What is a penile prosthesis?
A penile prosthesis is a medical implant placed inside the two erectile chambers of the penis (corpora cavernosa) to treat erectile dysfunction permanently. It is also known as a penile implant. The prosthesis takes over from the natural erection mechanism and allows the man to achieve sufficient rigidity for intercourse whenever he wishes.
A penile prosthesis is not the first option in the treatment of erectile dysfunction. First, the underlying causes are investigated, and methods such as lifestyle changes, oral medication and, where needed, injection therapy into the penis are tried. For patients who do not benefit sufficiently from these treatments, cannot use them because of side effects or prefer a permanent solution, a prosthesis is a strong option. For detailed information on erectile dysfunction and the other treatment steps, see the erectile dysfunction page.
Who is it suitable for?
A penile prosthesis is usually considered in the following situations:
- Erectile dysfunction that does not respond to oral medication or injection therapy
- Severe loss of erections due to diabetes or vascular disease
- Erectile dysfunction after surgery for prostate, bladder or rectal cancer, or after radiotherapy
- Advanced Peyronie’s disease (penile curvature) together with erectile dysfunction
- Conditions in which the tissue inside the penis has become severely hardened (fibrosis)
In patients with an active urinary tract or skin infection, uncontrolled blood sugar or general health problems that would make surgery unsafe, the operation is postponed or other options are considered.
Assessment before surgery
At the consultation, the doctor asks about the duration of erectile dysfunction, previous treatments, other illnesses and medications. A genital examination is carried out; if needed, blood sugar, HbA1c, hormone levels, a urine test and a urine culture are requested. People with heart disease may need a cardiology assessment before anaesthesia.
During this consultation, the types of prosthesis, the expected results of surgery and possible risks are explained in detail. Making the decision together with the partner, where possible, has a positive effect on satisfaction after surgery.
Types of penile prosthesis
The choice of prosthesis is made individually after examination, taking into account the patient’s expectations, manual dexterity, the anatomy of the penis, previous operations and general health.
Three-piece inflatable prosthesis
This consists of two cylinders placed inside the penis, a pump placed in the scrotum and a fluid reservoir placed in the lower abdomen. When the pump is pressed, fluid moves from the reservoir into the cylinders and the penis becomes rigid; afterwards, the fluid is returned to the reservoir and the penis becomes soft. This is the type of prosthesis that provides the most natural feeling of erection and flaccidity.
Two-piece inflatable prosthesis
This consists of the cylinders and a pump that also acts as the reservoir; no separate reservoir is placed in the abdomen. It may be preferred in patients who have had previous abdominal or groin surgery and in whom placing a reservoir is not suitable.
Malleable (semi-rigid) prosthesis
This consists of two bendable cylinders placed inside the penis. The penis is always semi-rigid; it is bent upwards for intercourse and downwards at other times. Because it has no mechanical parts, it is simple to use and the likelihood of failure is low. It may be a suitable option for patients with limited manual dexterity.
How is the operation performed?
The operation is performed under general or spinal anaesthesia. The erectile chambers are usually reached through a small incision where the penis meets the scrotum or at the base of the penis. The chambers are dilated appropriately, measurements are taken and cylinders of a suitable size are placed. With inflatable implants, the pump is placed in the scrotum and the reservoir in the lower abdomen.
To reduce the risk of infection, antibiotics are given before and after surgery, and particular attention is paid to skin preparation. The hospital stay is usually 1–2 days.
Recovery
- Swelling, bruising and pain in the penis and scrotum are expected in the first days and are controlled with painkillers.
- Most patients can return to desk work within 1–2 weeks.
- Heavy lifting and strenuous sport should be avoided for a few weeks.
- Sexual intercourse usually begins after 4–6 weeks, following a check-up.
- With inflatable implants, the patient is shown how to use the pump in practice at the check-up.
Risks and possible problems
As with any surgical procedure, penile prosthesis surgery carries risks:
- Infection: The most important risk. If it develops, the prosthesis usually has to be removed. In diabetic patients, good blood sugar control is important for reducing this risk.
- Mechanical failure: With inflatable implants, fluid leakage or pump failure can develop over the years; in this case, a further operation is needed to replace the part.
- Erosion and displacement: Rarely, parts of the prosthesis may press on surrounding tissue or move out of position.
- Bleeding and haematoma: Blood may collect in the scrotum; it usually resolves on its own.
- Changes in sensation and perceived length: Some patients may perceive the penis as shorter than before.
Because the erectile tissue is permanently altered once a prosthesis has been placed, it is usually not possible to go back to other treatments such as tablets or injections. For this reason, the decision should not be rushed and should be made after discussing all options.
Sex life with a prosthesis
A penile prosthesis makes erections independent of the natural nerve and blood vessel mechanism. This means that, when there is sexual desire and arousal, the man can achieve rigidity whenever he wishes and for as long as he wishes. However, the prosthesis does not increase sexual desire, does not change sensation in the penis and does not solve ejaculation problems; these functions depend on their state before surgery.
With inflatable implants, using the pump takes some practice in the first weeks; most patients get used to it quickly. At the check-up, the doctor demonstrates in practice how to inflate and deflate the pump and answers any questions.
In the medical literature, penile prosthesis is among the treatments with high satisfaction for both patients and partners. The most important factors determining satisfaction are a realistic discussion of expectations before surgery, choosing the right type of prosthesis and involving the partner in the process. For couples who have not had sexual intercourse for a long time, readjusting to a sex life may take time; sex therapy support may also be recommended during this period if needed.
Common misconceptions
- “The prosthesis is visible from the outside.” All parts are inside the body; no part is visible from the outside.
- “The prosthesis makes the penis bigger.” The prosthesis does not lengthen the penis; the aim is to provide sufficient rigidity at the existing size.
- “Sensation is lost after a prosthesis.” The nerves responsible for sensation in the penis are preserved.
- “A prosthesis is suitable for every man.” A prosthesis is an option considered for patients in whom other treatments have not been sufficient; suitability is determined after examination.
Follow-up
The first check-up after surgery is usually within 1–2 weeks, and the check-up at which use of the prosthesis begins is at around 4–6 weeks. After that, an annual check-up may be sufficient. If you notice fever, redness, increasing pain, discharge or a change in how the prosthesis works, seek advice without delay.
Penile prosthesis surgery in Bursa, Turkey
Op. Dr. Mücahit Kabar graduated from Uludağ University Faculty of Medicine and completed his urology residency at the Urology Clinic of Ankara Training and Research Hospital. He has scientific studies in the field of andrology published in international peer-reviewed journals. In Bursa (Nilüfer), he sees patients with erectile dysfunction and questions about penile prostheses at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00) and Özel Jimer Hastanesi (weekdays 13:00–17:00), with particular care for privacy.
Consultations are held in English or Turkish. The hospitals’ international patient departments can arrange interpreters for other languages and help with airport transfers and accommodation. If you are travelling from abroad, you can book the consultation in advance through the online booking page or appointment line of Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) or Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67); the final decision on any possible surgery is always made after an in-person examination. For questions before you travel, you can send a message via WhatsApp (+90 541 622 54 82). More information is available on the international patients page and the contact page.
