Erectile dysfunction (ED) is one of the main side effects that can happen because of prostate cancer treatment. For men that are sexually active, this is the most feared side effect. Most men will experience some loss of sexual function. However, there are treatment options for this depending on the severity of the lack of function. For mild to moderate ED, there are oral and injectable medications that can cause an erection. But what if you do not respond to medications or do not like or want to use them? What are your options? You may need a penile implant or prosthesis. This is a medical device that helps you get an erection.
What Does a Penile Prosthesis Do?
All penile prostheses have two cylinders that sit side by side in the corpora cavernosa or erectile chambers within the penis. The goal of a prosthesis is to help make the shaft of the penis hard. Due to the anatomy of the penis, the prosthesis does not cause engorgement or swelling to the glans (the tip) of the penis.
If you have had ED for a long time, then you will have penile shortening, meaning the penis shrinks. This device will NOT make the penis larger or return it to its original length but it will restore sexual function. It will not change anything with urination or orgasm. These devices are completely hidden within the body and cannot be seen. They also give spontaneity back to the patient by allowing quickly achieved erections, unlike pills and injections that need to be timed to work.
You cannot “try an implant” because once it is placed it changes the architecture of the erectile tissue (how the penis is structured inside). It is a permanent change — this means that you will need the device for the rest of your life to have erections.
Types of Penile Prostheses
There are two main types of penile implants—semirigid or inflatable.
Semirigid Penile Prosthesis
As the name implies, this device is always “semirigid,” and made of malleable material that can be bent. This is the simplest implant that consists of two cylinders that are placed in the erectile chambers. The size of the cylinders depends on penile size. When an erection is desired, you simply straighten the device upward to allow penetration. When it needs to be concealed or hidden, you bend it downward.
This device is less like a “normal” penis that goes from soft to erect. It is a good choice for patients that do not want to have to pump up an implant or are unable to due to poor dexterity (meaning you can’t move your hands well, maybe because of a stroke or Parkinson’s disease, etc.).
Inflatable Penile Prosthesis
There are two types of inflatable penile prostheses—a two-piece and a three-piece. These devices are filled with saline fluid that allows them to be inflated and deflated, which helps to make them more “normal.” The two-piece prosthesis consists of two cylinders and a pump. The pump is about the size of a large acorn and sits inside the scrotum next to the testicles. When an erection is desired, the pump is squeezed, and the fluid moves from the pump to the cylinders. When the erection is no longer needed, the penis is gently bent to push the fluid back to the pump. The degree of softness that can be achieved depends on the size of the cylinders/penile size. Larger cylinders will have more fluid left in them because the size of the pump is the same for all these implants.
This device is good for patients who want to hide their device better than the semirigid implant but who also may have had several abdominal surgeries that make it difficult to put in a reservoir for a three-piece prosthesis.
The three-piece prosthesis has two cylinders, a pump, and a reservoir (a small tank that holds fluid). The cylinders and pump are a lot like the two-piece prosthesis. The difference is the pump has a deflate button that allows all the fluid from the cylinders to go into the reservoir in the abdomen. This implant works the most like a “normal” penis — pump up to get an erection and deflate to regain softness. Most patients choose this device.
Restoring your sexual function is one way to improve your quality of life as a prostate cancer patient and survivor. When medications are no longer working, then the penile prosthesis is an excellent option to quickly get lasting and reliable erections. With all the good that comes with these implants, if you are considering having one placed, you must have realistic expectations of what it can and cannot do. Also, be sure that your urologist is comfortable performing this procedure or seek an opinion from a urologist who is an expert in sexual medicine.