This weekend, I received an email from a man, who described a history of prostate cancer, impotence / erectile dysfunction (as a result of prostate surgery) and penile curvature (Peyronie’s disease). At the present time he is no longer responding to medications for erectile dysfunction. He has already seen another urologist who suggested that he undergo surgery to place a penile implant for his condition. His question for me was about my approach. Here is a snippet of how I replied:
- In general, men with erectile dysfunction and Peyronie’s disease (curvature) are best treated with a penile implant, which can correct 20-30 degrees of curvature just by placing the device. This will recover some of the lost length that comes with Peyronie’s disease. Additional sutures are sometimes placed to further straighten the penis, but have the risk of some shortening of the penis. More invasive reconstruction is an option, and it involves incising the scarred area on the penis then placing the graft. It restores some of the lost length but has the added risk of temporary numbness because usually we will have to elevate the nerves that give sensation to the penis to place the graft. Permanent numbness is rare, however.
He then asked about which implant I use and why:
- In my practice, I only use Boston Scientific penile implants because they feel more natural and have antibiotic coating, lowering the risk of infection. Specifically, in men with curvature I will only use the CX700, because use of the LGX700 will result in an erection, but it won’t be firm enough because of the scar tissue in the shaft of the penis where the scar originates.
Finally, he asked about sex drive (libido) and insurance coverage:
Libido is a separate function and is not affected by penile implant. Similarly, men will still orgasm.
Many insurances cover penile implant and Peyronie’s surgery, and Medicare covers both. We obtain authorization at the time of scheduling surgery to confirm.