A permanent device inserted into the penis that allows for an erection in cases of impotence (erectile dysfunction), which often occurs in the wake of treatment for some types of male reproductive cancers. When other therapies for erectile dysfunction fail, men can choose from a variety of other options.

Surgical implantation of penile prosthetic devices is still an accepted means of restoring erectile capability in impotent men. In 1989 U.S. surgeons implanted an estimated 27,500 penile prostheses. That number has declined only somewhat since the advent of penile injection, alprostadil (muse) therapy, and Viagra. Since about 30 to 35 percent of impotent men who try Viagra or other medications do not respond well enough to resume sex, some impotent men will probably continue to have penile prosthesis surgery or other erection assistance to help them resume sexual activity.

The primary risk of the penile implant is infection; if this occurs, the entire device must be removed. Moreover, once a prosthesis has been implanted and then removed, other forms of treatment usually are not effective. This is why other treatment methods should be tried before choosing surgical prosthesis.

Types of Devices

There are more than 15 different varieties of implants, ranging from one-piece rigid structures to self-contained unit implants, which cost an average of between $8,000 and $15,000. Most involve synthetic cylinders surgically placed inside the penis; after four to six weeks, the patient is ready to engage in sex. Because erection is achieved through the implant parts and not the flow of blood into the penis, the erect penis is generally cooler to the touch than it would be otherwise.

The semirigid device does not increase penis width but bends up for intercourse and down at other times. This type of prosthesis is the easiest to insert and involves the fewest mechanical problems, but is also the least natural-looking.

Inflatable prosthesis look quite natural, since when deflated the penis is flaccid, and when inflated the penis is erect. The two-piece inflatable unit includes two cylinders, one in each side of the penis, with a small pump in the scrotum. Squeezing the pump pushes fluid into the cylinders, making the penis erect. The three-piece unit includes a reservoir inside the abdominal wall near the bladder that contains additional fluid; this allows for a more rigid penis.

However, the more complex the device, the more likely are mechanical problems. Today the failure rate is about 10 percent at 10 years. This treatment is irreversible and should be considered a last resort. Still, although the method is expensive and requires surgery, up to 90 percent of patients are satisfied with the inflatable prosthesis.

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