Erectile dysfunction (ED) is experienced by approximately 30 per cent of men when they reach the age of 50 or above. In certaincases the syndrome may also affect younger men and is generally caused by underlying health problems, such as diabetes, nerve disease or even psychological issues.
Most patients are prescribed special medications which are rather helpful in curing ED. However, in some cases any drug treatment fails, and invasive methods (or, simpler, surgery) become indispensable. Let us discuss main invasive treatments of ED and see how they help the male patients.
Penile implantation was invented more than three decades ago and is the oldest ED surgical treatment. Until some time ago it was considered the only invasive solution for sexual frustration.
Basically, a penile implant is a prosthetic device which is placed inside the penis in order to perform the functions that the body fails to fulfill on its own. Penile implant surgeries normally last for about an hour or two and usually take place with a general anesthesia. Interventions may be performed in general hospitals if they require an overnight stay or in outpatient clinics. Patients can resume their sexual life about 4-6 weeks after the surgery.
Penile implantation is most suitable for the patients who:
- have had a radical prostatectomy;
- have the blood vessels in their penis permanently destroyed by severe diabetes;
- have structural problems that make their erections impossible or difficult.
Most implants remain functional for at least 7-10 years before a replacement is needed. However, certain patients have stated to experience no problems with their implants for over 15 years. Besides, many manufacturers offer lifetime warranties for devices, their parts and components.
Penile implants are becoming more and more reliable, and several new models are invented every year. In order to eliminate the risk of infection which is on average experienced by 1 patient out of 100, many implants now feature antibacterial properties.
Two types of penile implants are available – semirigid or malleable rod implants and inflatable implants.
Semirigid penile implants
Semirigid devices consist of two matching silicon cylindrical parts which are surgically implanted into the erection chambers of the penis. Both cylinders form a flexible rod, and in order to achieve an erection it is enough to slightly adjust the position of the penis manually. Semirigid implants ensure easy and immediate penetration and are rather durable. They are typically indicated for men with spinal cord injuries and/or limited hand strength.
Here are the main advantages of semirigid prosthetic devices:
- Simple surgery;
- Relatively few post-intervention complications;
- No moving parts;
- Quite high efficiency.
Still, being the most simple and the least expensive option, semirigid or malleable rod implants have several major drawbacks. Once implanted, they destroy the natural erectile mechanisms and substitute them with constant semi-rigid position of the penis at all times. Only the newer models are more flexible and allow positioning the penis against the leg for a more natural appearance and feel. Semirigid devices may cause pains and inconveniences and they also make the penis look slightly artificial which may be rather difficult to conceal.
Inflatable penile implants
Just like their semirigid mates, inflatable implants are made of two cylinders but they also imply using two additional parts. There is a pump placed into the scrotum between the testicles and a saline reservoir implanted in the lower abdomen. This is a so-called 3-piece version of an inflatable implant but there is also a 2-piece version which implies putting both the pump and the reservoir in the scrotum.
In order to cause an erection, you should press on the pump, thus making fluid move from the reservoir to the cylinders. The expansion of the cylinders creates an erection. Pressing on a deflation valve in the lower part of the pump makes the saline flow back in the reservoir, and the penis returns to its normal flaccid state.
Inflatable devices are normally invisible to other people. All that others may notice is a small scar in the place where the penis meets the scrotal sac or an equally small mark in the lower part of the belly. The overwhelming majority of men would not notice if they meet a man with penile prosthesis in a locker room or a public restroom.
Inflatable implants do not affect the sensibility of the penis, a man’s ability to reach orgasm or ejaculation process. However, the latest models have specific cylinders which enable the regulation of the length and thickness of the penis.
Inflatable devices are considered more safe and comfortable then the semirigid ones. They enable more natural erections and let the man choose when he wants his penis to be in an erected position. However, many patients note that their erection with the implant is slightly shorter than before the surgery.
Another score in favor of inflatable implants is their high efficiency. Approximately 95 per cent of inflatable devices produce quick and stable erections which are suitable for normal sexual intercourse. Such implants also have high satisfaction rates, with around 85 per cent of the users being satisfied with the results and stating that they would choose this intervention again if they were given such a chance.
From the technological point of view there are fully inflatable and self-contained inflatable unitary implants. Both types ensure natural appearance of the penis, imitate the natural rigidity-flaccidity processes and enable user control of the intensity of erection.
Despite all their advantages, inflatable implants have certain drawbacks. All such devices have a rather high risk of mechanical breakdown and are relatively expensive. Apart from that, once an inflatable prosthesis is implanted, a man usually stops having natural erections. If the implant is removed, the ability to achieve natural erections will be lost forever.
Vascular Reconstructive Surgery
If you are not happy with the idea to cure erectile dysfunction by means of implanting an artificial device in your body, consider another invasive option – vascular reconstructive surgery. There are two main types of this intervention:
- Reconstruction of the arteries within the penis (revascularization). This option implies increasing blood flow to the genitalia which helps to achieve and maintain an erection. During the intervention the surgeon transfers an artery from a muscle in the patient’s abdomen or leg to the one within his penis, placing it along the damaged blood vessel and thus creating a new path for blood to move to and from the penis tissues.
- Blocking off the veins within the penis (venous ligation). Such surgery is aimed at preventing blood from leaving the penis which also improves erectile function and helps to maintain an erection longer. Blocking-off is performed only when a specific blood-flow problem is identified.
Vascular reconstructive surgery has its indisputable advantages. This treatment does not imply placing any artificial object, and hence the risk of getting infected or having pains is minimal. In case the intervention is successful, natural erection is not destroyed but improved and prolonged.
In most cases artery repairs are performed with a laparoscope which not only ensures quick recovery but also leaves only small incisions and makes the result absolutely invisible to other people. Hence, vascular reconstructive surgery normally does not change the natural appearance of the penis and enables the man to feel almost as confident as if he had no ED.
Having quite a few contraindications, vascular reconstructive surgery is partly experimental, and only few patients can be potential candidates for this treatment. Artery repairs are recommended only for younger men whose ED is associated with a local arterial blockage and was caused by an injury to the penis or the pelvis in general (eg. crotch injuries or fractures). Vascular surgeries are not offered to patients who have high blood pressure or suffer from diabetes.
Vascular treatment is technically difficult and requires extensive medical testing, with the efficiency rate being about 60 to 75 per cent for revascularization and 40 to 50 per cent for venous ligation. Interventions sometimes provide rather unimpressive results and some men state that their post-surgery erections do not make the penis rock hard. Besides, not every medical center performs reconstructive surgery for ED, and even if they do, the cost of the intervention will be very high.
Possible side effects of vascular reconstructive surgery include scar tissue formations and nerve damage, both of which may cause impotence. A more common but less severe consequence are uncomfortable erections. In certain cases the intervention may lead to distortion or numbness of the penis.
Despite all contraindications and possible complications, invasive treatment is a good solution for patients with erectile dysfunction who have failed to resolve their problem otherwise. However, it should be always borne in mind that invasive treatments (and especially penile implantation) typically have irreversible effect. They are used only when ED is highly unlikely to improve naturally or with the help of non-invasive medical treatment.