Complications of Surgery for Erectile Dysfunction
The decision to have surgery for erectile dysfunction should come after you have tried other, less invasive options. However, penile implant surgery can be very effective in restoring an erection that you can rely on.
Penile implant surgery also has certain disadvantages and risks to consider. It involves the placement of an artificial device inside your penis. Once you have surgery, you will need another operation before you can choose a different type of therapy. And even if you don’t intend to change your mind, if you have complications or device failure, you will need to have the implant surgically removed.
Two other types of surgery that are sometimes performed for men with ED include vascular surgery and surgery for Peyronie’s disease.
Vascular surgery is generally recommended only for men who have ED because of leakage from certain blood vessels in the penis, or blockage of blood vessels. This type of surgery is not commonly recommended, because it is not known to have a high success rate. Only a third or less of men undergoing the procedure regain normal erections.
Surgery for Peyronie’s disease is performed to remove or release the scar tissue that is affecting the penis and preventing erection. (Releasing the scar means to introduce a planned cut to make it more compatible with movement.) However, this type of surgery may result in a shorter penis if there is a great deal of scar tissue, and carries the risk of damage to normal penile tissues, which can make ED worse.
It is important to understand that no surgery is risk-free, and the expected benefits from the surgery must be weighed against the possible risks. These benefits do NOT include an increase in penis size or length. You should never undergo these surgical procedures if that is your main objective. The surgery also will not increase your desire for sex.
Before undergoing surgery, speak with your physician about the benefits you anticipate from surgery, how you expect to feel after surgery, and the risk of possible side effects or complications and how to cope with them.
Possible complications that may follow surgery for penile implants include:
Difficulty concealing a malleable device: Malleable (non-hydraulic, semirigid) devices are flexible rods, not designed to allow the penis to be in a completely relaxed state after implantation, but instead result in permanent firmness. The recipient must learn to adjust to a penis that is always somewhat rigid, and must learn to conceal their penis appropriately. As inflatable devices have improved and more has been learned about their safe use over the long term, the use of malleable devices has declined.
Erosion of a malleable device: when a firm foreign body is implanted in the body, there is a risk that diseased tissue may break down, leading to erosion of the foreign substance through the body. If you are at high risk of this type of reaction to a malleable device, you should not have it implanted. Some conditions that may place men at high risk include spinal cord injury or diabetes; men who have had past irradiation of the penis. If you have any questions about your risk, ask your physician to evaluate you before surgery.
Failure of an inflatable device to function properly: before you have an inflatable device implanted, learn exactly how it works, so you can be better prepared to use it easily and reliably. Ask to see a video of the device’s function, for detailed instructions with photographs, and for an opportunity to handle a sample device. These devices are more reliable today than when first introduced, but any device is subject to the risk of mechanical failure.
Migration: the unintended movement of a penile implant within the penis is likely to interfere with its cosmetic appearance and function, and may cause you discomfort or pain. Ask your physician to evaluate you promptly if you sense that the device has migrated away from its original placement.
Infection: this is a serious complication that requires immediate evaluation and treatment. Waiting only allows the infection to progress and makes the situation potentially worse. Ask your doctor to evaluate you as quickly as possible if you detect signs or symptoms of a possible infection, such as tenderness or pain, redness, swelling, or fever. Be aware that an infection can appear even months or a year after surgery. Your physician can explain to you how best to proceed; usually the implant is surgically removed, but in such a way as to improve the success of a second operation to implant a new device.
Reoperation: following certain types of problems with the device, you may need to have it removed and, if desired and recommended by your physician, a new device implanted. It is important for you to understand that each operation results in scarring, potential shortening of the penis, and potential difficulty with new operations. When you have the original surgery performed, choose a physician who is well-trained and who performs the procedure frequently, with good success rates. Try to follow your physician’s advice as closely as possible with respect to preparing for the operation, recovering afterward, and returning for follow-up evaluation.
Possible complications that may follow vascular surgery include:
Possible complications that may follow surgery for Peyronie’s disease include:
Be sure to follow your physician’s advice with respect to self-care after surgery, follow-up evaluations, and possible signs of complications to look for. Tell your physician promptly if you see or sense anything that seems wrong to you after surgery, and get evaluation and treatment immediately if the situation appears urgent. Give yourself an opportunity to recover after surgery, and make sure you have a period of time where you can focus on taking care of yourself without outside stress so you can heal more quickly, adjust more easily to your new condition, and appreciate the benefits of your surgery.