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Surgical Options for Erectile Dysfunction

Learn about surgical options to treat erectile dysfunction in this Howcast video.

Transcript

When we talk about surgery for erectile dysfunction, then we have probably already exhausted many of the other treatment options that are available. As a last resort, then, we will discuss with patients the option of surgical intervention. What this requires is implantation of a penile prosthetic device.

Penile prostheses have been used for hundreds of years, historically. Many, many, many years ago, people actually implanted fragments of bones into the penile tissues. This allowed patients to have a firm penis. Penile implantation therapy has come a long way. We no longer implant bones. But we have prosthetic devices that can be used. These come in many shapes and forms.

We have something called a semi-rigid penile prosthesis where the erectile bodies are identified, the tissue within the erectile bodies are cored out and we insert malleable rods directly into the penis. These rods are firm all of the time. They can be manipulated to different shapes and angles. This is the simplest form of a penile prosthetic and requires insertion of two rods within the penile tissues.

There is also something called an inflatable penile prosthesis. These also come in several different types. The principles are the same. These generally have anywhere from two to three components, depending on the type of prosthetic you are using. They have cylinders that go into the penile tissues. In their natural state, they are deflated and soft. However, there is a system whereby fluid can be pumped into these cylinders to make them firm and rigid. There are various different pump mechanisms and things like that.

There is a device that is a two-piece unit, which is comprised of the cylinders as well as a reservoir and a pump, all contained in one, and usually, that reservoir and pump is contained within the scrotal area. The three-piece unit has two cylinders. The cylinders are connected on one end to a reservoir, which is a sac that is filled with fluid, and then on the other end to a pump mechanism, or an activation mechanism, that is then implanted into the scrotal area. Again, in the natural state, these cylinders are flaccid. When you're ready for sexual activity, you would activate the activation, or pump, mechanism that will then trigger the cycling of fluid into the penile bodies, into the penile cylinders.

A couple of important things to note with surgical therapies. It is not a way of increasing penile length. In fact, in many cases, the length will actually shorten slightly. It does require a surgical procedure, where there are incisions. Also, these are mechanical devices, which are prone to all of the potential consequences or side effects that we can see with mechanical devices. This includes things such as infections. Infections can be a serious complication when talking about penile prosthetic devices. If there is an infection, then these commonly have to be removed.

Also, you should note that once you have this procedure done, you can no longer ever have normal erections or even the ability to have normal erections. Because during the procedure the normal erectile tissues are completely cored out and they will no longer function normally. So, it is a procedure, which can benefit many patients in the appropriate circumstances. But you should seriously consider some of the potential risks and long-term potential side effects to these types of products. This should be discussed extensively with your surgeon or with your urologist prior to undergoing this procedure. You should also talk to them about the potential alternative treatments that are available prior to undergoing surgical intervention.

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