One Size Does NOT Fit All

I am a novice when it comes to blogging.  One of the things I find interesting when I look at this website’s statistics is the search terms used by people that ultimately lead them to this page.  This post is in response to one of the searches that included “penile implant regret”. I am not sure what regret the person who searched the internet for that topic had, but I will share the details of a case that I recently managed.

Last year, I saw a man and his wife for second opinion.  He had undergone penile implant surgery for erectile dysfunction a couple of months prior.  His point of regret was penis size. He reported that he had lost almost 3 inches of penile length and his girth was significantly reduced.  The penile implant was functioning, but both he and his wife were unsatisfied with the outcome.  Upon examination, it was clear to me that the penile implant that was placed simply wasn’t long enough. The cylinders stopped short of the head of the penis. The reasons for that are many and may include:

  1. Penile abnormalities like scar tissue or Peyronie’s Disease
  2. Unforeseen technical challenges at the time of surgery
  3. Under dilation of the penis
  4. Under measurement of the penis
  5. Surgeon experience (or inexperience) and/or preference

No matter what the cause this man felt short-changed.

Options for management:

  • Do nothing – the implant was functioning well but the placement placed him at risk for thinning of the penile skin
  • Remove the implant – he wanted to remain sexually active
  • Remove the existing penile implant and replace it with a new one, making every effort to place a longer penile implant

Uncertain about his options, it took until this year for him to decide to replace the implant.  Prior to his first surgery he used a vacuum penis pump and after his first consult with me began using it to stretch the penile tissues (even though he had an implant).  Last month we removed the implant.  I was able to place a penile implant that was 5cm (about 2.5 inches) longer than what he already had in place.  My verdict was that he was short changed by a ‘one size suits all’ approach to penile implantation.

What are my thoughts on penile implant size?

  • The best time to get it right is the first time
  • Removal and replacement should be considered only after a discussion about goals and expectations, addressing the benefits but also the shortcomings of revision surgery.  This could be higher rate of infection, falling short of goals or not fixing the problem you set out to treat.
  • Men need to understand that the biggest complaint after implant is that penis will seem shorter than it did before, even when we are doing what we can to optimize implant
  • To optimize the penis length before implant men may use a vacuum erection device to stretch the penile tissues
  • In my opinion, experience matters. The old teaching was to undersize implants. Prosthetic urologists are move adept and getting the sizing correct.  We have a broader skill set that we use even in difficult cases when we encounter unexpected anatomy.

The overall satisfaction rate for penile implant surgery is >90%.  Partners of men with implants report similar satisfaction rates.  Seeking a second opinion at least helps men better understand their surgical options.