Penile Implants

Penile implants are recommended only when other treatment options for erectile dysfunction fail to work.
There are different types of penile implants, each having its own pros and cons.

Penile implant surgery is not recommended in the following cases:

1. Possibility of erectile dysfunction being reversible
2. Erectile dysfunction due to emotional problems
3. Lack of sexual sensation or desire
4. Presence of urinary tract infection
5. Presence of lesions, inflammation, or other problems associated with the skin of the penis or the scrotum

Types:
The type of penile implant used will vary depending on the preference and need of the individual. The different types of penile implants are:

1. Inflatable implant: This type of implant consists of two cylinders situated in the penis and an inflatable pump in the scrotum area. As the pump is squeezed and released, the cylinders will fill with a saline solution that will mimic a penile erection. The different types of inflatable implants include:
2. One-piece inflatable: These types of penile implants have a saline solution at the end of each of the cylinders in the penis.
3. Two-piece inflatable: These types of penile implants have a saline solution within the pump in the scrotum.
4. Three-piece inflatable: These types of penile implants will have a fluid-filled container present in the abdomen. They feel more like a natural erection than other types of penile implants.
5. Inflatable implants for transgender individuals: A new inflatable type of implant, known as the ZSI-475 FTM implant, has one inflatable pump in the shape of the testicles and a stopper in the shape of the penis glans is anchored to the public bone of a transgender individual.
6. Semi-rigid or malleable rods: Two flexible rods are implanted by the surgeon into the penis. These implants do not change in stiffness or size and maintain a semi-rigid state. These implants usually bend downwards but can be straightened into an upward position for sexual activity. These penile implants are more uncomfortable compared to inflatable implants.

Symptoms

A penile implant surgery is performed to treat erectile dysfunction in a man. This surgery is usually performed in the following cases:

1. Persistent erectile dysfunction impairing a man’s sexual life
2. Medications for erectile dysfunction, such as sildenafil, vardenafil, tadalafil, and avanafil have failed to work
3. A penis pump (a vacuum constriction device) has failed to work
4. Penile injection medicines like TriMix have failed to work
5. Presence of Peyronie’s disease (when scar tissue in the penis causes it to curve, bend, or lose its girth or length) that does not improve with other treatment methods
6. History of prostate cancer
7. History of prostatectomy (surgery to remove a part or all of the prostate gland)
8. As a part of a gender affirmation surgery (surgery to transition people to their self-identified surgery)

Diagnosis

1. Physical examination: The patient’s penis and testes are examined physically by the doctor. The nerves in the penis region are also checked for sensation.
2. Blood tests: A sample of the patient’s blood is sent to the laboratory to check for signs of diabetes, heart disease, low levels of testosterone, and other health conditions.
3. Urinalysis: This test helps in checking for signs of diabetes or other underlying health conditions.
4. Ultrasound: This test involves the use of a transducer, which is a wand-like device. This device is held over the blood vessels that supply blood to the penis. This creates a video image to let the doctor check for any blood flow problems. This test may sometimes be done along with the injection of certain medicines into the penis for stimulating the blood flow and producing an erection.
5. Electrocardiogram (ECG): This test is performed to evaluate the electrical activity of the heart.
6. Psychological exam: The doctor will ask the patient certain questions to screen for depression or other possible mental conditions that could lead to erectile dysfunction.

Treatment

1. The procedure may be performed under general anesthesia (the patient is made unconscious during the procedure) or spinal anesthesia (the area from the waist downwards is made numb).
2. The urologist will insert a catheter into the bladder through the penis.
3. A catheter is a hollow, soft tube that will allow urine to flow out of the body. The catheter will normally be removed after the surgery.
4. A pain medicine will be injected to keep the patient numb even after the completion of the procedure.
5. An incision is then made on the genital area and a penile implant is inserted into the corpora cavernosa (two tubes of spongy tissue that can get filled with blood and make the penis hard).
6. The penile implant size will be customized according to the size of the penis.
7. In the case of a two-piece inflatable implant, the urologist will later insert the pump and valve inside the scrotum. Additional small incisions may or may not be necessary to place these components.
8. In the case of a three-piece inflatable implant device, besides the pump and the valve the urologist will also implant a reservoir of fluid above or below the abdominal wall by using a small initial incision. Sometimes, a second incision in the abdomen may also be used.
9. After the insertion of the implant, the surgeon closes the incisions using dissolvable stitches.
10. Small silicone tubes known as surgical drains may be stitched in the incision sites.
11. These surgical drains help in removing the blood or fluid from inside the body.
12. A bandage will then be placed over the incision site.
13. The procedure usually takes one to two hours to complete.

Risks

Penile implant surgery may be associated with the following complications:

1. Uncontrolled bleeding
2. Infection
3. Damage to the urethra (from where the urine is eliminated from the body)
4. Scar tissue formation
5. Mechanical failure
6. Erosion of skin (wearing away of the layers of skin)
7. Adhesion of the implant to the skin inside the penis
8. Displacement of the pump or reservoir
9. Reduced blood flow to the penis head
10. Feeling of shorter length of the penis

After Procedure

1. Most patients can go home on the same day of the surgery.
2. The doctor will prescribe pain-relieving medications and antibiotics to relieve discomfort and prevent infection.
3. It is normal to have some pain and swelling after the procedure. This pain should usually decrease free one week. However, you may continue to have mild tenderness for six weeks after the surgery.
4. You can usually resume work one week after surgery. However, if you have a physically challenging job, you may have to wait for two to four weeks before you can resume work.
5. If a surgical drain has been placed, your doctor will remove it one to three days after the surgery.
6. Have a follow-up appointment with your doctor after four to six weeks to learn how to use the penile implant.

Home remedies:

The following tips can help in a quick and smooth recovery following penile implant surgery:

1. Avoid strenuous activities and heavy lifting for four to six weeks after surgery.
2. Avoid sexual activity for four to six weeks after surgery.
3. Take all your prescribed medications regularly.
4. Keep the surgical area dry and clean.
5. Wash your hands thoroughly before changing the bandages.
6. Wash your hands before and after using the restroom.
7. Apply an ice pack to the surgical area for up to 10 minutes, several times a day to ease your pain and swelling.

Benefits:

The advantages of penile implant surgery are:

1. Relatively safe procedure with less risk of complications
2. Good results
3. Good durability of penile implants, that is, most penile implants last for about 20 years
4. Improved sexual life
5. Increased self-esteem of the patient
6. Outpatient procedure, that is, the patient can go home on the same day of the procedure 

Cost of penile implant surgery in India- 

The cost of penile implant surgery in Mumbai is between INR 1,00,000 to INR 3,00,000.
The cost of penile implant surgery in Delhi is between INR 90,000 to INR 2,75,000.
The cost of penile implant surgery in Bangalore is between INR 90,000 to INR 2,75,000.
The cost of penile implant surgery in Chennai is between INR 80,000 to INR 2,50,000.