Reasons for installing a flexible penile implant, its advantages and disadvantages

Erectile dysfunction (ED) can significantly impact a man's self-confidence. Many men suffer in silence due to embarrassment or feelings of inadequacy. However, the truth is that ED doesn’t just affect the man—it also affects his partner, often leading to tension and frustration in the relationship.With advancements in medicine and technology, there is now a highly effective and practica solution to this problem: penile implants. These implants have become one of the best surgical treatments for permanently addressing ED.In this  article, we will discuss everything about penile implants—how the work, their different types, and how they can help restore a natural and fulfilling marital life.

Penile Implant:
A penile implant is a medical device surgically placed inside the penis to help men with erectile dysfunction (ED) achieve and maintain a firm erection suitable for sexual intercourse. This implant is considered a permanent solution for individuals who have not responded well to medications or other non-surgical treatments.

Appearance of the Malleable Implant

The malleable implant consists of two thin, flexible rods inserted into the penis. These rods are made from medically safe materials such as silicone or other durable substances, ensuring flexibility and ease of control. The design is discreet and does not affect the natural appearance of the penis.

How Does the Malleable Implant Work?

This implant functions through a simple mechanical mechanism. It is placed inside the corpora cavernosa, the structures responsible for erection. When the man desires to engage in sexual activity, he manually bends the implant into an upright position. After intercourse, he can return it to a flaccid state. The implant remains stable in any position, allowing the patient full control over their erection without the need for external devices or additional steps.

Which Type of Penile Implant Is the Least Risky?
The malleable (semi-rigid) penile implant is considered less risky than the inflatable (hydraulic) implant because it has a simpler design and does not require complex mechanical components. However, inflatable implants are more commonly used for treating erectile dysfunction as they provide a more natural erection experience. Unlike the malleable implant, which remains in an erect position throughout intercourse, the inflatable implant allows for greater control over erection and relaxation.

What Is the Success Rate of Penile Implant Surgery?
With skilled hands and medical advancements, the success rate of penile implant surgery ranges between 98% to 99%. This high success rate is due to extensive expertise and improvements in surgical techniques.
Of course, there is a very small risk (around 1% to 2%) of complications or challenges, but these are usually manageable and treatable. This means that the vast majority of patients achieve complete success, with rare exceptions, as ultimately, everything happens by the will of God.

What Type of Anesthesia Is Used for Penile Implant Surgery?
Several types of anesthesia can be used for penile implant surgery, including:

• General anesthesia: An available option, but not always the best due to its overall effect on the body.
• Spinal anesthesia: The preferred and safest option, as it numbs only the lower part of the body without affecting consciousness, reducing risks associated with general anesthesia.
• Local anesthesia: Used in some cases, numbing only the surgical area.

Overall, spinal anesthesia is the recommended choice as it is the safest and most comfortable option for the patient during surgery.

Is Urination Normal After Penile Implant Surgery?
Yes, in the vast majority of cases, urination remains completely normal after surgery, God willing. Some patients may experience mild burning or slight difficulty in urination within the first 24 hours post-surgery, but this is rare. Most patients do not face any urination issues following the procedure.

Does the Patient Experience Pain After Penile Implant Surgery?
Like any surgical procedure, it is natural to experience some pain after the operation. However, the pain is typically mild to moderate in most cases. Severe or unbearable pain is not expected, which is why patients can usually return home the same day without showing any obvious signs of undergoing surgery.

This pain may last for a few weeks due to two main reasons:

1. Post-surgical pain, which gradually decreases over time.
2. The presence of a continuous erection without sexual activity, as the patient must wait for the healing period before engaging in intercourse, which may cause mild discomfort. However, this pain is not a cause for concern.

When Can a Patient Resume Sexual Activity After Penile Implant Surgery?
On average, patients are advised to wait approximately 45 days before resuming sexual intercourse. Some may feel eager to try after 30 days, but it is always best to wait to ensure full recovery.

In cases where the dorsal (suprapubic) surgical approach is used—where the incision is made at the base of the penis near the lower abdomen—the recovery period may be shorter, allowing the patient to resume sexual activity sooner compared to other surgical techniques.

Reasons for Getting a Penile Implant

The reasons for penile implant surgery vary depending on individual health conditions, but the most common causes include:

• Erectile dysfunction due to chronic illnesses: Conditions like diabetes or chronic high blood pressure can damage blood vessels and nerves responsible for erection, leading to erectile dysfunction.
• Nerve and vascular damage: Injuries or previous surgeries can impair the blood flow and nerve function necessary for erection.
• Psychological erectile dysfunction: Long-term psychological issues may contribute to erectile dysfunction. If other treatments fail, an implant may be the best solution.
• Aging: As men age, circulatory efficiency declines, potentially leading to erectile dysfunction, making a penile implant a long-term solution.

How Does a Penile Implant Work?

A penile implant operates through a purely mechanical mechanism, as it is surgically placed inside the corpora cavernosa, the structures responsible for erection. After the surgery, the patient can control their erection by activating the implant, depending on its type:

• Inflatable implant: Consists of fluid-filled cylinders that expand when activated by a pump implanted in the scrotum, providing an erection that closely mimics a natural one.
• Malleable (semi-rigid) implant: Remains in a fixed position, allowing the patient to manually bend or straighten it as needed.

Types of Penile Implants

There are different types of penile implants, varying in design, structure, and method of use. The two most common types are:

1. Malleable (semi-rigid) implants
2. Inflatable (hydraulic) implants

Differences Between Malleable and Inflatable Implants

There are key distinctions between these two types:

1. Malleable (Semi-Rigid) Implant

It is called "malleable" because it can be easily bent and straightened. It is made of medical-grade silicone with an internal flexible metal core.

Advantages:

• Provides a permanent erection, which is why it is sometimes referred to as a "rigid" implant.
• Easy to use—the patient can simply bend it downward after intercourse to keep it discreet under clothing.

2. Inflatable (Hydraulic) Implant

This type differs in structure as it consists of three main components:

• Two silicone cylinders placed inside the penis.
• A pump implanted under the skin in the scrotum, which the patient uses to control the erection.
• A fluid reservoir implanted under the abdominal muscles.

 How It Works:

• When the patient presses the pump in the scrotum, the saline solution flows into the cylinders, making the penis erect.
• To return to a flaccid state, the patient presses a release valve, allowing the fluid to return to the reservoir, causing the penis to relax

Which Type of Penile Implant Is Better?

• Malleable (semi-rigid) implant: Simpler to use and less complicated but keeps the penis in a permanently erect state.
• Inflatable (hydraulic) implant: Provides a more natural feeling, allowing the patient to fully control erection and relaxation.

Factors Affecting Implant Choice

Choosing the right type of penile implant depends on several key factors:

1. Cause of Erectile Dysfunction:

   • The appropriate implant type is determined based on the underlying cause, whether organic (such as diabetes or vascular diseases) or psychological.

2. Lifestyle:

   • The patient's level of physical activity and personal preferences influence the choice. Some prefer ease of use, while others seek a more natural experience.

3. Doctor’s Recommendation:

   • The physician will determine the most suitable implant type after evaluating the patient's health condition and needs.

Who Is a Candidate for a Penile Implant?

Penile implant surgery is suitable for certain groups of men, including:

✔️ Men who did not respond to medication: If drugs like Viagra or Cialis fail to produce results.
✔️ Men with persistent erectile dysfunction: Those suffering from chronic ED that does not improve with non-surgical treatments.
✔️ Patients with stable health conditions: Such as those with diabetes or heart disease, as long as their condition is stable enough to undergo surgery.

How Is Penile Implant Surgery Performed?

The surgery is performed under general or local anesthesia and includes the following steps:

 Preparation & Anesthesia:

• The patient is anesthetized, and the surgical area is thoroughly sterilized to minimize infection risk.

 Making the Incisions:

• The surgeon makes small incisions in the penis or scrotum, depending on the implant type.

 Implant Placement:

• For a malleable (semi-rigid) implant: It is inserted and secured inside the corpora cavernosa.
• For an inflatable (hydraulic) implant: The cylinders are inserted into the penis and connected to a pump and reservoir inside the body.

 Closing the Incisions:

• After placing the implant, the surgeon stitches the incisions using surgical sutures.

 Post-Surgery Monitoring:

• The patient is observed to ensure there are no complications.

How Long Does a Penile Implant Surgery Take?

 The procedure typically takes 1 to 1.5 hours, depending on the implant type and case complexity.
 It is performed in a fully equipped operating room under the supervision of a urologist or specialized surgeon.

Key Benefits of the Malleable Penile Implant

The malleable implant is a practical and permanent solution for erectile dysfunction and is widely used in the Arab world due to its many advantages:

✔️ Easy to Use – A simple design with two bendable rods that can be manually adjusted for erection or relaxation without complications.
✔️ Permanent Solution – Unlike medications or injections, the implant remains in place for life, allowing spontaneous erections at any time.
✔️ Faster Recovery – The procedure is less complex than inflatable implants, allowing patients to resume sexual activity within weeks.
✔️ Lower Infection Risk – Unlike hydraulic implants, there are no tubes or reservoirs, significantly reducing the risk of infection.
✔️ Natural Feel & Partner Satisfaction – The implant provides a realistic sensation, enhancing enjoyment during intercourse.
✔️ Ideal for Patients with Mobility Issues – Unlike inflatable implants, which require pump activation, the malleable implant is manually adjustable, making it perfect for those with limited hand mobility.
✔️ More Affordable – It is significantly cheaper than inflatable implants, making it a cost-effective and efficient solution.

When Will the Results of a Malleable Penile Implant Be Noticeable?

Recovery takes time, and some swelling or bruising may occur, which typically subsides within a few weeks.
No physical exertion or sexual activity is allowed until the doctor gives clearance.

Recovery Timeline:

 After 14 days – Surgical stitches are removed.
After 2-4 weeks – Follow-up with the doctor for an evaluation and guidance on using the implant.
After at least 6 weeks – The patient can start using the implant for sexual activity, but only with the doctor's approval.

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Difference Between Malleable and Inflatable Implants

Malleable (Semi-Rigid) Implant

✔️ Permanent Erection – Remains in a semi-erect state, and the patient can manually adjust it as needed.
✔️ Simple & Easy to Use – No complex mechanical parts.
✔️ Lower Cost – More affordable than the inflatable implant.
✔️ Higher Safety – No pump or reservoir, reducing the risk of mechanical failure or infections.

Inflatable (Hydraulic) Implant

✔️ On-Demand Erection – The patient controls erection using a hidden pump inside the scrotum.
✔️ More Natural Appearance – When not in use, the penis appears completely flaccid.
✔️ Greater Comfort – Provides a more natural feel compared to the malleable implant.
Higher Cost – More expensive due to its complex structure.
Requires Skill to Use – The patient must learn how to operate the pump and release the fluid after use.

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Which Implant is Better: Malleable or Inflatable?

The choice depends on the patient's needs and budget:
Looking for a simple & cost-effective solution? → Malleable Implant
Prefer a natural look & more flexibility? → Inflatable Implant

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Lifespan of Penile Implants

 How long does an implant last?

• Malleable Implant: 10 to 15 years.
• Fully Rigid Implant: 15 to 20 years, but less comfortable.
• Inflatable Implant: 10 to 15 years, but may require maintenance or replacement if the pump or reservoir malfunctions.

 In rare cases, an implant may need early replacement due to mechanical failure or wear and tear. However, with proper care and usage, these implants provide long-term solutions for erectile dysfunction.

Risks of Implanting a Malleable Penile Prosthesis

The implantation of a malleable penile prosthesis is generally a safe procedure. However, like any surgical intervention, it carries some potential risks and complications:

1. Infection

Infections may occur within the first three months after surgery, with a higher risk in diabetic patients.
If an infection develops, the doctor may need to remove the implant through another surgery.
Prevention: Proper wound care, handwashing before changing dressings, and regular follow-ups with the doctor.

2. Implant Erosion

In rare cases, the implant may adhere to the skin or penetrate the penile tissue, causing inflammation.

3. Other Potential Complications

• Post-surgical bleeding.
• Injury to the urethra during implantation.
• Reduced blood flow to the penile glans, which may affect sensitivity.
• Scar tissue formation inside the penis, potentially impacting flexibility.
• Choosing an inappropriate implant size, which may cause glans drooping or tissue erosion.

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Alternatives to Penile Implant Surgery

Not all cases require surgery! There are different treatment options:

1. Hormonal Therapy

Testosterone replacement therapy can improve erectile function in men with low testosterone levels.
It is available in the form of gels, creams, injections, or patches.
Note: It is not suitable for men with normal testosterone levels, as it may lead to prostate enlargement and other complications.

2. Medication for Erectile Dysfunction

• Sildenafil (Viagra): Effective but works best on an empty stomach.
• Tadalafil (Cialis): Has a longer duration, remaining effective for a day or more.
• Vardenafil (Levitra): Functions similarly to Viagra.

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How Does an Erection Occur After Implant Placement?

The mechanism of erection depends on the type of implant used—either hydraulic (inflatable) or malleable.

Inflatable Penile Prosthesis (Hydraulic Implant)

This type closely mimics a natural erection.

Components:

• Fluid reservoir (hidden in the abdomen).
• Silicone cylinders inside the penile cavernous bodies.
• Small pump implanted in the scrotum.

How It Works:

• For an erection: Pressing the pump in the scrotum transfers fluid from the reservoir to the cylinders, making the penis firm and erect.
• For relaxation: Pressing the pump again returns the fluid to the reservoir, allowing the penis to relax.

Result: Provides a very natural look and allows easy control over the erection.

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Malleable (Semi-Rigid) Penile Prosthesis

A simple and practical solution!

Components:

• Two flexible silicone rods with an internal bendable metal core.
• Surgically placed inside the cavernous bodies of the penis.

How It Works:

• To achieve an erection, the penis is manually lifted to the desired position.
• After intercourse, it can be bent downward to return to a relaxed state.

Result: Easy to use, does not require pumping or fluid transfer, but the penis remains in a semi-erect position at all times.

Which Type of Implant is Better?

• Hydraulic Implant (Inflatable): Provides a more natural appearance and allows full control over erection.
• Malleable Implant: Simpler design, more affordable, and does not require pump operation.

The choice depends on the patient’s needs, budget, and personal preference!

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Can a Penile Implant Be Removed in Case of Complications?

Yes, the implant can be removed in certain cases, especially if complications occur, such as:

• Severe infection.
• Persistent bleeding.
• Chronic, unbearable pain.
• Implant breakage or malfunction.

How Is the Implant Removed?

The procedure is performed under general anesthesia and involves:

• Making surgical incisions in different areas depending on the type of implant:

  • For the Hydraulic Implant:

    • Incision at the base of the penis on both sides.
    • Incision in the scrotum to remove the pump.
    • Inguinal incision in the abdomen to remove the fluid reservoir.

  • For the Malleable Implant:

    • A smaller surgical incision is made for easier removal.

• Removing the implant and cleaning the surrounding tissues to ensure there is no infection.

• In some cases, the implant can be replaced immediately, but if a severe infection is present, the doctor may wait before re-implanting a new device.

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Disadvantages of the Malleable Implant

Despite its simplicity, there are some drawbacks to consider:

• Permanent rigidity: The penis remains semi-erect at all times, which may be uncomfortable during daily activities.
• Limited flexibility: Does not provide a natural feel like the hydraulic implant, which only becomes erect when needed.
• Foreign body sensation: Some patients take time to adjust to having the implant inside their body.
• No size control: Unlike the hydraulic implant, the penis cannot be reduced in size when an erection is not needed.

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Procedure for Malleable Penile Implant Surgery

The malleable penile implant is placed through the following steps:

1. Anesthesia: The doctor decides whether general or local anesthesia is best for the patient.
2. Surgical Incision: A small incision is made at the base of the penis to access the two cavernous bodies.
3. Implant Placement: The malleable rods are inserted evenly into both cavernous bodies, ensuring they are securely positioned while remaining flexible.
4. Closing the Incision: Once the implant is in place, the surgeon stitches the incision using medical sutures and covers it with protective dressings.

Pre-Procedure Steps for Malleable Penile Implant Surgery

Before the surgery, the patient must follow several important steps:

1. Diagnosis and Examination:

   • The patient visits a urologist specializing in andrology for a comprehensive assessment to determine if the implant is the best solution.
   • This may include a physical examination or imaging tests.

2. Medical Consultation:

   • The doctor explains all aspects of the procedure, including benefits, risks, and possible complications, ensuring the patient makes an informed decision.

3. Pre-Surgical Preparations:

   • The doctor may instruct the patient to stop taking blood-thinning medications (such as painkillers and anti-inflammatory drugs) to minimize bleeding risks.
   • It is important to inform the doctor of any allergies or pre-existing medical conditions.

4. Surgical Consent:

   • The patient must provide official consent after the doctor explains all the details of the operation.

5. Fasting Before Surgery:

   • The patient must fast for several hours before surgery to reduce the risk of complications during anesthesia.

6. Antibiotics:

   • In some cases, the doctor may prescribe antibiotics before surgery to prevent infections.

These steps are crucial to ensuring a safe procedure and achieving the best possible outcome.

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Post-Surgery Care & Recovery Tips

The recovery period lasts around six weeks, during which sexual activity is strictly prohibited to allow proper wound healing.

Essential Post-Operative Care Tips:

• Elevate the Scrotum:

  • Support the scrotum using a towel or cloth between the thighs to reduce swelling.

• Cold Compresses:

  • Apply an ice pack to the scrotum and penis (wrapped in a cloth) to avoid direct contact with the skin and prevent tissue damage.

• Supportive Underwear:

  • Wear tight-fitting underwear to support the surgical site and speed up healing (stitches typically heal within five days).

• Avoid Strenuous Activities:

  • Refrain from any heavy physical exertion or demanding tasks for at least two weeks post-surgery.

• Testing the Implant:

  • Do not attempt to use the implant before 2 to 4 weeks.
  • The first trial should be done under the doctor's supervision to ensure proper use.

• Following Medical Instructions:

  • The doctor will provide guidelines on implant usage, either verbally or through instructional videos.
  • Strictly follow these guidelines to ensure longevity and optimal function.

• Taking Prescribed Antibiotics:

  • Complete the full course of antibiotics to prevent infections.

Choosing the Right Specialist

The best doctor for penile implant surgery is a urologist specializing in andrology, preferably with expertise in sexual dysfunction surgeries and implant procedures.

When selecting a doctor, look for a consultant or specialist with significant experience in implant surgeries, as surgical precision plays a key role in achieving the best results and minimizing complications.