Penile implant surgery may be indicated in severe cases of erectile dysfunction and also when erectile dysfunction is associated with changes in penile anatomy.
Penile prosthesis is a therapeutic alternative indicated for men who do not achieve a satisfactory response to clinical treatments for erectile dysfunction, such as oral medications or intracavernosal injections.
The procedure may also be considered in cases of significant penile curvature, narrowing, or reduction in penile size, when the deformity causes structural instability severe enough to make penetration during sexual intercourse difficult or impossible.
The main goal of the implant is to provide the conditions necessary for adequate penile rigidity for penetrative function, while respecting the anatomy, clinical history, and individual characteristics of each patient, with a focus on functional recovery and quality of life.
What is erectile dysfunction
Erectile dysfunction is characterized by difficulty obtaining or maintaining an erection rigid enough, or for long enough, to allow satisfactory sexual intercourse.
It is important to note that isolated episodes may occur in situations of tiredness, anxiety, or stress, without necessarily representing a clinical condition.
However, loss of penile rigidity in most sexual encounters and a reduction in the frequency of erections, including the absence of morning erections for three months or longer, may indicate erectile dysfunction; therefore, the condition should be evaluated by a urologist.
What is a penile prosthesis and who is it indicated for
Penile implant surgery is a treatment indicated for conditions that result in loss of penile function, such as severe erectile dysfunction of organic origin and the anatomical changes seen in Peyronie’s disease.
Penile prosthesis for erectile dysfunction may be indicated when the man does not respond, or stops responding, to oral medications or intracavernosal injections.
Men with penile curvature, cardiovascular disease, diabetes, reduced testosterone levels, or a history of prostatectomy may have a higher likelihood of being candidates for penile implant surgery.
Types of penile prosthesis
Currently, the penile implants most commonly used in clinical practice for erectile dysfunction are:
- Inflatable or hydraulic prosthesis: this model may have two or three components and is activated by a pressure pump placed in the scrotum, which produces the erection. When deflated, it allows the penis to return to a partially flaccid state.
- Malleable or semirigid prosthesis: made up of two metal rods coated with silicone, this implant keeps the penis elongated permanently. The organ must be positioned manually for sexual intercourse.
Does a penile prosthesis work? What changes after implantation
Penile prosthesis surgery is a treatment used when there is an appropriate clinical indication.
The main change after implantation is that the patient may recover penile function. As a result, it may be possible to achieve adequate penile rigidity, including after orgasm.
The ability to reach orgasm, sensitivity, and ejaculation generally remain unchanged, since the surgery seeks to preserve the nerve structures as much as possible and does not involve manipulation of the urethra.
In clinical practice and in studies, some patients report improvement in penile rigidity after implantation, which may positively affect confidence and male sexual health.
The results, however, depend on each patient’s clinical condition and on the adaptation process to the device.
Penile prosthesis vs. other treatments
The most appropriate therapeutic approach for each case of erectile dysfunction depends on the severity of the condition and, consequently, on its impact on sexual life.
In mild to moderate cases of erectile dysfunction, clinical treatment with medications or intracavernosal injections may help facilitate erection. This is because it promotes oxygenation of the corpora cavernosa of the penis.
However, in severe erectile dysfunction, the vascularization of these tissues may already be compromised. In these cases, clinical treatment does not always produce a satisfactory response, and penile prosthesis may represent a therapeutic alternative.
The implant may also be considered in certain cases of erectile dysfunction associated with Peyronie’s disease, when anatomical changes compromise erection.
How penile prosthesis surgery is performed
Penile implant surgery aims to provide sufficient rigidity to allow adequate penile rigidity, helping restore erectile function.
For this purpose, before placing the prosthesis, the surgeon may use the Egydio Technique for penile reconstruction. This approach aims to adapt penile dimensions to prosthesis placement, allowing the insertion of a prosthesis with a length and girth suited to the patient’s penile anatomy.
Through multiple carefully calculated geometric incisions, the technique allows controlled expansion of the corpora cavernosa within the safe anatomical limits imposed by the nerves, blood vessels, and urethra.
The surgeon’s experience and appropriate postoperative follow-up influence the planning, progression, safety, and outcomes of the procedure. Even so, as with any surgery, there are associated risks, which should be properly explained and discussed during the medical consultation.
Pre- and postoperative period: what the patient needs to know
Following pre- and postoperative instructions is important to reduce the risk of complications, including problems related to adaptation to the penile prosthesis.
Before surgery, the urologist performs a detailed clinical evaluation to define the best surgical strategy. This assessment includes the following examinations:
- Palpation of the penis;
- Measurement of the penis;
- Drug-induced erection test;
- Penile Doppler ultrasound to evaluate blood flow in the region.
The postoperative period includes a recovery phase lasting between 45 and 60 days, depending on each patient’s progress, with gradual return to activities:
- 5 to 10 days after surgery: care of the surgical dressing;
- 7 to 10 days after surgery: return to work, provided there is no physical exertion, and authorization to drive;
- 30 to 45 days after surgery: resumption of physical activity;
- 45 to 60 days after surgery: resumption of sexual activity.
During this period, the patient should attend follow-up consultations to evaluate healing, learn how to activate the prosthesis, and receive guidance on resuming sexual life with safety and quality.
Why seek a specialist in penile prosthesis
Penile reconstruction is an important stage of the surgery, because the result will determine the appropriate sizing of the penile prosthesis.
A urologist with experience in penile prosthesis should plan and evaluate each patient’s individual needs with precision and in an individualized manner. This care is important to align the outcome of the procedure with the patient’s real expectations, especially when there is a desire to preserve penile size.
Penile prosthesis implantation is a well-established treatment, with safety data described in the literature when properly indicated. The cost of a penile prosthesis may be covered by the Portuguese National Health Service or by health insurance, depending on each case.
If you have questions about erectile dysfunction treatment in Portugal, send your question and wait for contact from the clinical team.