Reconstruction with hydraulic prostheses for UGRS
Doctors at UGRS have not only become known for the fact that we do very precise work with strictly controlled, precisely fitting proportions. But also for the low risk, especially with regard to a low infection rate during professional implantation.
In addition, we work tirelessly and successfully to ensure that our patients receive at least partial reimbursement from their health insurance companies.
We have this claim in particular because the surprising need for a prosthesis often arises for patients due to the sometimes under-described risks of prostate removal.
Unfortunately, this is not possible for statutory patients due to the strict separation of the statutory system from the private system in Germany. We can only treat these patients on a self-pay basis.
In individual cases, however, the statutory health insurance fund will cover the prosthesis and its material costs.
Please read our patient information below:
Who will treat me in Darmstadt?
Your doctors in the Prosthetics Section:
Photos in update
(In the middle: Prof. Poblador; details about our doctors can be found here)
Contents
When is a hydraulic internal prosthesis necessary?
A hydraulic erectile tissue implant is the best solution for severe erectile dysfunction, i.e. impotence. This is when conservative and drug treatments no longer help. 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
Many men who suffer from severe erectile dysfunction after radical prostate removal, for example, do not go to their doctor for a long time out of shame to look for treatment options.
Once they have taken this step, they first try out conservative options in various degrees of effectiveness, which is usually quite right.
If these no longer have any effect after some time, the affected patient often experiences an additional effect: the lack of a natural erection, sometimes for years, also results in a shortening of the penis due to contraction and/or tissue breakdown.
This places an additional burden on the patient concerned. So first of all, before we go into a detailed description of the procedure, here is some important information for patients suffering from this condition:
In most cases, a hydraulic implant can be used to restore the original length of the penis as it was before the underlying disease, either by pure stretching or by additional reconstructive measures.
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?
In principle, yes, depending on the mandatory examination that must precede the assessment of the individual case. This examination and the possible initiation of conservative therapy as a temporary solution should be carried out by a doctor specializing in erectile dysfunction. A professional ultrasound examination with vascular ultrasound and a standardized erection test are usually sufficient and quickly provide clarity.
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). Individual diagnostics and individual assessment are essential for professional treatment of the patient.
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 physician 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).
as the hydraulic prosthesis both corrects the shape and restores the lost function.
Here too, individual diagnostics and individual treatment planning are of particular importance. In the case of massive induratio penis plastica, hardening of the plaque structure should not be waited for. Otherwise there is a risk that a reconstructive grafting method will also have to be used to restore the length.
This reduces patient satisfaction (Citation: 7).
Does medication still help with vascular problems?
Here too, an experienced doctor is important for the assessment. Even in cases of moderate vascular erectile dysfunction, certain medications can still help and also improve spontaneous erections, which are sometimes so important for mental health (Citation: 8).
Even if the medication taken in tablet form is no longer effective, injected active substances can still be used for a while to provide effective conservative treatment, provided the patient has been fully informed of the risks of such treatment and is willing to accept them.
Only when 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?
Yes, there is a standardized procedure for medical erection induction
By injecting a special substance, it is possible 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 correctly assess the test result and determine the correct timing of the treatment steps.
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?
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?
Based on our experience, we can usually offer this procedure 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, in an invisible position
- 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 in the hotel is recommended to avoid a sometimes long journey home on the day of the operation itself
- 3-4 days: Physical rest
- 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 sometimes very demanding from a surgical point of view. 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).
In particular, special hygiene as well as the speed of the procedure is required to minimize the risk.
This is why patients are operated on by UGRS doctors.
Frequent problems with poor implementation:
-
Incorrect implant length → unnatural appearance, pain, instability
The manufacturers of these systems produce different sizes and lengths in finely tuned stages in order to be able to offer an individual solution for almost every patient. If a clinic only has three or four sizes available, many patients will end up with suboptimal sizes and lengths. - Improper surgical technique → Breakthrough through the tip of the penis possible
-
Inaccurate placement → Pump visible or difficult to operate
Implants are mechanical instruments that can only function if the individual parts have been installed correctly. -
Unsuitable instruments → Damage to the tubes or cylinders
The use of unsuitable sharp-edged, inflexible surgical instruments is often an underestimated risk. Implant manufacturers offer instruments specially made for these products that do not damage the prostheses during installation. -
Inadequate disinfection → increased risk of infection
The prosthesis is inserted into the organ along its entire length as it replaces the original size and function. It must be prepared for this with particular attention to hygiene. Forgetting to do so, or not doing so properly or with the right hygiene can lead to serious infections and the need for corrective surgery in a large clinic, which we unfortunately experience time and again. - Improper suturing → visible or painful scars
What details make the difference?
Small things with a big impact:
For example, the length and effectiveness of wound drainage plays a major role in the frequency of wound infections (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. If the prosthesis is carried out properly and to a high standard with a great deal of experience, it functions optimally and brings back the joy of life.
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). This is already a very high value per se, the significance of which increases even further when one considers the serious underlying disease on which the intervention was based.
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)
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). This means that the patient would no longer be able to operate the prosthesis properly or behave correctly during post-operative care.
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.
Cost of penile prosthesis
Clarity right from the start – without hidden fees.
A high-quality medical service has its price, especially when the quality of the material used plays a significant role. But with us, you know where you stand right from the start. We focus on fair, transparent pricing for prosthesis surgery without unexpected additional costs. Because trust begins with openness.
All prices include examination, preliminary consultation, surgery, anesthesia, aftercare and medical care AND implant (approx. EUR 8,000).
Costs of implanting a hydraulic penile prosthesis
- Approx. EUR 9,000 plus penile prosthesis
Payment by bank transfer, credit card, cash or other payment options. Please contact us!
Costs covered by private health insurance:
The prosthesis is often reimbursed by private health insurance. For the rest: This text is unfortunately a little longer now. A German private patient is often not what he thinks he is. The vast majority of insurance companies will only cover you if the operation takes place in the so-called private ward of a public hospital. Many patients who feel like first-class patients are not allowed to be treated in a private clinic at all. In a privately run public hospital, yes, but that is not a private clinic, it is still a clinic that follows certain budget and administrative guidelines.
A private patient often feels special because he or she is something special at a doctor’s appointment and in the eyes of general practitioners. There is no difference between a hospital and a clinic apart from a possibly nicer room, because the operating theatres are the same, the staff are the same and the head doctor is the same, because the head doctor is there anyway, because the department needs a head, even according to the requirements of the statutory healthcare system.
This is neither a criticism of the doctors nor of you the patients, but it makes no sense to raise false hopes.
But there is a way out:
Years ago, we refused to accept that patients were being sold insurance policies that did not include what the patient thought they did.
You and we are not only German citizens, but above all European citizens. And thank goodness European law has created a possibility here which means that a patient who is not entitled to any reimbursement in Germany or only a minimal reimbursement is entitled to a significant reimbursement (up to 90%) for surgery at our center in Spain. This is due to the higher priority of the European law applicable to German patients there.
It is a quite grotesque situation, which can be summarized under the term “German madness”, but it is so. So if you are interested in having your costs reimbursed, please contact us.
Unfortunately, this option does not exist for patients with statutory health insurance. Because in Germany the statutory system is strictly separated from the private system. We can only treat patients with statutory health insurance as self-pay patients.
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 reports of the UGRS doctors are based on extensive personal experience, evidence-based medicine, scientific findings and detailed patient surveys.
The article has been checked, verified and approved by the Co-author Jörg Hagen. Author: Prof. Agustin Fraile Poblador.
About the author
Agustin Fraile Poblador is an international luminary in the field of urological reconstructions. He specializes in inflatable penile prostheses, induratio penis plastica and artificial urethral sphincters.
Activities
His medical positions are in addition to his work at the UGRS Center Darmstadt:
- Coordinator of Andrology and Reconstructive Urology, ROC CLINIC (Madrid, Spain) https://rocclinic.com/en/medical-equipment/dr-agustin-fraile-poblador/
- Coordinator of Reconstructive Urology and Andrology at St Lukasz Szpital, (Bydgoszcz, Poland) https://szpital-lukasza.pl/cur/assets/files/cv_dr_agustin_fraile_poblador.pdf
- Head of Urology Service, Hospital HM Rivas (Madrid, Spain) https://revista.uromadrid.es/editor-invitado-editorial-2023-9/
- Associate member of the ESGURS (EAU Section of Genitourinary Reconstructive Surgeons) https://urosource.uroweb.org/resource-centres/ESGURS-ESAU25/265766/webcast
- Member of the Scientific committee of Reconstructive Surgery of the ESSM (European Society of Sexual Medicine) https://www.essm.org/wp-content/uploads/education/past-congress/Final_Program_ESSM_2016_lowres.pdf
- Coordinator of Andrology and Reconstructive Urology, University Hospital Ramón y Cajal (Madrid, Spain) https://www.lyxurologia.com/en/medical-specialists/dr-agustin-fraile/
Awards
Agustin Fraile Polabor has been a sought-after speaker at national and international specialist congresses for 20 years and has been recognized for the outstanding quality of his medical work at the following scientific congresses, for example:
- 39th Annual European Association of Urology (EAU) Congress, April 5-8, 2024, Paris (France)
- 13th Meeting of the EAU Section of Genito-Urinary Reconstructive Surgeons (ESGURS), 23-24Nov 2023, Firenze (Italy)
Special recognition of his medical work
He has been appointed as an instructor by the European Association of Urology (EAU) at the following congresses:
- 40th Annual European Association of Urology (EAU) Congress, March 21-24, 2025, Madrid (Spain). Professor at the European School of Urology (ESU) Course: Male Prosthetic Urology
- 41st Annual European Association of Urology (EAU) Congress, March 13-16, 2026, London (UK). Professor at the European School of Urology (ESU) Course: Male Prosthetic Urology
He is a lecturer and trainer for
Boston Scientific, Coloplast and Promedon for penile prosthesis, artificial urinary sphincter and male suburethral sling. He gives regular training courses in Spain, Poland, Czech Republic, Italy, Turkey, USA, UK, Argentina and the Dominican Republic.
The Center for Advanced Medical Learning and Simulation (CAMLS), Tampa (Fl, USA)
His memberships in addition to the UGRS membership:
-
Global Health Training Center
https://globalhealthtrainingcentre.tghn.org/community/members/1225198/ -
ROC Clinic Madrid
https://rocclinic.com/en/medical-equipment/dr-agustin-fraile-poblador/ -
European Association of Urology (EAU)
https://uroweb.org/search?q=poblador - Spanish Association of Urology (AEU)
- Member of the European Society of Sexual Medicine (ESSM)
- Member of the Urological Society of Madrid (SUM)
Publications
Prof. Agustin Fraile Poblador is the author of more than 40 scientific publications, for example to be found at:
https://www.researchgate.net/scientific-contributions/A-Fraile-Poblador-2126490040
The Journal of Urology – American Urological Association
https://www.auajournals.org/doi/10.1097/01.JU.0001191460.14228.29.08
Pubmed – National Library of Medicine:
https://pmc.ncbi.nlm.nih.gov/articles/PMC8511538/
Wiley Online Library – International Journal of Urology
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.
© Copyright Jörg Hagen, Doctor
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.
List of sources:
6 Mathers MJ, Klotz T, Vahlensieck W, Zellner M, Lümmen G, Roth S, Huland H, Sommer F. (2008) Is rehabilitation of erectile function following pelvic surgery reasonable? Review of the literature: from sports to PDE5 inhibitors [Is rehabilitation of erectile function following pelvic surgery reasonable? Review of the literature: from sports to PDE5 inhibitors]. Urologe A. 2008 Jun;47(6):685-92.
DOI: Link
PubMed: Link
11. Osmonov D, Ragheb AM, Petry T, Eraky A, Bettocchi C, Lamers KG, Van Renterghem K, Tropmann-Frick M, Chung E, Jünemann KP, Garaffa G, Porst H, Mohamed AG, Wilson SK. (2025) Value of prolonged scrotal drainage after penile prosthesis implantation: a multicenter prospective nonrandomized pilot study. Int J Impot Res. 2025 Jan;37(1):87-91.
DOI: Link
PubMed: Link
12 Palmisano F, Boeri L, Ievoli R, Sánchez-Curbelo J, Spinelli MG, Gregori A, Granata AM, Ruiz-Castañé E, Montanari E, Sarquella-Geli J. (2022) Ten-year experience with penile prosthetic surgery for the treatment of erectile dysfunction: outcomes of a tertiary referral center and predictors of early prosthetic i. Asian J Androl. 2022 Jan-Feb;24(1):32-39.
DOI: Link
PubMed: Link
15. Siana JE, Gottrup F. (1988) Nikotin og karbonmonoxids indflydelse på perifert vævs funktion og sårheling [The effects of nicotine and carbon monoxide on peripheral tissue function and wound healing]. Ugeskr Laeger. 1988 Jul 4;150(27):1650-2.
PubMed: Link
16 Jorgensen LN, Kallehave F, Christensen E, Siana JE, Gottrup F. (1998) Less collagen production in smokers. Surgery. 1998 Apr;123(4):450-5.
PubMed: Link
Your request to us
Your contact: Felix Jung
Intimate Surgery Office
Mon – Fri from 9.30 am – 7 pm
Alternatively, you can conveniently book an appointment online for a telephone consultation with one of our doctors.
or fill out our contact form:
