An inflatable penile implant is a device used in the treatment of severe erectile dysfunction in selected cases. Its operation allows the penis to alternate between rigidity and flaccidity through a surgically implanted hydraulic mechanism. This content provides general clinical information about how an inflatable penile prosthesis works, possible indications and aspects related to penile implant surgery.
An inflatable penile implant may be indicated for patients who have not achieved a satisfactory response with other treatments for erectile dysfunction or who have experienced significant side effects.
Placement of the device requires surgery and, after implantation, activation is performed by operating a pump located in the scrotum, which transfers saline solution from the reservoir to the cylinders implanted in the penile shaft.
What is an inflatable penile implant?
This model has cylinders implanted inside the penis and a pump inserted in the scrotum. When clinically authorised and after medical guidance, the patient can operate the pump so that the saline solution reaches the cylinders, promoting penile rigidity.
Who is an inflatable penile implant indicated for?
The inflatable penile implant, also known as a hydraulic penile implant, may be indicated for patients with severe erectile dysfunction. In general, these are cases refractory to conservative treatments, such as oral medication or intracavernosal injections.
Patients who have experienced significant side effects with medication or injections may also be considered candidates for penile implant surgery.
In addition, the implant may be recommended in selected cases of penile deformities after medical assessment, as may occur in patients with Peyronie’s disease.
Although age is not, by itself, a determining factor for the indication of an inflatable penile implant, it should be considered during clinical assessment.
Younger patients tend to keep the implant for a longer period and, for this reason, may have a greater likelihood of requiring future device replacement.
On the other hand, older patients may have motor limitations of the hands, which can make handling the scrotal pump more difficult and affect the ability to obtain adequate rigidity.
Difference between inflatable and malleable penile prostheses
The difference between an inflatable penile prosthesis and a malleable penile prosthesis lies mainly in the degree of control and the final appearance.
An inflatable penile prosthesis allows the patient to inflate and deflate the device according to the instructions received and their adaptation to handling. In some cases, it may provide a more discreet appearance when compared with other models.
A malleable penile prosthesis consists of rods that keep the penis in a state of partial rigidity. Some patients may experience discomfort or require adaptation, especially during the initial period, and guidance on care and positioning should be defined by the medical team.
What are the types of inflatable penile implant?
There are two types of inflatable penile implant, composed of two or three components:
- Two-piece inflatable penile implant: a pair of cylinders with an integrated reservoir, implanted in the penis, and a pump positioned in the scrotum.
- Three-piece inflatable penile implant: a pair of cylinders implanted in the penis, an activation pump housed in the scrotum and an independent reservoir, usually positioned in the abdominal region.
In addition, inflatable penile implant models differ according to the type of cylinder expansion.
- Standard: the cylinders have length and diameter characteristics that may be suitable for specific cases, according to penile anatomy and medical assessment.
- Narrow: the cylinders have a smaller diameter and may be considered for patients with specific anatomical characteristics, such as longer and thinner penises. Model choice should take stability, anatomy and therapeutic goals into account, according to medical assessment.
Penile implant components: cylinders, pump and reservoir
An inflatable penile implant is composed of the following elements:
Pump
The pump is positioned in the scrotum and is responsible for transferring the saline solution from the reservoir to the cylinders, and vice versa. This is the component the patient operates to obtain penile rigidity.
Cylinders
The cylinders are tubular structures inserted inside the corpora cavernosa. These structures receive the saline solution from the abdominal reservoir and participate in the mechanism that allows penile rigidity during use of the device.
Adequate functioning is related to the appropriate choice of cylinders, according to penile anatomy and the surgical technique used.
Reservoir
Usually located in the pelvic region, in the lower abdomen, the reservoir of the inflatable penile implant tends not to be externally visible, although perception may vary according to the patient’s anatomy and clinical context.
This reservoir is filled with saline solution, which is transferred to the cylinders when the pump is operated, participating in the penile rigidity mechanism of the device.
Use of extenders
If the selected cylinder is shorter than the length of the penis, the surgeon may use prosthesis extenders. These are pieces that attach to the cylinder to increase the length of the implant.
The use of extenders should be carefully assessed, as it may influence the rigidity and stability of the prosthesis. In certain situations, it may be associated with reduced stability during penetration, with a possible functional impact on the implant.
How is inflatable penile implant surgery performed?
Inflatable penile implant surgery may have a variable duration, depending on the complexity of the case, the patient’s anatomy, the technique used and the need for associated procedures.
The procedure is performed under sedation or general anaesthesia.
Through a subcoronal incision made below the glans, the surgeon introduces the prosthesis components into the corpora cavernosa of the penis, aiming to respect the anatomical structures according to the surgical conditions of each case. This stage may be performed with the organ in an induced erection.
The surgeon then tests the functioning of the implant by inflating and deflating the prosthesis several times. This check allows assessment of whether there are mechanical limitations that may influence the functioning of the device.
In cases where there is penile curvature, retraction or loss of volume due to fibrosis, associated penile reconstruction may need to be considered, according to clinical and surgical assessment. The absence of reconstructive treatment, when indicated, may influence the stability and functioning of the prosthesis.
Postoperative period and recovery
After penile implant surgery, the patient may experience pain, usually controlled with analgesic medication.
The patient should remain at rest and keep the surgical dressing in place for a few days.
In addition, postoperative medical follow-up is essential, with reassessment appointments to monitor recovery progress.
The recovery period may extend for several weeks, varying according to each patient’s clinical progress. Light activities, such as working and driving, may be resumed in some cases after medical guidance, while more intense activities, such as sport, should wait for authorisation from the healthcare team. Sexual activity should be resumed only after medical advice.
How an inflatable penile implant works
After the components have been implanted and the intraoperative functioning of the device has been checked, the medical team should guide the patient on the appropriate use of the prosthesis.
To activate the prosthesis, the patient should press the pump according to the guidance received, promoting the transfer of liquid from the reservoir to the cylinders. This mechanism allows the device to inflate and may provide penile rigidity during use.
For the penis to return to a partially flaccid state, it is necessary to perform a downward bending movement in the case of a two-piece prosthesis, or to press the pump deactivation mechanism in the three-piece model, allowing the liquid to return to the reservoir.
How much does an inflatable penile implant cost?
The cost of the inflatable penile implant alone may vary between €5,000 and €9,000.
The total cost of surgical treatment depends on several factors, including medical team fees, anaesthesia and the institution where the surgery is performed. Detailed information should be provided during consultation.
Is an inflatable penile implant covered by insurance or the NHS?
In Portugal, coverage for this type of surgery depends on the framework of the National Health Service or the patient’s health insurance.
Within the National Health Service, access is subject to individual clinical assessment, the criteria of the hospital institution and the applicable care framework. Any reimbursement or access to the procedure should be confirmed with the responsible healthcare unit.
In health insurance, coverage depends on the contracted conditions, the provider network and any applicable exclusions or limits.
How long does an inflatable penile implant last?
The durability of an inflatable penile implant varies from case to case and may last for several years, depending on the implanted model, clinical conditions, type of use and evolution of the device over time.
In some cases, implant replacement may become necessary due to wear, mechanical failure or functional or structural changes in the device.
The need for revision surgery should always be assessed in consultation by a urologist, according to the performance of the implant.
Inflatable penile implant: possible benefits and limitations
After discussing the indication and the different types of inflatable penile prosthesis, it is important to understand the possible benefits, limitations and care associated with its use.
Penile rigidity
The implant may allow penile rigidity during sexual activity in appropriately selected patients, depending on device function, adaptation to its use and the individual clinical context.
Controlled erection
Appearance and adaptation to the device
An inflatable penile prosthesis may provide greater discretion in some cases when compared with the malleable model, as it allows a partially flaccid state of the penis. Adaptation under underwear and aesthetic perception vary according to anatomy, implant type and individual clinical progress.
Possible impact on sexual life
The prosthesis may contribute to greater predictability in sexual activity in selected patients. This aspect may influence performance anxiety and frustration associated with recurrent episodes of difficulty during sexual intercourse, although the response varies between patients.
Psychological well-being and adaptation to treatment
Resuming sexual activity, when it occurs satisfactorily for the patient, may have an impact on psychological well-being and perceived self-esteem, with this response being variable and dependent on individual factors.
An inflatable penile implant may be a therapeutic option in selected cases of erectile dysfunction, and its indication should result from specialist urological assessment.
For clinical clarification and individual assessment, you may request information about a medical consultation to understand whether this treatment may be suitable for your case.