Penile Implant for Erectile Dysfunction

Causes of Severe Erectile Dysfunction

Severe erectile disorders for which a penile implant may be appropriate usually have one of three main causes: impaired blood flow to the penis, induratio penis plastica (Peyronie's disease), or nerve damage following radical prostate removal. Vascular problems reduce blood flow to the penis and thereby cause erectile dysfunction of varying severity. Induratio penis plastica causes hardened areas within the erectile tissue, which can further restrict the ability to achieve an erection.

After radical prostate removal, around 50 percent of men develop severe erectile dysfunction^[5]. This often comes as a surprise, because this risk is sometimes not adequately discussed before the surgery.

The Psychological Burden – and the Question of Penile Length

Many men who experience severe erectile dysfunction, for example after radical prostate removal, avoid seeking medical help for a long time out of shame. When they eventually do, conservative treatment options are usually tried first, in various stages – rightly so.

If these no longer show any effect after a while, affected patients often experience an additional effect: because natural erections may have been absent for years, the erectile tissue contracts and partially breaks down – the penis becomes shorter. This places an additional burden on many patients.

In most cases, a hydraulic implant can largely restore the original penile length that existed before the underlying condition – either through stretching alone or with an additional reconstructive procedure. This still applies even when the erectile dysfunction has already been present for a long time. In overweight patients, reducing suprapubic fat tissue can additionally help to enhance the visual effect^[3].

When Is a Penile Implant Appropriate?

A penile implant is not a first-line therapy. It becomes an option when other treatments have been exhausted or are not suitable:

• Erectile dysfunction caused by physical damage – for example impaired blood flow or nerve damage following prostate surgery
• PDE-5 inhibitors (tablets) no longer help or are not tolerated
• Damage to the erectile tissue caused by induratio penis plastica (Peyronie's disease)
• Severe erectile dysfunction after radical prostatectomy – affecting approx. 50 percent of men who undergo the operation

Even with moderate vascular erectile dysfunction, medication – whether tablets or injections – can, under specialist supervision, remain effective for some time and support spontaneous erections that are also psychologically important^[8]. A penile implant should only be considered once these options no longer help or are no longer tolerated.

In cases of induratio penis plastica accompanied by erectile dysfunction, the penile implant is also the gold standard, as it corrects both the shape and restores the lost function^[7]. If the plaque structure has hardened significantly, treatment should not be delayed too long, otherwise an additional reconstructive grafting procedure may become necessary to restore length – which reduces later patient satisfaction.

Does Surgery Have to Happen Immediately After Prostate Surgery?

No. Even with severe erectile dysfunction after prostate surgery, there is no need to rush. Erectile function can still improve within the first 24 months^[6]. At the same time, experience shows that waiting too long can lead to further changes in the penis that make later procedures more complex. The decision on the right timing should therefore always be made on an individual basis.

Diagnostics Before Implantation

The decision to proceed with a penile implant should always be made by a specialist physician with extensive experience both in treating severe erectile disorders and in the implantation technique itself.

A key diagnostic tool is an injection of a vasodilating medication, which checks whether blood flow in the penis is still sufficient for an erection: the medication maximally dilates all the vessels. Vascular erectile dysfunction can be clearly demonstrated with this test. Nerve damage after prostate surgery can be inferred indirectly – if the vessels are working properly, the nerves are usually the affected structure. Damage to the erectile tissue caused by induratio penis plastica, however, cannot be detected with this test; here, a physical examination and an ultrasound are decisive.

Correctly interpreting the test result requires considerable experience, particularly in cases of nerve damage and combined findings. This is exactly one of the reasons why UGRS, as a specialised centre, is frequently consulted for an assessment or a second opinion.

Structure of the Penile Prosthesis

Three-piece hydraulic penile prostheses are considered the gold standard for safety and patient satisfaction^[1]. They consist of two cylinders inserted into the natural erectile tissue, a pump located in the scrotum that triggers the erection, and a reservoir placed in the lower abdomen and inserted through the same skin incision. The implants are available in different sizes, feature an antibacterial surface, and allow a natural erection and detumescence function, without the components being visible when not activated.

The Operation – What Really Matters

Implantation sounds technically simple: all three components are inserted through a single small incision between the penis and scrotum, the pump is placed invisibly in the scrotum, the reservoir is inserted through the same access point in the lower abdomen, and the skin is then closed – leaving a scar that is barely visible later. The procedure is generally performed on an outpatient basis under general anaesthesia.

In reality, the operation is surgically highly demanding, and the results depend significantly on the experience of the surgeon. When performed inadequately, the following problems typically occur: an incorrect implant length resulting in an unnatural appearance, pain, or instability, when a clinic only stocks a few sizes; improper technique with the risk of the implant breaking through the tip of the penis; imprecise placement of the pump, causing it to become visible or difficult to operate; damage to the tubing or cylinders caused by unsuitable instruments not designed for the implant; an increased risk of infection due to inadequate disinfection; and visible or painful scarring caused by improper suturing.

One of the dangers of prosthesis implantation is infection of the wound cavity. The risk of this is significantly influenced by the duration of the operation. This is why the surgeon's experience is so important: greater experience shortens the operating time and, with it, considerably reduces the risk of infection.

Even seemingly minor details have a demonstrable influence on the outcome: whether the wound drain is left in place for 24 or 72 hours measurably affects the infection rate^[11]. Such finer points are, as a rule, known only to a very experienced surgeon – one reason why many patients specifically choose UGRS physicians.

Healing Process

The procedure can be performed on an outpatient basis, thanks to the extensive experience of the UGRS surgeons. Staying overnight in a hotel near the clinic is recommended, so that no long journey home is required on the day of surgery itself. An overnight stay at the clinic is of course also possible, if preferred. The subsequent healing process typically proceeds as follows:

• Days 1–4: Physical rest, mild discomfort possible
• From day 3–4: Return to everyday activities for office-based work
• After 4 weeks: First activation of the implant
• After 5 weeks: Sexual intercourse and sport possible again

Completely abstaining from smoking during the healing phase, along with optimally controlled diabetes (if present), is of great importance for the healing outcome. Both factors have a demonstrable influence on wound healing and infection rate^[14][15][16], and therefore also on the likelihood that corrective surgery becomes necessary. Patients are therefore advised to abstain from smoking entirely during the healing phase, to have any existing diabetes optimally managed in consultation with their family doctor, and to strictly follow the aftercare instructions provided by the surgeon.

Combining With Penis Enlargement

Penis enlargement and a penile implant can be combined – but only with particular expertise. Without a specific technique, the penis would become unstable during erection. UGRS has developed its own method for this, to provide additional stabilisation of the penile base for the prosthesis.

The sequence is mandatory: penis enlargement is performed first, and once healing is complete – usually after around six months – the prosthesis is implanted.

Does Age Play a Role in Surgical Success?

No – age alone plays no role in the success of the procedure. Patients both under and over 75 years of age achieve comparable results and would recommend penile implant surgery at similar rates^[17]. Age can only become problematic if it is accompanied by an age-related cognitive impairment such as dementia^[18], which could prevent the patient from operating the prosthesis correctly or from behaving appropriately during aftercare.

A professionally implanted penile prosthesis also does not interfere with later urological treatments – for example in connection with prostate conditions^[19]. Other urological procedures remain fully possible without restriction.

Costs and Reimbursement

High-quality medical care has its price, especially when the quality of the materials used plays a significant role. At UGRS, we rely on transparent pricing with no hidden extra costs.

The implantation of a hydraulic penile prosthesis costs approx. €9,500. This includes the examination, initial consultation, surgery, anaesthesia, as well as aftercare and medical follow-up. In addition, there is the cost of the implant itself, at approx. €8,000. Payment can be made by bank transfer, credit card, cash, or other flexible payment options.

Private health insurance not infrequently covers the cost of the prosthesis – though usually only if the operation takes place in the private ward of a statutory hospital; this should not be equated with an actual private clinic. Under European legislation, privately insured patients additionally have the option, when treated at the UGRS centre in Spain, of receiving significantly higher reimbursement of up to 90 percent, even if only minimal or no reimbursement would be available in Germany. Please feel free to contact us if you are interested in this option.

For patients with statutory health insurance, this option is unfortunately not available, owing to the strict separation between the statutory and private systems in Germany. We can only treat patients with statutory insurance on a self-pay basis.

Our Experience, Your Advantage

20 Years – and a Track Record That Proves It

The surgical treatment of severe erectile disorders using a penile implant is among the most demanding procedures in reconstructive genital surgery. The choice of surgeon is therefore one of the most important decisions patients make.

UGRS Center Darmstadt has more than 20 years of experience in reconstructive surgery of the male genital area. Prosthesis surgery is led by Prof. Agustín Fraile Poblador.

• More than 20 years of experience in reconstructive genital surgery
• Specialisation in microsurgical reconstruction techniques
• Holistic treatment concept: function, form, and psychological well-being
• Discreet consultation, confidential atmosphere

When Is a Second Opinion Worthwhile?

The surgical treatment of severe erectile disorders using a penile implant is among the most demanding procedures in reconstructive genital surgery. The choice of surgeon is therefore one of the most important decisions patients make.