Penile Implants

Who is a candidate for penile implant surgery?

A penile implant may be considered when erections remain inadequate despite appropriate treatment, or when other options cannot be used, are poorly tolerated or no longer meet the patient’s needs. It is a hospital-based operation, and assessment confirms whether the expected benefit justifies surgery.

• Men with severe erectile dysfunction associated with diabetes, vascular or nerve injury, previous pelvic surgery or other physical conditions.
• Men who cannot use suitable medicines or injections because of contraindications, side effects or treatment burden.
• Men with Peyronie’s disease, fibrosis or previous penile surgery together with erectile dysfunction that supports an implant-based approach.
• Men who understand the alternatives and lasting implications of implantation and can follow the recovery plan.

An implant can be removed or replaced if necessary, but removing it does not restore the original erectile mechanism. This is why careful discussion of alternatives and expectations is essential.

Assessment before penile implant surgery

Preparation includes a review of your medical records and previous erectile-dysfunction treatments, an examination and relevant blood tests. In Dr. Amin’s practice, urinary-system and inguinal-hernia assessment, with ultrasound where appropriate, forms part of the work-up for most implant candidates.

Penile colour Doppler ultrasound is arranged for selected patients when assessment of blood flow or tissue changes will help diagnosis and treatment planning. Any urinary symptoms, previous operations, curvature, loss of length, previous filler or difficulty using the hands should be discussed before choosing a device.

Penile implants in patients with diabetes

Well-controlled diabetes does not automatically exclude penile implant surgery. Dr. Amin reviews glucose control, HbA1c, general health and other factors affecting healing before recommending an individual plan.

In Dr. Amin’s preoperative optimisation protocol, the preferred goals are fasting blood glucose below 150 mg/dL, blood glucose two hours after a meal below 180 mg/dL, and HbA1c below an individually agreed target, usually 7–7.5%. These are his clinical preparation goals, intended to support recovery and reduce avoidable complications; they do not guarantee a complication-free recovery. If control is inadequate, treatment may be postponed while diabetes care is optimised.

The American Urological Association guideline does not specify this numerical combination as a mandatory threshold for every implant patient. The European Association of Urology guideline notes that an ideal pre-implant HbA1c threshold has not been established by randomised trials. Suitability depends on the whole assessment, not one test result alone.

Choosing between an inflatable and a malleable implant

For men who are suitable and can operate the pump, an inflatable implant offers a transition between a firm erection and a softer resting state that many patients find closer to their previous experience. Dr. Amin generally prefers an appropriate Boston Scientific or Coloplast inflatable device when this fits the patient’s anatomy, hand function, expectations and budget.

A malleable, or semi-rigid, implant remains a useful option. It is positioned by hand, is mechanically simpler and usually costs less. It may be preferable when pump operation would be difficult or when simplicity is the priority. The most suitable implant is not necessarily the most expensive one.

• Malleable implants: bendable rods that stay firm and are positioned manually.
• Two-piece inflatable implants: cylinders and a pump, without a separate abdominal fluid reservoir.
• Three-piece inflatable implants: cylinders, a scrotal pump and a separate reservoir, allowing inflation and deflation.

A malleable implant can sometimes be exchanged for an inflatable device later. This requires another operation and reassessment of tissue condition, health and surgical risk; it is not a simple external upgrade.

Brands and device choice

Options discussed in Dr. Amin’s practice include Boston Scientific, Coloplast and Rigicon. Examples include the inflatable AMS 700 family and two-piece Ambicor from Boston Scientific, the Coloplast Titan family, and Rigicon’s Infla10 family. Malleable examples include Tactra, Genesis and Rigi10 respectively. Exact models and local availability are confirmed during consultation.

Coloplast is a Danish parent company whose US urology business includes the heritage of the former Mentor products. A company’s headquarters do not by themselves establish the manufacturing origin or regulatory status of every device.

Compare penile implant models, types and indicative costs

FDA-approved inflatable options

When an inflatable implant is suitable, Dr. Amin generally prefers FDA-approved options from Boston Scientific, such as the AMS 700 family, or Coloplast, such as the Titan family. Selection remains individual and takes account of anatomy, hand function, previous treatment, preferences and local availability. FDA authorisation is one consideration; it does not guarantee an individual result.

The FDA record for the AMS 700 and the FDA record for the Coloplast Titan document premarket approvals. “FDA approved” and “FDA cleared” describe different regulatory routes and are not interchangeable. Status applies to the particular device and indication, rather than automatically to every product made by its manufacturer.

Does a penile implant increase size?

The primary purpose is rigidity, not enlargement. An implant is fitted to the available erectile chambers. Restoring firmness may improve the functional appearance compared with a weak erection, but it does not guarantee greater anatomical length or recovery of length lost through fibrosis or other disease.

Sizing requires careful intraoperative measurement and judgement. The internal corporal measurement is different from visible penile length. The choice of cylinder and rear-tip extenders must suit the anatomy and the device’s sizing instructions.

Progressive shortening, increasing curvature or fibrosis deserves prompt assessment. In Peyronie’s disease with severe erectile dysfunction that responds inadequately to treatment, an implant may be considered, with straightening or reconstruction when needed. The phase and stability of disease and tissue condition influence timing; increasing plaques alone do not make immediate implantation appropriate for everyone.

Read more about implant sizing, progressive shortening and device selection

Implants after prostate cancer treatment

Erectile dysfunction can follow radical prostatectomy or radiotherapy for prostate cancer; after radiotherapy it may develop gradually. Before considering an implant, Dr. Amin reviews recovery, previous treatment and the likelihood of further natural recovery. He coordinates with the cancer team to assess current disease control and any planned additional treatment.

There is no single waiting period after prostatectomy or radiotherapy that is suitable for every patient. Timing is agreed individually once recovery and the cancer-treatment plan have been reviewed. A current oncology assessment guides this decision; it cannot guarantee that cancer will never recur.

When urinary leakage and erectile dysfunction occur together

If troublesome stress urinary incontinence accompanies severe erectile dysfunction after prostate treatment, both problems should be assessed. In selected patients, an artificial urinary sphincter and an inflatable penile implant can be placed during the same operation; other patients benefit from staged procedures. Dr. Amin’s reconstructive practice includes combined sphincter and implant surgery, with planning based on leakage severity, previous radiotherapy and the condition of the urethra and surrounding tissues.

Read about artificial urinary sphincter surgery for men and urine leakage after prostate surgery.

Planning the operation

• Complete the medical assessment and discuss suitable devices, alternatives and expected outcomes.
• Agree the surgical plan, including any additional reconstruction, and obtain an itemised quotation.
• Confirm the exact device and its supply through an authorised route arranged with the clinical team.
• Complete preoperative preparation, admission and anaesthetic assessment.
• Arrange postoperative reviews, device training and support before the operation.