Penile prosthesis (implant)
For men in whom other erectile dysfunction treatments have failed, implant surgery has among the highest satisfaction rates of any procedure in men's health.
What a penile prosthesis is
A penile prosthesis is a device implanted inside the penis to produce an erection reliably, on demand, whenever you choose. It replaces the erection mechanism rather than trying to stimulate it, which is why it works when tablets, injections and vacuum devices have not.
There are two types:
- Inflatable (three-piece) implants — two cylinders in the erectile bodies, a small pump concealed in the scrotum, and a fluid reservoir placed in the abdomen. Squeezing the pump produces a natural-feeling, rigid erection; releasing a valve returns the penis to a flaccid state. This is the most commonly used type and gives the most natural result both erect and flaccid.
- Malleable (semi-rigid) implants — two bendable rods that are positioned by hand. Simpler, with no mechanical parts to fail, and easier to use for men with limited hand dexterity, but the penis remains permanently firm and is bent down when not in use.
Who it is for
Implant surgery is considered where erectile dysfunction has not responded to, or is unsuitable for, other treatments. Common situations include:
- ED after radical prostatectomy or pelvic radiotherapy where recovery has not occurred
- Severe diabetic or vascular ED
- Peyronie's disease with significant ED, where curvature can be corrected at the same operation
- ED following prolonged priapism, where the erectile tissue has scarred
- Men who cannot tolerate or do not wish to continue injection therapy
This decision is irreversible
Implanting the device requires the natural erectile tissue to be dilated, and it cannot be undone. If the implant is ever removed, natural erections do not return. That is the single most important thing to understand before consenting, and it is why I encourage men to have exhausted or genuinely rejected the alternatives first, and to involve their partner in the discussion.
Before surgery
Assessment covers your ED history and what has been tried, your general health, diabetes control, any previous pelvic or penile surgery, and examination for Peyronie's plaques and penile length. Where you have diabetes, good glycaemic control before surgery materially reduces infection risk and may need optimising first. Urine is checked and treated for infection. Your expectations — and your partner's — are discussed carefully, including what the implant will and will not change: it produces rigidity, but it does not alter sensation, orgasm, ejaculation, libido or penile length.
The operation
Surgery is performed under general or spinal anaesthetic, usually through a single small incision at the base of the penis or in the scrotum. The erectile bodies are dilated and measured, the cylinders sized and inserted, the pump placed in the scrotum and the reservoir positioned in the abdomen. Where there is Peyronie's curvature, straightening is performed at the same time. Infection precautions are rigorous, including antibiotic-coated or hydrophilic-coated devices and a strict no-touch technique.
Most men stay one night. A catheter is used overnight in many cases.
Recovery and using the device
Expect swelling, bruising and discomfort for two to four weeks. The device is left deflated initially and you will be shown how to operate it at a follow-up appointment, usually around four to six weeks after surgery. Sexual activity is normally resumed at around six weeks, once you are comfortable and have been taught to use the pump. Learning to cycle the device takes a little practice, and function improves over the first few months as the tissues settle.
Risks
The main risks are infection, which is uncommon but serious and usually requires removal of the device; mechanical failure over time, which is repairable; erosion or migration of components; persistent pain; and a perceived reduction in penile length. Diabetes, previous radiotherapy, revision surgery and immunosuppression increase infection risk. All of this is discussed in detail before you consent.
My practice
I am Director and Clinical Lead for the Andrology Prosthesis Centre at Guy's Hospital, a supra-regional network for prosthetic surgery which includes Guy's, King's College Hospital, Imperial College and Oxford. I am a past National Chair of the BAUS Andrology section, teach prosthetic surgery nationally and internationally, and have performed live surgery workshops. I accept complex and revision referrals, including implantation after priapism and after failed surgery elsewhere.
Frequently asked
Will anyone be able to tell I have an implant?
Not when clothed, and not in normal circumstances. Modern three-piece implants leave the penis looking and feeling natural when deflated, and the pump sits discreetly within the scrotum. A partner will know, and a doctor examining you will find it, but it is not externally visible.
Does an implant change sensation or orgasm?
No. The implant provides rigidity only. Sensation, the ability to reach orgasm and the sensation of orgasm are unchanged, because the nerves responsible are not disturbed. If you were unable to ejaculate before surgery — after prostatectomy, for example — that will not change either.
How long does the device last?
Modern implants are durable, and the large majority are still working many years after implantation. Mechanical failure can occur eventually, and the device can be revised or replaced, which is a simpler operation than the original because the space already exists.
Will I lose length?
Many men perceive some loss of length, though measured length usually changes little. This is partly because the implant restores rigidity to the length you currently have rather than the length you remember before ED developed, and partly because ED and prostatectomy themselves cause shortening over time. Discussing this honestly beforehand avoids disappointment afterwards.
Can an implant be placed if I have had priapism or previous surgery?
Yes, though scarring makes it technically harder, and in prolonged priapism early implantation is sometimes recommended precisely because scarring worsens with time. These cases benefit from a surgeon who does them regularly — they are a substantial part of my referral practice.
Speak to my team
Appointments at The Shard and Canary Wharf are arranged by my PA, Jeanette Bush. Tell us briefly what the problem is and we will find the right clinic slot for you.