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Penile Prostheses

Penile prosthesis implantation represents the ultimate option for the treatment of end-stage erectile dysfunction (ED). 
Modern prostheses have a high mechanical reliability, are associated with low infection rates which translates  into high patient satisfaction. The satisfaction rates are higher than any other treatment modality.

Originally developed in the 1970’s, and refined in the following decades, penile implants now represent a durable and safe solution for men when all conservative treatment options have failed or are contraindicated. 

What are the indications for penile prostheses?

  1. Any patient with Erectile dysfunction that fails to respond to oral medication, penile injections , vacuum devices or any other modality.
  2. Patients where conservative therapy is contraindicated eg:
    1. Viagra, Cialis, Levitra, Spedra  when taking Nitrate containing drugs
    2. Caverjet/Viridal  - in patients on Warfarin, history of priapism
    3. Vacuum devices – anticoagulants
  3. Patient choice after trying other treatments
  4. Advanced Peyronie’s Disease
  5. Following penile or pelvic trauma
  6. Priapism
  7. Buried penis
  8. In conjunction with penile reconstruction.

Patients considered for penile prosthesis implantation should have a thorough physical and psychological assessment to ensure that surgery is the appropriate option for them. While implant surgery is quite effective at achieving functional goals, patients need to undergo adequate counseling regarding what to realistically expect from this procedure and possible complications. Penile prosthesis implantation usually represents the final step of a long diagnostic and therapeutic pathway, when all the spectrum of medical treatments has proved ineffective or not suitable.

When penile prosthesis implantation is contemplated, the patient’s preference as well as lifestyle, body habitus and previous medical history will often determine the best device option for the patient.

It is important to review all device options with the patient to give him enough time to absorb and process all of the information to make a decision. In these conversations, patients should be shown samples of the various devices in order to allow them to appreciate the texture of the cylinders and familiarize themselves with the shape of the pump. 

Adequate preoperative counseling and management of patient’s expectations play a very important role in determining postoperative patient’s satisfaction rates. Internet advertising can often be misleading and produce unrealistic expectations. Patients need to be fully aware that the goal of penile prosthesis implantation is to guarantee a straight and rigid penis for penetrative sexual intercourse with preservation of sensation and orgasmic function. Occasionally there maybe reduced glans engorgement that will need additional medical treatment. Penile prosthesis implantation will not increase the length of the penis or restore the length loss due to Peyronie’s Disease, fibrosis or long lasting ED. Patients also need to be aware that penile prosthesis implantation represents the last resort and is irreversible, as it causes permanent damage to the muscle of the inside of the penis. 


The inflatable implants last 10 -15 years depending on use after which they will need to be changed. 

Check list:

  • Tried/been offered all other therapies
  • Handled all of the implant types
  • Expectations met
  • Complications discussed
  • Able to meet and discuss with other patients
  • Possible psychosexual counseling
  • Partner in agreement 

Common questions that should be asked:

  • Will it feel different during sexual intercourse?

  • Does a penile prosthesis allow for some romantic spontaneity?
  • How will my penis look?
  • How long will I be in the hospital?
  • Will anyone be able to tell that I have an implant? 

What are the different types of penile prostheses?

Coloplast Corporation and American Medical Systems (AMS) produce the most widely used penile prostheses. Both companies produce inflatable and malleable penile prosthesis.

A malleable prosthesis gives a  semirigid erection at all times. The penis is maneuvered into position for intercourse and bent either alongside the inner thigh or under the trouser belt for concelement when not needed.
An inflatable prosthesis involves the transfer of fluid into the penis when an erection is desired, and then back into a reservoir when a flaccid penis is needed.

In a 3 piece device, the fluid is stored in the reservoir which is hidden in the pelvis. By squeezing the pump that is within the scrotum, fluid is then transferred into the cylinders within the penis to become erect. 

Once finished, a release button on the pump is pressed to allow the fluid to return to the resevoir and deflate the penis.

In general, young and physically active patients with good dexterity and a larger penis are better served with 3 piece inflatable penile prosthesis, since this type of device allows excellent girth expansion and rigidity and during deflation allows the penis to be easily concealed. On the other hand, in older patients, where concealment of the penis is not an issue and poor dexterity is more common, a malleable penile prosthesis might be the better choice.

A 2 piece device is also available which has a mixture of attributed and is reserved for  those who have had extensive abdominal surgery to avoid the placement of a reservoir.

Implant types 


Coloplast Titan Touch

Hydrophilic coat for antibiotic absorption 


AMS 700 series

Antibiotic impregnated into device 

Malleable penile prostheses 


AMS Spectra 


The Coloplast Genesis 

2 piece prosthesis – pump and cylinders only 


The AMS Ambicore 

The Operation

Patients are admitted usually on the day of surgery or the night before if traveling long distances.

All patients should be screened before surgery for MRSA skin infection, urine culture to exclude infection and routine blood tests for the anaesthetic.
The operation takes approximately 1 hour and is performed under general anaesthetic.

Diagram of where the components are positioned:


Step 1: The incision

Step 2: Incision in one corpora and dilate to the tip

Step 3: Measure the length of the prosthesis needed

Step 4: Insert the cylinders on both sides

Step 5: Place reservoir in pelvis through same incision

Step 6: Place pump in scrotum and close wound

The penis is wrapped up overnight and deflated the next day, the catheter removed and the patient discharged.

  • Discharged with 7 days of antibiotics and pain killers
  • To wear supportive underware for 1 week
  • Shower after day 2 – a waterproof dressing will cover the wound
  • To see the doctor at 7 days for a wound check
  • To commence pumping the device at 2 weeks if pain allows after tuition
  • Time off work 2 weeks
  • Sex is allowed at 6 weeks 

Nice position of the pump at 2 weeks

What are the satisfaction and modern outcomes?

Currently available prosthesis models have undergone numerous design enhancements to improve long-term reliability and overall patient’s satisfaction. The  overall satisfaction with penile prostheses is generally around 90% .

Recent long-term data shows that need for revision for any reason is as low as 7% in modern devices with functional longevity over 60% at 15 years. Antibiotic coating has perhaps been the most significant improvement in design of penile prosthesis with a more than 50% decrease in infection rates. The current expected infection rate is 1% for uncomplicated implants, but this may be higher in diabetics or in those having a revision.
  • Penile prosthesis implantation is indicated in patients when all conservative treatments have proven not successful or are contraindicated,
  • Penile prosthesis implantation is a safe and reproducible procedure and is associated with a patient’s satisfaction rate of more than 90%,
  • The operation is a minor operation that takes 1 hour, with current infection rates of 1%,
  • Ask your surgeon how many prostheses he inserts per year as this is directly proportional to a successful outcome,
  • The implant may need to be changed at 12 years,
  • The pre-operative assessment and counselling is the most important attribute to get a good outcome.

About Men’s Health International Surgical Centre

MHISC is a collective group of five International and European recognized surgeons. Leading experts from England, France, Italy and Serbia have been brought together to establish a global centre of excellence in the fields of genital and urethral reconstruction, erectile dysfunction (penile implants), peyronie’s disease, genital reconstruction for trauma, cancer and male infertility.

The idea is to create a base in Europe which will carry out the above surgeries and treatment in a bespoke, boutique private facility. Patients travelling to the centre would be offered the best treatment available in a comfortable and luxurious setting.

Given the nature of the procedures performed, confidentiality is paramount and therefore establishing a centre in Europe would allow patients from around the world to travel with discretion. This is particularly the case with patients from the Middle East who are currently travelling outside the Middle East to have their surgeries carried out by our specialists.

Ideally located between Geneva and Lausanne, Clinique de Genolier offers sweeping views of Lake Geneva, Mont-Blanc and the Alps. A presidential suite and junior suites furnished in contemporary style and “La Table”, a gourmet restaurant, ensure an exceptional standard of hospitality for the patients.

With 106 beds and 198 admitting physicians, it is one of the largest private clinics in Switzerland. Clinique de Genolier offers specialist medical care, one of the most up-to-date operating theaters in Europe, an experienced medical team and premier-quality hotel services.

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