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Sex Health Blog

Surgical Therapies for ED

Jun 14, 2011

No doubt about it – erectile dysfunction can be frustrating. ED treatment can be frustrating as well. You may have seen all the advertising for medications and supplements and wondered why they aren’t working for you. Or you might have tried vacuum devices or injections with little success. What can you do?

Many men decide to have surgery to treat erectile dysfunction. Some surgical therapies repair or replace the arteries and veins in the penis. Others involve penile implants – devices that you control when you want to start and stop an erection.

Today, we’ll take a closer look at these surgical therapies.

Anatomy of an Erection

Blood flow to the penis is a critical part of an erection. When a man is sexually stimulated, penile arteries widen, allowing the spongy erectile tissue (corpora cavernosa) to fill with blood. This blood is what makes the penis erect and firm enough for sexual intercourse.  Veins in the penis compress, keeping the blood in.  After the man ejaculates, the veins open up again and the blood flows back into the body.

Men with erectile dysfunction often have problems with this blood flow. Usually, there is not enough blood flowing into the penis to cause an erection firm enough for satisfying sex.

Vascular Surgery

Vascular surgery can help by repairing or replacing blood vessels that are either blocked or leaking. There are two main types of vascular surgery.

Penile Revascularization (Artery Bypass Surgery)

Penile revascularization is an option for men who have a blockage in a penile artery. Blockages prevent blood from entering the penis properly. With this procedure, the blockage can be bypassed. Another artery is removed from another part of the body and transferred to the penis. This creates a clear path for blood flow.

If you have penile revascularization, you’ll be under general anesthesia during the surgery, which usually takes between four and six hours. There are two incisions – one in the abdomen (from which the “donor” artery is removed) and one in the penis or scrotum. Most men are in the hospital for one night and stay home from work for one week. They must also avoid heavy physical activity and cannot have sex for a few weeks afterward.

Vein Ligation Surgery

For some men, erectile dysfunction problems are caused by veins that leak, preventing blood from staying in the penis for an erection. In vein ligation surgery, the veins are blocked off, keeping the blood inside.

Vein ligation surgery is not usually recommended, except for some men who have a certain kind of leak (called an isolate cural venous leak). Usually, blood leakage is caused by problems in the erectile tissue, not the veins themselves, so many feel this surgery is focused more on a symptom than the actual problem. Few medical centers in the United States perform vein ligation surgery.

Vascular Surgery – Pros and Cons

When successful, vascular surgery can help a man have natural erections again. Usually there is no obvious indication that surgery has taken place. However, the success rate of penile revascularization is about 50%. Many men who have surgery have ED problems again after two years. The risks of infection, scar tissue formation, and pain are higher. Surgery can also be expensive.

Penile Implants

Some men have success with a penile prosthesis, or implant, which is surgically placed inside the penis. Implants allow a man to achieve an erection when he chooses to.

A man undergoing implant surgery will have general anesthesia, with incisions made in the penis, lower abdomen, of scrotum. Some patients stay in the hospital for one night; others may go home the same day. For a few weeks after surgery, most men have pain that can be managed with oral medications. Sexual activity should be avoided for about a month after surgery.

Two types of penile implants are available in different diameters and lengths.

Semi-rigid Malleable (Non-hydraulic)

With this type of implant, flexible rods (usually made of stainless steel or plastic) are inserted in the penis. A man can then adjust his penis manually depending on his needs. For sexual intercourse, he can bend the penis into an erect position. For urination, he can bend it back down.

Inflatable Implants (Hydraulic)

Inflatable prosthesis can have 2 or 3 parts, depending on the style. For each type, inflatable cylinders are surgically inserted in the penis. When a man wants to have an erection, he can fill the cylinders with fluid (usually a saline solution) by pressing a special pump placed in the scrotum. When he wants the penis to be flaccid, he presses the pump again, causing the fluid to drain out of the cylinders.

The main difference between the 2- and 3-part implants is the location of the fluid. In 2-part implants, the fluid remains in the back part of the cylinders. With 3-part implants, there is a separate reservoir for the fluid.

Penile Implants – Pros and Cons

Generally, penile implants have a high success rate. About 80% to 90% of men with implants say they’re satisfied. Many have no significant problems with sensation or orgasm.

With both types of implants, there is risk of infection and mechanical failure. Some implants need to be replaced in time. Fluid can leak from inflatable implants, although the saline solution usually doesn’t cause problems. Some men with 2-part inflatable implants feel that their penis is more noticeable because of the fluid stored at the back of the cylinders.

Some men are no longer able to achieve natural erections after having an implant.

Which Surgical Option is Right For You?

If you are interested in surgical therapies for erectile dysfunction, seeing your doctor should be your first step. He or she can discuss the advantages and disadvantages of each procedure and help you decide what is best for your personal situation.