What You Should Know About Erectile Dysfunction Surgery

Erectile dysfunction (ED) is the inability to achieve and/or maintain an erection firm enough for satisfactory sexual activities. 

Many men experience erectile issues occasionally throughout their lives, but ED is a typically chronic condition that may cause those experiencing it to feel stressed and alone. However, ED is a common condition affecting around 18%¹ of men in the US. 

Causes of erectile dysfunction

Many factors can contribute to erectile dysfunction, including:

• Lifestyle factors, such as smoking or drinking too much

• Psychological issues, such as stress, anxiety, and depression

• Certain medications, such as antidepressants

• Various health conditions or diseases, such as type 2 diabetes and cardiovascular disease

• Hormonal imbalances

• Injury to the pelvic area, such as from an accident or past surgery

Treatment options

Many treatment options are available to manage and treat ED. Which ones are used depends on the condition’s underlying causes and each individual’s needs and preferences. Treatment options may include:

• Altering lifestyle factors, such as quitting smoking or increasing physical activity

• Counseling for psychological issues like stress or anxiety

• Changing medications that may be contributing to the ED

• Hormonal therapies, such as testosterone replacement therapy

• Oral medications, such as sildenafil (Viagra)

• Medications that can be injected directly into the penis

• Medications that can be inserted into the end of the penis

• A vacuum device that works by drawing blood into the penis

• Surgical procedures

Can erectile dysfunction be fixed with surgery?

Surgery can be an effective ED treatment option for people who mainly fail medical treatment, allowing them to achieve and maintain an erection to participate in sexual activities again. 

Your healthcare provider will work with you to identify and address any underlying causes of the condition. They will likely recommend medications before they recommend surgery. 

Oral medications are considered first-line treatment options for ED alongside lifestyle changes. Healthcare providers usually try these before other, more complex, or invasive treatments. 

Second-line treatment options include vacuum devices, injectable medications, and insertable medications. 

ED surgery is generally recommended for those who have found first- and second-line treatments ineffective or who can’t use them for various reasons, such as allergies, or for patients undergoing surgery for curvature abnormalities.

What is the surgery for erectile dysfunction?

Vascular reconstructive surgery

An erection occurs when there is increased blood flow into the penis. When there is inadequate blood flow, it cannot stay fully erect. Vascular reconstructive surgery is a procedure that aims to increase blood flow to the penis to help a man achieve and maintain an erection. 

The most common vascular reconstructive surgery involves anastomosis of the inferior epigastric artery to the dorsal penile artery, called the Hauri technique. This allows increased blood flow to the penis by bypassing narrowings within the penile blood supply and increasing the supply.

This surgery has a reasonable success rate² and may be most effective for otherwise healthy young men who are non-smokers and have recently acquired erectile dysfunction due to a focal arterial occlusion. 

Of note, only about 7%³ of men with vascular erectile dysfunction are candidates for revascularization, and the long-term success rate is about 50% to 60%. 

Penile implant surgery

Penile implant surgery is a procedure that involves implanting a prosthetic device into the penis that helps a man achieve and maintain an erection. 

Once the prosthetic device is implanted in the penis and recovery from the surgery is complete, the device can be used to achieve an erection. How the device is used to achieve an erection depends on the implant type. 

What is a penile implant?

A penile implant is a prosthetic (artificial) device inserted into the penis, allowing you to achieve an erection manually. 

There are several options available for penile implants,⁴ and which one you choose depends on your personal needs and preferences. There are two main categories of penile implants: inflatable and semi-rigid. 

Inflatable implants are more commonly used, and they can be inflated to achieve an erection and deflated when not needed. In contrast, semi-rigid implants are somewhat firm all the time. 

Two-piece implant (inflatable)

A two-piece implant consists of two cylinders placed inside the penis and a reservoir of salt water and a pump placed inside the scrotum. These implants allow the penis to be partially flaccid when deflated.

The advantage of a two-piece design is that it is a simple operation, with less than 5% mechanical failure rates over five years.

Three-piece implant (inflatable)

A three-piece implant is another type of inflatable implant. It consists of two cylinders inside the penis, a pump inside the scrotum, and a reservoir of salt water placed behind the abdomen wall. 

These implants allow the penis to be nearly fully flaccid when deflated. 

Semi-rigid implant

This implant consists of one or two rods placed inside the penis that are somewhat malleable in shape and maintain a semi-firm state. They are usually made of silicone or rubber and have a metal core. These bend easily but may have springback, determining the ease of concealment.

Who needs penile implant surgery?

First-line treatments for erectile dysfunction, such as medications, are not effective for everyone. Some people can’t take certain medications, and others may not respond to them. 

In cases like these, a healthcare provider may recommend penile implant surgery. It may also be recommended for men with a condition called Peyronie’s disease,⁵ which causes scarring along the shaft of the penis that may extend into the deep tissues of the corpus cavernosum, a curved penis, and painful erections that may prevent penetration. 

How does a penile implant work?

How a penile implant works depends on the type of implant you choose. But with all of them, erections achieved should feel similar to a regular erection, and they do not inhibit your ability to orgasm. 

Inflatable implants mimic the blood flow into the penis, usually when a man gets an erection. 

For two-piece implants, you would inflate the implants with salt water by squeezing the pump in the scrotum. The pump moves the salt water from the reservoir in the scrotum into the cylinders inside the penis, inflating them and causing the penis to become erect. 

To deflate the implants, you would release a valve at the base of the penis that moves the salt water back into the reservoir. 

Three-piece implants work similarly, except the salt water is pumped from the reservoir behind the abdominal wall instead of inside the scrotum. 

Because semi-rigid implants are always firm, a penis with these implants is always in a semi-rigid state. You would usually have the penis positioned against the body when not in use and then move it into position when required.

How effective is a penile implant for erectile dysfunction?

Penile implant surgery is successful and effective for many people. Research has shown over 80%⁶ of patients and partners are satisfied with the results of three-piece inflatable implants.

Satisfaction rates for two-piece inflatable implants range from 75% to 96.4%.⁷ Inflatable implants tend to be preferred over semi-rigid implants and are more commonly used. 

Regardless, patient satisfaction rates from surveys show a range of 69% to 86.6% with semi-rigid implants. 

Benefits of penile implants

Penile implants are discreet as they are completely concealed inside the body. They allow men control over their sexual activities, achieving required results quickly and easily. 

Penile implants are also durable, with up to 85%⁸ of implants lasting around ten years. 

Is a penile implant safe?

Penile implants are generally considered safe, but some complications can occur. These include reservoir leakage, mechanical malfunctions, and infection. 

Issues with the implant itself may require repair surgery, and infection treatment may require removal of the implant. 

What should I expect?

Before surgery

Penile implant surgery is usually performed at a hospital or surgical clinic by a specialized doctor called a urologist. You may be given some antibacterial soap to wash with for a few days before the surgery. 

You may also be instructed not to eat before the surgery. You will need to arrange for someone to drive you home once you are discharged from the hospital or clinic. You may also be asked to stop particular medications that may affect bleeding before the surgery.

Your doctor may give you the option of being awake or asleep during the procedure. If you decide to remain awake, the bottom half of your body will be numbed with medication before the procedure begins. If you choose to be asleep, you will receive medication to make you unconscious and be monitored carefully throughout the surgery. 

The surgical area will be shaved and cleaned, and you will also receive IV antibiotics during the surgery. Both these methods help prevent infection.

During surgery

The procedure may be done differently depending on the type of implant. It should take around 45 minutes to 2 hours. 

The surgeon will make an incision either below the head of the penis, at the base, underneath it, or in the lower abdomen. They will then stretch the tissue inside the penis and place the implant inside. 

They will place a valve and pump inside the scrotum if they are implanting a two-piece inflatable implant. If they are implanting a three-piece implant, they will place a pump inside the scrotum and a reservoir under the abdominal wall. 

After they ensure all implant pieces are in the correct position, they will sew the incision site closed. 

After surgery

You may be able to go home the same day you receive the surgery, but in some cases, you may be required to stay in the hospital overnight. 

You will be prescribed pain medication to help with the discomfort, and you may also be prescribed antibiotics to prevent infection. You may be instructed to use ice packs to help with swelling and discomfort. 

Your healthcare provider will instruct you when you can resume work and physical activity and when you can resume sexual activity. They may also provide instructions on how to use the implant. 

Results

Penile implant surgery will likely require 4–6 weeks of recovery before you can resume sexual activity. As mentioned earlier, most people who receive penile implants are satisfied with the results. 

Risks of penile implant surgery

As with any surgical procedure, there are some risks involved in penile implant surgery. 

Infection

The most severe risk of penile implant surgery is infection. Antibiotics are usually given during and after surgery to prevent it. 

If an infection does occur, more antibiotics will be needed, or the implant may need to be removed and replaced. 

Bleeding

Bleeding may result in bruising or a hematoma, an area of pooled and clotted blood. Hematomas may be managed with antibiotics to prevent infection, compression dressings, rest, and ice application. 

The lowdown

Erectile dysfunction surgery is one option for managing erectile dysfunction. It may be recommended for men who have found other treatment options, such as medication, ineffective for treating the condition. Vascular reconstructive surgery may be effective for some, but penile implant surgery has a higher success rate. 

There are inflatable and semi-rigid implant options available, and sexual activity may be resumed 4–6 weeks following surgery. Occasionally, complications such as infection, bleeding, or device malfunction may occur, in which case more surgery may be required to fix the issue.