5 weeks: No sex or sport allowed
- After 4 weeks: First activation of the implant
What is really important during the operation?
Why is the surgeon's experience so important?
Implantation sounds simple – but is surgically very demanding. Experience, care and precision are crucial for an optimal result.
The surgeon’s experience is particularly important in order to achieve good results and avoid risks and pain (Citation: 9, 10).
This is why patients are operated on by UGRS doctors.
Frequent problems with poor implementation:
- Incorrect implant length → unnatural appearance, pain, instability
- Improper technique → Breakthrough through penis tip possible
- Inaccurate placement → Pump visible or difficult to operate
- Unsuitable instruments → Damage to the hoses or cylinders
- Inadequate disinfection → increased risk of infection
- Improper suturing → visible or painful scars
What details make the difference?
Small things with a big impact:
For example, it plays a major role in the frequency of wound infections whether wound drainage is carried out for 72 hours or only for 24 hours (Citation: 11). These differences are often only known to an experienced surgeon.
Does experienced surgeons increase partner satisfaction?
A particularly experienced, high-quality performance of the operation significantly increases the satisfaction of patients and their partners.
Impressive result: If the operation is performed to a particularly high standard, the result is so natural that partner satisfaction rises to 88% (Citation: 12).
How do smoking and diabetes affect the outcome of surgery?
Smoking and diabetes have a considerable influence on wound healing and the infection rate. They therefore have a considerable influence on the surgical outcome. The need for corrective surgery increases significantly (Citation: 13)
This connection between wound healing, smoking and diabetes was a research focus of UGRS physician Dr. Jörn Siana, who has set international standards.
He was able to demonstrate early on that smoking and diabetes generally impair wound healing.
So what should patients bear in mind?
Important recommendations for optimal healing:
- Abstain completely from smoking during the healing phase
- Optimally adjusting diabetes in cooperation with the family doctor
- Strict adherence to the rules of conduct provided by the surgeon
Does age play a role in the success of the operation?
No – age does not play a role in success.
Both patients under 75 years of age and patients over 75 years of age have identical results. Both age groups would recommend the implantation of a penile prosthesis equally often (Citation 17).
When can age become a problem?
The patient’s age can only become a problem if an age-related cognitive impairment such as dementia exists at the same time (Citation: 18).
Possible problems with cognitive impairment:
- The patient can no longer operate the prosthesis properly
- Risk of damage due to improper handling
Important note: For such patients, it is particularly important to consult an experienced doctor for advice.
Does a penile prosthesis hinder later urological treatments?
No – a professionally implanted penile prosthesis does not hinder subsequent therapies.
A penile prosthesis implanted by an experienced doctor, for example, does not hinder the treatment of prostate diseases (Citation 19). Other urological procedures remain possible.
Can penis enlargement and penile prosthesis be combined?
Yes, but only with special expertise.
Special experience, skill and expertise are crucial for this combination. Reason: The penis would otherwise become unstable during an erection.
How does the UGRS solve this problem?
Innovative stabilization technology:
The UGRS has developed a special technique to stabilize the base of the penis for the implantation of a penile prosthesis.
In what order must the operations be performed?
Note the important sequence:
- 1. first: penis enlargement surgery
- 2. 6 months later: implantation of the penile prosthesis
Why this order? The healing of the enlargement must be complete before the prosthesis can be inserted.
Any questions ?
Our experienced secretarial staff will help you plan your treatment under “Contact us”. Our doctors are also available for a second opinion.
Important to know:
The consultations, treatments, second opinions and expert opinions of UGRS doctors are based on extensive personal experience, evidence-based medicine, scientific findings and detailed patient surveys.
The medical information provided on this website is for general information purposes only and does not replace a personal consultation with our doctors. As a tertiary medical center, we are also available for second opinions.
About the author
Jörg Hagen, doctor
The author Jörg Hagen has been the medical director of UGRS International Germany since 1995 and has over 30 years of experience in penis enlargement and complex urological issues. He is regarded as one of the leading experts in the interests of patients in Europe. His international activities, excellent diagnostics and legal successes in patient rights make his assessments particularly well-founded. Patients appreciate his scientifically based, discreet and trustworthy care. His articles are based on many years of practice and well-founded information at the highest level.
© Copyright Jörg Hagen
List of sources:
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