Cavernous body implantation (penile prosthesis, erectile tissue prosthesis) is an established surgical procedure for the treatment of severe erectile dysfunction (impotence, erectile dysfunction, ED) when drug or conservative therapies are not sufficiently effective. The aim of the treatment is to restore a reliable, controllable erection that enables a fulfilling sexuality - independent of medication.
What is a penile prosthesis?
A penile prosthesis is a medical implant that is surgically inserted into the penis. It enables an erection independent of natural mechanisms.
There are two main types:
Hydraulic (inflatable) penile prostheses: enable an erection at the touch of a button, very natural feeling and appearance
Semi-rigid (flexible) prostheses: permanently dimensionally stable, easy to handle
In most cases, we use hydraulic, three-part penile prostheses. These consist of two cylinders in the erectile tissue, a pump in the scrotum and a fluid reservoir in the lower abdomen.
In a non-activated state, the penis is usually largely flaccid in everyday life. By activating the pump, which is discreetly placed in the scrotum, the erection is built up in a targeted manner. This system enables a natural operating principle and a high degree of control over the timing and duration of the erection.
Semi-rigid (flexible) prostheses are also used in selected situations.
The implant is selected individually and together with the patient.
How a penile prosthesis works
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Who is a corpus cavernosum prosthesis suitable for?
Implantation can be considered for
Severe erectile dysfunction without sufficient response to tablets (PDE-5 inhibitors)
Lack of effectiveness or intolerance of injection therapy (SKAT) or vacuum aids
erectile dysfunction after prostate surgery or radiotherapy
vascular or diabetic erectile dysfunction
selected cases of induratio penis plastica (Peyronie’s disease) with additional erectile dysfunction
The decision to implant is always made after careful clarification and detailed medical consultation.
What can you expect after the implantation of a penile prosthesis?
A corpora cavernosa prosthesis enables a reliable, mechanically controllable erection, independent of medication or external aids. The aim of the treatment is to make your sexuality predictable and spontaneous again.
The prosthesis does not affect sexual pleasure or the feeling of orgasm. The sensation is usually retained and depends primarily on the underlying disease. In everyday life, the implant is discreet and usually not visible from the outside.
It is important to have realistic expectations: the prosthesis replaces the erectile function, but does not completely restore previous penis length or function. It is also an irreversible procedure, so this form of therapy is usually recommended after conservative forms of treatment have been exhausted. With careful indication and good information, most patients report a high level of satisfaction with the functional result.
Procedure
Initial consultation and clarification
The first step is a detailed personal consultation in our andrology clinic. We take the time to understand your individual situation in detail. As part of a detailed anamnesis, we record your medical history and assess the erectile dysfunction treatments you have undergone to date. This is supplemented by a physical examination. A special focus is placed on an open and realistic discussion of your expectations and the possible results of treatment with a penile prosthesis.
If necessary, we will discuss your case on an interdisciplinary basis in the Andrology Board together with specialists from endocrinology and angiology. This is how we ensure that you receive the best possible treatment.
Surgery
The penile prosthesis is implanted under general anesthesia and usually takes about one to two hours. After the operation, a short inpatient stay of one to three days is usually planned in order to ensure safe post-operative monitoring.
Follow-up treatment and instruction
After the operation, we accompany you closely through the wound healing phase. Once healing is complete, a gradual and careful introduction to the use of the penile prosthesis takes place. You will receive personal guidance from experienced doctors and nursing staff. After a few weeks you can have sexual intercourse again.
The aim is for you to learn how to use the prosthesis safely and independently and to regain confidence in your sexuality. Regular follow-up checks help to ensure the long-term function of the prosthesis and to detect possible complications at an early stage.
What are the risks?
As with any operation, there are certain risks involved in implanting a penile prosthesis. These include infections, post-operative bleeding, delayed wound healing or technical problems with the implant. Careful care after the procedure is important to avoid complications. Patients should therefore carefully follow the instructions on wound care and handling the prosthesis. Infections or functional disorders of the prosthesis can also occur in the long term.
Costs of implanting a penile prosthesis
The costs of erectile tissue implantation are covered by statutory basic insurance. However, an application for cost coverage should be submitted to the health insurance company before the operation.
Frequently asked questions about penile prostheses
An erection with a penile prosthesis feels different to a natural erection as it is produced by the implant and not by blood flowing into the penis. With hydraulic (inflatable) prostheses, the erection can appear very natural, both in shape and stiffness, by operating a small pump. Semi-rigid (flexible) prostheses are permanently fixed, but can be moved into position manually.
As a rule, the penile prosthesis is not noticeable in everyday life. Hydraulic (inflatable) prostheses lie discreetly in the penis and are only inflated when needed, which creates the erection. Semi-rigid (flexible) prostheses are permanently dimensionally stable, but can be positioned in such a way that they are hardly noticeable in everyday life.
Most patients and their partners hardly notice the prosthesis during normal everyday life or sexual intercourse. Over time, you get used to the implant and handling becomes routine.
No, the penile prosthesis is not visible from the outside. The implant lies completely inside the penis, and even with an erection the penis looks natural. Hydraulic (inflatable) prostheses produce an erection at the push of a button, while semi-rigid prostheses are permanently dimensionally stable but can be positioned inconspicuously. The treatment is therefore discreet and does not affect the external appearance.
Yes, the ability to orgasm is usually retained if it was present before the operation.
Yes, a penile prosthesis does not usually affect the ability to ejaculate or conceive children. The prosthesis only replaces the erectile function, but not the function of the testicles or the vas deferens. This means that ejaculation and fertility remain unchanged in most cases.
However, there may be a slight temporary change in ejaculate volume or ejaculation control shortly after the operation until healing is complete and the handling of the prosthesis is safely mastered.
Modern penile prostheses are very durable. Many implants function for 10 years or longer without any problems, depending on the type, quality and individual handling. In rare cases, mechanical problems or infections may necessitate an earlier revision. Regular follow-up checks help to ensure the long-term function of the prosthesis.
After the implantation of a penile prosthesis, sexual activity should only be started once the wound has healed and the handling of the prosthesis has been safely mastered. This is usually the case around 6 to 8 weeks after the procedure.
During this time, it is important to follow the doctor’s instructions for rest and wound care exactly. You can resume a normal sex life once you have been cleared by your doctor.
The primary purpose of a penile prosthesis is to restore erectile function and not to enlarge the penis. In most cases, the length of the implanted penis corresponds to the natural length in the stretched, unerect state. After the operation, the penis may appear slightly shorter during an erection than before the procedure, as the natural swelling capacity is missing. In some cases, the penis is shorter than before the procedure. The aim of the prosthesis is a functional and natural penis, not an increase in size.
