When is penile prosthesis an option?
For men with erectile dysfunction, a complete history and physical examination identifies potential causes of erection issues. If a man is an appropriate candidate, there are four possible treatment options including oral medication (phosphodiesterase inhibitors such as sildenafil or Viagra), penile injection therapy/intraurethral suppository, vacuum erection device (VED), or penile prosthesis. See our summary of erectile dysfunction for more background.
If phosphodiesterase-5 inhibitors (PDE5i) and injection therapy (prostaglandin-based mixtures) are not successful in improving erectile function (or are contraindicated), then penile prosthesis may be the appropriate option for some men. The two major manufacturers of penile prostheses (either inflatable or semi-rigid) include American Medical Systems (Endo Pharmaceuticals) and Coloplast and decisions to use one company versus the other are largely based on physician or patient presence since both devices are associated with excellent outcomes. The cylinders or rods of the prosthesis are inserted into each corporus cavernous (the two erectile chambers, see image below), one of which is shown highlighted in yellow in the sketch below. For the inflatable penile prosthesis, a pump is placed in the scrotum which is used to activate the prosthesis, and fluid is drawn from the reservoir which is traditionally placed in the lower pelvis (in the space of Retzius, next to the bladder) but new reservoir modifications allow placement more superficially (called “ectopically” above the transversalis fascia and below the transversus abdomens muscle).
The American Medical Systems patient resource site and the Coloplast patient resource and Straight Talk sites are useful to review before considering such a procedure. We are pleased to discuss additional aspects of erectile dysfunction and the penile prosthesis insertion procedure. Please contact us for additional information.
- Penile prosthesis insertion is a safe and reliable option for certain men with erectile dysfunction (from multiple causes) who have failed other types of therapy.
- Excellent outcomes can be obtained with a variety of devices and patients can return home either the day of or one day following the procedure.