Host 1: 

Welcome to Health Lab, your destination for news and stories about the future of health care. Today: The truth about penile implants. Suffering from erectile dysfunction? Penile prosthesis surgery is safer, and more successful, than you think.

If you experience erectile dysfunction, you’re not alone: according to the National Institutes of Health, it impacts 30 million men in the United States. 

While cases occur due to complications from prostate cancer treatments, others can be related to long term effects stemming from medical conditions such as diabetes, heart disease, high blood pressure and aging. 

What’s not common, though?

Patients knowing about a safe solution that can actually fix the problem: a penile implant.

And the even bigger problem?

Most primary care providers, and even some urologists, don’t educate patients about their options either due to a lack of knowledge of available treatments, or because their focus is on other pressing medical problems during the little time doctors get with their patients.

What is erectile dysfunction?

Erectile dysfunction is described as having trouble getting or maintaining an erection firm enough for sex. 

Although having problems from time to time is normal, issues with erections occurring more frequently, and interfering with your sex life, need to be discussed with a provider. 

The common condition not only impacts self esteem, but also relationships. 

And it can be difficult to ask for help.

Addressing the issue

The first line of treatment used for ED is an oral agent, pills such as Viagra and Cialis. 

When pills stop working, other options, such as penile injections, are often sought out. 

But when those don’t work?                       

Penile implants are the next treatment of choice, and contrary to popular belief, they’re not new – they’ve been around since the late 70s.

Penile implants have around a 95% patient satisfaction rate as compared to pills, which only have around 50%, and injections only 30%. 

What is penile implant surgery? 

The penile implant is a fluid-filled three-piece device, with a part that goes into the penis that gets inflated to give an erection. Everything is placed inside and controlled by a small pump that’s hidden inside the scrotum.

The control mechanism is then placed inside the scrotum, and the procedure is done through a small, less than 4 cm (2 inches), incision. 

After the procedure, patients rest at home and return in at two weeks for a wound check and then again at six weeks to get taught how to activate the device and start using it. 

Generally, patients return to their daily activities, unrestricted, at six weeks, too. 

The approach aids in preserving the normal, pleasurable sensation had with sex and provides people the ability to achieve an orgasm. 

Durability and complications

It’s important to remember that high volume providers and centers (hospitals) have mature processes in place and are able to perform these procedures quickly, reducing the risk of complications like infections. 

Complication rates and suboptimal outcomes, related to sizing and placement, are higher in lower volume practices. 

This, unfortunately, adds to the stigma that these procedures are more dangerous than they really need to be and cautions patients, as well as their surgeons, to be more anxious about offering or undergoing it. 

Patients should be encouraged by their providers to seek out this option, but only with high volume surgeons and centers. 

More on the provider issue

Another layer of complexity? 

After prostate cancer treatment, there’s a wide variability in reported ED rates, which can be as high as 70%; Patient reported outcomes indicate a higher rate of erectile dysfunction than physician-reported outcomes. 

This issue is likely for two reasons: erectile dysfunction is usually managed by the person who handles the prostate cancer treatment, which creates a hurdle with patients feeling uncomfortable bringing up the problem.

And the second, on the urologist side, the problem with ED reporting is the inherent conflict in acknowledging a complication of the treatment they've given. 

Whether it’s a diabetes follow up, prostate cancer treatment visit, cardiac condition, or other, many times providers rely on the patient to bring up the concern when they feel it’s critical enough, forgetting that it’s usually very difficult for people to initiate that conversation. 

Michigan Medicine is making access easier for patients who want to discuss erectile dysfunction, by offering both in-person and virtual options to discuss the concern. 

For more on this story and for others like it, visit Health Lab at michiganmedicine.org/health-lab 

Host 2:

Health Lab is a part of the Michigan Medicine Podcast Network, and is produced by the Michigan Medicine Department of Communication. You can subscribe to Health Lab wherever you listen to podcasts.