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Placement of penile prosthesis within a man's body is a drastic, yet usually effective, treatment for erectile dysfunction when nothing else works. Here is a description of the procedure with 10 things doctors usually don't tell their patients.

Pioneered by Dr. F. Brantley Scott, a professor of surgery and a urologist at the Baylor Medical School in Houston, Texas in the 1970's, the penile implant has been used to enhance the sex lives of hundreds of thousands of men around the world. In the United States alone, over 20,000 men a year have penile implant surgery.

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Penile implant surgery is a treatment of last resort for men who suffer erectile dysfunction, the condition also known as impotence. The procedure is also used to treat an unusually small penis, or micropenis, and to repair or even replace the penis when it is accidentally or intentionally injured.

Penile implants are also a feature of female-to-male gender reassignment surgery, and they are frequently recommended for the treatment of Peyronnie's disease, in which the erect penis points to one side rather than forward, making conventional intercourse impossible.

In penile implant surgery, the doctor places an inflatable penile prosthesis inside the man's abdomen. This device replaces the two tubular structures, the corpora cavernosa, that run the length of the penis and fill with blood to enable an erection. The replacement device may consist of stiff metal rods that leave the penis permanently stiff, so that it only needs to be placed where desired for sexual intercourse, or the implant may be inflatable, operated by a hydraulic pump concealed in the abdomend and activated by the man when an erection is desired. The inflatable penile prosthesis fills two rods at the sides of the penis with salt water solution to create an erection, the pump activated again to drain the penis when intercourse is complete.

A Significant Drawback to Penile Implant Surgery

Penile implant surgery is irreversible. The procedure destroys the natural erectile tissue of the penis. This can never be replaced. Most men lose 7 to 10 mm (about half an inch) of length of the erect penis after implant surgery. The resulting penis typically appears normal, although it is not possible to enlarge the head, or glans penis, by this procedure. 

An Unmatched Advantage to Penile Implant Surgery

The erection powered by a penile implant can be maintained as long as desired. There is no risk of priapism,  the permanent vascular damage that can be caused by, as the ED pill commercials always point out, "an erection lasting four hours or more." 

Penile implant devices are not, however, permanent. Usually after 8 or 10 years, the device wears out and has to be surgically replaced, especially in the case of the inflatable devices.

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