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Penile Implants for ED Treatment

 

When non-surgical ED treatments fail or are not well tolerated, penile implants remain an excellent option to restore the ability to have sexual intercourse, while suffering with erectile dysfunction. Penile implants are manufactured by American Medical Systems (AMS) and Coloplast, formerly Mentor.

 

Malleable Penile Prosthesis

A malleable penile prosthesis are penile implants that have 2 separate cylinders that are semi-rigid.; These penis implants never change in size and are similar in some ways to a goose neck lamp as the neck of the lamp maintains a certain position when not manipulated, but can be bent or straightened. The malleable penile implant is generally maintained in a downward position, and then bent into an upward position prior to intercourse. The advantage of the malleable penile prosthesis is the technical ease of insertion, and ease of use. The disadvantages of the malleable penile implants include the semi-rigid appearance of the penis at all times, and an increased risk of discomfort and erosion. Semi-rigid devices are infrequently selected at this time.

 

Malleable penile implant
Malleable Penile Implants

 

AMS Penile Prosthesis, Ambicor

A 2-piece penile implant is available from AMS called the Ambicor Penile Prosthesis. This device does not contain a reservoir, only the cylinders and a pump. As the pump is used, fluid is transferred between the pump and the cylinders. The advantage is that there is no need to place a reservoir. In some cases, prior abdominal, hernia, vascular, or reconstructive surgery represents a contraindication to reservoir placement, and we then use an Ambicor penile implant in these cases. The disadvantage of the Ambicor penile prosthesis is that the device, compared to the 3 piece inflatable penile prosthesis (that has a separate reservoir), is that it is less soft when flaccid and less rigid when firm. When non-surgical treatments for erectile dysfunction fail or are not well tolerated, penile implants remain an excellent ED treatment option to restore the ability to have sexual intercourse.

 

Ambicor Penile Prosthesis
Ambicor Penile Prosthesis


Inflatable Penile Implant Prosthesis 3-piece

The most commonly used penile implants, also called a penile prosthesis, is a 3 piece device consisting of cylinders that are placed within the penis, a pump that is placed under the skin of the scrotum, and a reservoir that is placed adjacent to the bladder. One could argue that the 2 cylinders should be counted as 2 pieces, but are considered as one piece. Options include the AMS 700 penile prosthesis, manufactured by American Medical Systems, and the Titan penile implant, manufactured by Coloplast. The Mentor penile prosthesis is now a Coloplast product as Coloplast purchased Mentor. The 3 pieces are connected by tubing that transfer’s fluid between the components. When a man wants to have penile rigidity, he squeezes the pump several times, and this causes a transfer of fluid from the reservoir to the cylinders leading to penile rigidity. The pump has a valve or button. When this is depressed, the fluid is then transferred back from the cylinders to the reservoir. The Coloplast and AMS penile implants are similar in overall appearance and function. However, there are differences. The Titan products are silicone penile implants with cylinders composed of a solid silicone elastomer called Bioflex. This features a hydrophilic coating, meaning that when immersed in fluid containing antibiotics prior to placement, the antibiotics will stick to the exterior of the cylinders, a feature that may prevent infections. The AMS product is coated with antibiotics, and this is called Inhibizone.

 

Penile Implant Illustration AMS Penile Prosthesis Penile Implant Rear Tip Penile Implant Reservoir Penile Implant Pump Coloplast Titan Implant

This slideshow will provide you with pictures of inflatable 3-piece penile implants. All penile prosthesis components are placed inside the body. The 3 pieces are the cylinders (2 of them) that go inside the penis, a pump that is placed in the scrotum next to the testicles, and a reservoir that is located next to the bladder and cannot be felt.

This is a picture of an inflatable penile implant is manufactured by American Medical Systems (AMS). The yellowish color is an antibiotic coating, and this helps prevent the complication of an implant infection after penile prosthesis surgery. You can see the 2 cylinders, the pump, and the reservoir.

The penile prosthesis cylinders come in several different lengths. Precise adjustment of the penile implant length at the time of the implant surgery can be achieved with the addition of rear tip extenders that can add length in 0.5 cm increments.

The reservoir of a penile implant contains fluid. This fluid moves through the tubing from the reservoir into the cylinders when the pump (see next picture slide) is squeezed. The fluid then returns back to the reservoir when a button on the pump is pushed..

The penile implant pump is placed in the scrotum under the skin between the testicles. When the penile prosthesis pump is squeezed, the penis becomes inflated and rigid as fluid moves from the reservoir into the cylinders within the penis, causing the cylinders to expand. After intercourse, when the button is pushed, the fluid then goes back into the reservoir, and the penis again becomes soft and deflated.

This is the 3-piece inflatable penile implant manufactured by Coloplast. This device is soaked in an antibiotic solution prior to implantation. The surface of the penile implant was designed so that the antibiotics are then absorbed by the penile prosthesis. The goal is to reduce the incidence of the complication of penile implant infections. This implant is deflated by pushing (with a thumb and finger) the button between the arrows as shown.




Titan penile prosthesis
"Titan" Inflatable Penile Implant - Prosthesis manufactured by Coloplast, cylinders not inflated

Titan penile implant
"Titan" Inflatable Penile Implant - Prosthesis manufactured by Coloplast, cylinders inflated

 

It is difficult to really determine which product is better. Urologists who publish or give lectures on the topic of penile implants are often paid consultants with one company and tend to support that particular erectile dysfunction product. These relationships must be mentioned when manuscripts are submitted for publication in Urology journals or abstracts are submitted for presentation at Urology meeting such as the Annual Meeting of the American Urological Association. However, these relationships that create the potential for bias are seldom disclosed on the internet. The Center for Reconstructive Urology and Dr. Gelman has never accepted any monetary funding from an implant manufacturer.

 

Penile Implant Surgery

To find out more about penile implant surgery and the complications of penile implant surgery visit our surgery page. Dr. Gelman and The Center for Reconstructive Surgery does an excellent job in explaining the details of surgery to help you make a much more informed decision on whether or not penile implant surgery is right for you.

 


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Center for Reconstructive Urology | 333 City Boulevard West, Suite 1240 | Orange, CA 92868
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