If medication doesn’t successfully treat erectile dysfunction, your doctor may recommend surgery or the use of a penile device. Surgery may also be the only treatment option for men with severe erectile dysfunction due to a physical trauma, prior surgery in the pelvis, or a medical condition, such as cancer. Our doctors work with you to determine which device or procedure best suits your needs and lifestyle.
One of the first and most effective treatments for erectile dysfunction, a vacuum erection device is a cylinder that is placed around the penis to help pump blood until an erection is created. Today it is most often used when medications for erectile dysfunction do not work.
To use this device, lubricant is applied to the penis, which is inserted into a tube attached to the vacuum device. Then you manually pump the vacuum device until air is pumped out of the tube and an erection is achieved. The erection is then held in place during intercourse by a constrictive band around the base of the penis for up to 30 minutes. After intercourse, the band is removed, and the erection goes away.
Side effects may include light bruising on the penis, which is usually not associated with pain and generally goes away within days.
Some men dislike the lack of spontaneity associated with using medication or a vacuum device. In this case, our specialists may recommend a mechanical device called a penile prosthesis, which is implanted in the penis to create an erection-like state.
A penile prosthesis can be implanted in men with erectile dysfunction related to the symptoms of diabetes, vascular disease, and spinal cord injuries. There are two types of implants, neither of which change sensation in the skin of the penis or negatively affect a man’s ability to orgasm or ejaculate.
Malleable penile implants are mechanical devices that are surgically implanted in the penis to provide permanent firmness. A surgeon makes an incision near the base of the penis and creates an opening in the two long tubes of spongy tissue of the shaft. One semi-rigid rod is placed in each opening. The procedure, performed with anesthesia in the hospital, takes 30 to 60 minutes. Often, you can leave the hospital the day of surgery.
Following surgery, your doctor may advise you to avoid sexual activity for at least six weeks and may also prescribe pain medication as needed. These implants are always firm, making them more detectable in clothing than inflatable implants. This can be concealed by manually bending the implanted rods downward.
Inflatable penile implants can be inflated to create an erection-like state and then deflated after sexual intercourse, allowing for reliable, rigid, and spontaneous erections. In a one- to two-hour procedure, a surgeon installs the implant—which includes two inflatable cylinders, a reservoir, and a pump unit—into the penis and scrotum. Pressing on the area of the scrotum where the pump portion of the device is embedded allows fluid to flow from the reservoir implanted near the bladder, inflating the prosthesis and creating an erection-like state.
The surgical procedure to install the penile prosthesis requires anesthesia and four to six weeks of recuperation, during which your doctor may advise you to avoid sexual activity. Some men go home the day of surgery, although some may require extra monitoring and return home the next day. Pain medicine is prescribed as needed after the surgery.
Inflatable implants are mechanical devices and, as such, can break down eventually. If this occurs, surgery may be required to remove, repair, or replace them.
This surgical procedure is used mostly in men younger than age 40 who have had a traumatic injury to the pelvis that affects penile blood vessels. In these men, microsurgical revascularization can improve erections by restoring blood flow to the penis.
Performed with anesthesia in the hospital, this procedure allows the doctor to surgically bypass blocked penile arteries by connecting an artery in the lower abdomen to one at the top of the penis. This ensures adequate blood flow, which is needed to sustain an erection.
This procedure is not recommended for men with atherosclerosis, a condition that causes hardening of the arteries, which can lead to permanent damage to the lining of the blood vessels of the penis.