Nuffield Health The Manor Hospital, Oxford
Mr Musaab Yassin · Consultant Urological Surgeon & Andrologist
For erectile dysfunction that no longer responds to anything else — a concealed device giving a reliable erection on demand, and the highest satisfaction rates in the field. It is also irreversible, which is why the decision deserves this much detail.
01 · Understanding the implant
Tablets, injections and vacuum devices all work with what is left of your own erectile tissue. An implant does something different: two cylinders take the place of that tissue, so an erection no longer depends on blood flow, nerves or timing. It works every time, on demand, for as long as you want.
The three-piece inflatable prosthesis is the device that gives the most natural result — genuinely rigid when inflated, genuinely soft when not. Everything is inside the body and nothing is visible.
To get an erection you squeeze the pump a few times, moving fluid from the reservoir into the cylinders. When you have finished, you press a release valve on the same pump and the fluid returns, leaving the penis soft. It takes a little practice and then becomes unremarkable.
02 · What comes first
An implant has the highest satisfaction of any treatment for erectile dysfunction. It also permanently replaces your erectile tissue, which is the one thing about it that men are not always told plainly enough.
The decision that cannot be reversed
Placing the implant requires dilating and replacing the spongy chambers that would otherwise fill with blood. Afterwards, tablets, injections and vacuum devices no longer work — there is nothing left for them to act on. If the device ever has to be removed, for infection or any other reason, you are left with neither the implant nor your own erections.
That is not a reason to avoid it. It is the reason an implant comes after other treatments have genuinely been tried, rather than instead of them — and the reason the consultation takes as long as it does.
If those have been tried honestly and have not delivered a usable result, an implant is a rational, well-evidenced next step rather than a defeat.
For men with Peyronie's disease and severe erectile dysfunction together, an implant solves both problems in one operation. Straightening surgery alone would leave the penis straight but too soft for penetration; the cylinders act as an internal expander, correcting the curvature from within while restoring rigidity.
03 · The operation
The implantation itself is well-established and reliable. What separates good practice from average is the obsessive attention to sterility around it, because an infected prosthesis almost always has to come out.
04 · Recovery
Scrotal swelling and bruising peak in the first fortnight and are considerably more dramatic than most men expect. It settles. Nothing about the final result should be judged before six weeks.
You wake with a temporary catheter, removed the following morning before discharge. Ice to the groin — never directly on skin — supportive underwear continuously, and rest. The device sits partly inflated at this stage as an internal splint.
Keep the incision completely dry for 48 to 72 hours, then gentle warm showers; no baths or pools. Light desk work is reasonable. No heavy lifting, no strenuous activity, no cycling. Take pain relief regularly rather than waiting — this is a sore fortnight and there is nothing to be gained from enduring it.
Once the swelling has settled you are shown how to find the pump, inflate and deflate. You will then be asked to inflate and deflate it every day. That is not practice for its own sake — cycling the device stretches the capsule forming around the cylinders, which protects both function and length. Men who skip it do less well.
The capsule around the device has healed. Strenuous exercise, cycling and sexual activity are all cleared. Most men find the first few uses take some concentration and then it stops being something they think about.
05 · What to expect
Published satisfaction after an inflatable implant runs at roughly 90 to 95%, among the highest of any procedure in surgery, and partner satisfaction is comparable. Almost all of the dissatisfaction that does occur traces back to two expectations that were never discussed beforehand.
An implant will not make you longer than you naturally are, and it may leave you slightly shorter than you remember. Years of severe erectile dysfunction cause the erectile tissue to shorten and scar before surgery ever happens, and the cylinders can only fill the space that is there. Men who expect the length they had at thirty are disappointed by a technically perfect operation.
This is why daily inflation and deflation from week three matters, and why length is measured and discussed honestly before you consent rather than discovered afterwards.
The cylinders sit within the shaft. The head of the penis is not part of the device and does not inflate with it, so it stays softer than the shaft — noticeable to some men, unremarkable to most, and manageable with a tablet where it matters.
The implant replaces erectile tissue only. It does not touch the nerves that carry sensation, the skin, or the urethra — so sensation and the ability to reach orgasm are unchanged.
One honest clarification, because the usual phrasing misleads: the implant does not change your ejaculation from what it is now. If you have had a prostatectomy and produce no ejaculate, an implant will not bring it back. If diabetes or previous surgery has altered ejaculation, that stays as it is. What the device restores is rigidity — nothing more, and nothing less.
Bring your partner if you have one
Satisfaction after this operation is measured for couples as well as for men, and expectations that have never been said out loud are the commonest source of disappointment. The consultation is a better place to have that conversation than week seven.
06 · Living with it
Nobody can tell. Deflated, the penis looks and feels normal; the pump sits in the natural folds of the scrotum. Changing rooms, swimming, airport security — none of it is an issue.
It lasts. Modern three-piece devices commonly function for ten to fifteen years, and the great majority are still working at ten. When a component eventually fails, revision is a planned operation with good outcomes.
Tell any clinician you have an implant
Before any catheter, cystoscopy, imaging or unrelated operation, say that you have a penile prosthesis with an abdominal reservoir. It changes how some procedures are performed and how scans are interpreted. It is a two-second sentence that prevents a genuine problem.
07 · When to contact the clinic
Bruising and marked scrotal swelling are expected in the first fortnight. These are not. Contact the clinic straight away, or go to your nearest A&E out of hours.
An infected implant will not settle by itself. Early treatment occasionally saves the device; delay rarely does.
Pain in the penis or scrotum not relieved by your painkillers, or getting worse day by day rather than better.
A painfully full bladder with nothing coming out needs dealing with the same day. Tell whoever assesses you that you have a penile prosthesis with an abdominal reservoir before any catheter is passed.
An erection you cannot let down is uncomfortable and, left for a long period, risks pressure damage to the skin. It is usually a technique problem in the early weeks rather than a fault, but do not spend the weekend struggling with it — ring us.
Who to call
Out of hours, do not wait. Go to your nearest Accident and Emergency department and tell the staff you have an implanted penile prosthesis. WhatsApp and email are not monitored out of hours.
08 · Questions
No. Everything is inside the body. Deflated, the penis looks and feels normal, and the pump sits in the natural loose skin of the scrotum where it is not obvious even to a partner unless you point it out. There is a small scar in the crease where the scrotum meets the penis, which fades.
It feels rigid and reliable, which for most men is the point. It is not identical: it is straighter and firmer than a natural erection, the head stays softer than the shaft, and it appears when you decide rather than when your body does. Around 90–95% of men report satisfaction, and most describe the predictability as the thing they value most.
No, and this is the most important thing on the page. Placing the cylinders replaces the erectile tissue that tablets, injections and vacuum devices rely on. After an implant those treatments no longer work, and if the device were ever removed you would have neither it nor your natural erections.
That is why the operation comes after other options have genuinely been tried, and why nobody should be rushed into it.
Possibly slightly, compared with what you remember. The implant fills the space available and cannot create new length, and years of severe erectile dysfunction shorten and scar the tissue before surgery ever takes place. Daily inflation and deflation from week three helps stretch the capsule and preserve what you have.
Length is measured and discussed before you consent. Men who go in expecting restoration to their twenties are disappointed by an operation that has gone perfectly well.
Six weeks, once the capsule around the device has healed and you have been cleared. Attempting earlier risks displacing components before the tissues have settled. The first few times take some concentration; that passes quickly.
Commonly ten to fifteen years, with the great majority still working at ten. Eventually a component wears out — usually a slow fluid leak with loss of rigidity — and is replaced in a planned operation with good results. It is a maintenance expectation rather than a failure, and it is better known at the outset.
It makes an implant more attractive rather than less. Where severe curvature and erectile dysfunction occur together, straightening surgery alone leaves a straight penis too soft for penetration. The cylinders act as an internal expander that corrects the curve from within while restoring rigidity, and any residual bend can be modelled on the table. It is the one operation that answers both problems at once.
Usually yes, but control matters more for you than for anyone else. Raised blood sugar substantially increases the risk of implant infection, so your team will want a recent HbA1c and may ask you to improve it before proceeding. That delay is frustrating and it is the right call — losing a device to infection costs far more than a few months of preparation.
Taking the next step
The assessment covers what has genuinely been tried, whether anything reversible has been missed, an examination, and a frank discussion of length, sensation and what the device will and will not do. Because this step cannot be undone, nobody should take it without having had that conversation properly — and with a partner present, if you have one.
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