Good penile implant surgery should result in long-term usefulness of the penile prosthesis without complications.
When penile implants are inserted by an extremely skilled and highly experienced surgeon expert at fixing erectile dysfunction in men, whatever the cause, the patient can expect to have a normal sex life for many years.
Lots of men considering penile prosthesis surgery wonder what kind of man gets a penile implant and how truly normal they can expect to be. They have asked numerous questions about penis implants which are answered here.
Breaking news for the 40% of men with ED who have found all other male impotence treatments worthless is that penile implant surgery for male erectile dysfunction treatment no longer means you must accept a substantially shorter penis.
The Sava Perovic Foundation Surgical Team can significantly LENGTHEN your penis during implant surgery — 3-4 cm (1.1 to 1.6 inches)! And, AMS penile implant prosthesis models now include the AMS 700 LGX which together with Perovic surgery solves the #1 patient concern after penile prosthesis implantation — loss of inches! It's the highly effective penis enlargement surgery so many men seek but is only available to men with erectile dysfunction.
The Foundation continues the legendary work of Professor Dr Sava Perovic, one of the world's leading urological surgeons with nearly four decades of pioneering developments in a vast array (more than 74) of the most challenging and complex urologic surgeries anywhere. He created 30 of the procedures himself.
Below are his responses to questions patients have asked. The Chairman of the Sava Perovic Foundation is Dr Rados Djinovic, who was personally trained by Dr Perovic in all his procedures for more than seven years. He now answers questions from patients since Dr Perovic succumbed to cancer 4 April 2010. This is NOT medical advice for you. It was medical advice only for the patient that asked the question. When repeated here, the questions and answers become information for general educational purposes only.
What does Professor Perovic think about the semi-rigid "silicon soft dynamic anti-extrusion" (SSDA aka Silicone Semi-rigid Dynamic Anti-erosion) penile implant prosthesis which consists of a medical grade silicone elastomer which has three zones with different features: 1) "central zone" with variable diameters and rigidities; 2) "distal zone" comprised of softer silicone to reduce extrusion risk; and 3) "proximal zone" which is 3 mm narrower than the central zone and comprised of a sequence of slightly conical segments?
“We have not used this prosthesis, but you must understand that all semi-rigid prostheses are of similar quality. And all have some small advantages and disadvantages. WE use mostly the AMS 650 and Promedon (Argentina) — which is also very similar to mentioned one.”
What is the difference between this "Silicone Semi-rigid Dynamic Anti-erosion" (SSDA) penile implant prosthesis and a standard semi-rigid prosthesis? My urologist says the SSDA is more comfortable and destroys less erectile tissue than semi-rigid harder implants). Is this true?
“There is NO difference regarding destruction of erectile tissue. Every producer states their implant is the best and has many advantages, but in reality they are all very similar. The good thing with AMS is they give a life-long warranty. If there is some problem, they will provide a new implant for replacement free of charge.”
Is it true this implant allows and helps the residue tumescence better than a semi-rigid implant?
“No.”
Can this implant help me to solve my erectile dysfunction?
“Yes, but I would advise you to be informed about the AMS Ambicor 2-component inflatable prosthesis with a very small pump that is easy to use (only 3-4 squeezes) and easy to deflate (bend the penis downward). If I needed to choose one for myself, I would probably implant this prosthesis.”
Can Dr Sava Perovic implant a "silicon soft dynamic anti-extrusion" (SSDA) prosthesis for me?
“Yes, no problem.”
Does Dr Perovic like the "Silicone Semi-rigid Dynamic Anti-erosion" (SSDA) implant?
“As much as all others.”
Can a patient getting penile implant surgery also get your famous penile girth enhancement using tissue engineering with PLGA scaffolds as well as penile lengthening during the same surgical session?
“We cannot perform lengthening and implant scaffolds at the same time – too high a risk of infection. We can do lengthening and implant the prosthesis first and then perform girth enhancement using scaffolds six months later.”
How many hours of surgery are required to perform penile implant surgery and penile lengthening at the same time using the InteXen AMS 500 grafting material?
“Approximately three hours.”
How many nights must a patient getting penile implant surgery stay in hospital?
“He would stay only 2-3 nights.”
How many days stay in Belgrade total? Please advise.
“We prefer a patient stay in Belgrade one full week.”
Will there be any discomfort after implant?
“Of course, but only mild discomfort for the first few days.”
After implantation, will I get a rock hard erection -- or just a 60% erection?
“You will not get a ‘rock hard ’ erection but certainly more than 60% — probably 80-90%”
Will penile prosthesis implantation make my penis shorter?
“No.”
(Note: this only applies to surgery performed by Dr Perovic, not penile implant surgery anywhere else from any other surgeon! Implant surgery from any other surgeon will almost CERTAINLY MAKE YOU SIGNIFICANTLY SHORTER!)
Can you make my penis longer at the same time you do prosthesis implantation?
“YES!”
(Note: lengthening requires use of high-tech grafting material which costs an additional Euros €500 but all prices quoted for surgery in Belgrade are PACKAGE prices that include everything EXCEPT the cost of the implant itself.)
Will my penis lose any of it's original girth (circumference) because of the surgery?
“No.”
Can you increase the girth of my penis at the same time you implant the penile prosthesis?
“Penile girth enhancement phalloplasty using tissue engineering with PLGA scaffolds is better done in a separate stage.”
Are there any disadvantages to getting the surgery in Serbia rather than my own country?
“None at all.”
What are the advantages to getting surgery in Belgrade?
“Yes – you will be longer under our surveillance.”
(Note: You also get the benefit of Professor Perovic's ENTIRE personal Team of surgeons and medical professionals!)
What are the possible complications I could develop during or after this surgery?
“Of course, infection in the penile prosthesis. There are three primary possible complications, including prosthesis infection in 4-5% of patients. The rate of infection significantly decreased after introduction of antibiotic-coated inflatable penile implants by AMS. About 7% of patients with a semi-rigid prosthesis experience protrusion but less then 3% if they use an inflatable prosthesis. In rare instances, inflatable devices fail. In these cases, as well as in all cases of infection, the manufacturer provides a new prosthesis without additional charge.”
Do I understand correctly that the only true and lasting male erectile dysfunction cure is venous ligation — total penile disassembly — and implantation of a penile prosthesis?
“Only prosthesis implantation.”
Will I lose sensation in my penile shaft?
“No.”
Will my ability to ejaculate be affected in any way by implant surgery?
“No.”
Will my ability to have an orgasm be affected by this surgery?
“No.”
What will be the maximum length of time I will be able to maintain an erection after fully recovered from prosthesis surgery?
“As long as the penile prosthesis remains inflated, for example — hours.
Will my wife be able to feel that I have an implant while we are having sex?
“No.”
How long will the implant last?
“Nobody can tell, but many of penile prostheses implanted 20 or more years ago are still functioning.”
If the implant malfunctions, must I buy a new one or will the manufacturer replace it for free?
“Replacement is free of charge by the manufacturer.”
If I need prosthesis re-implantation, what would be the total cost?
“Nominal — just enough to cover basic hospital expenses — our work is for free.”
How many times can I get prosthesis re-implantation? In other words, how many years total can I expect to be able to maintain my ability to have sex as a result of getting implants? How many years will it solve my ED?
“For a lifetime.”
If I ever get an infection of the genital area, is it certain that penile implant protrusion must follow or can the infection sometimes be defeated?
“Infections can be defeated.”
How urgently must I get back to Belgrade if infection and protrusion occurs?
“Within one week.”
If I suffer penile implant protrusion or other complications, will it impact on my ability to urinate?
“No.”
If it isn't scarring, what is causing my penis to shrink AND shorten AND causing the decreased firmness AND function of my erections?
“Definite damage of your small blood vessels inside the cavernosal tissue is causing impaired erection.”
I had penile duplex ultrasound done in August 2009. Dr Levine said no fibrosis, everything was normal, and used 30 mg of papaverine. He states that I had a 9/10 erection. I thought it was a 6/10. My peak systolic flow was 15.4, no diastolic flow. Is that peak systolic flow low?
“Very low.”
Does that indicate vascular insufficiency?
“Yes.”
Why isn't he telling me this?
“I don't know.”
I am currently taking medications for impotence. I'm using Viagra 100mg, sometimes every day, to try to induce erections. I have nocturnal erections but having trouble with impotence. I get erections too soft for intercourse. I am currently using 40 mg of Levitra for sex which works pretty good sometimes. Is it true impotence drugs like Viagra should make the glans engorge more bringing better rigidity and pleasure?
“It is supposed to do so.”
After my priapism my testicles shrank up and feel cold and are almost a purple color. Why is that?
“Strange.”
I am 29 years old with erectile dysfunction. Impotence drugs (pde5) work sometimes but are not really an impotence cure. In your own professional opinion, would you still consider giving me a penile implant?
“Yes.”
Is 29 years old too young for a penile implant or does age not matter?
“Age doesn't matter. If there is definitive ED, the only good, long-term solution is a penile implant.”
How old was the youngest patient you have given a penile prosthesis? Is impotence in young men rare?
“Probably 19-20 years old. It happens rarely, but it happens.”
American doctors say that I'm too young for a penile prosthesis implant since the oral impotence drugs work sometimes. If the impotence pill and other ED cures don't work, the doctors then advise the use of injections. I don't like injections because they hurt and caused all of the problems I am experiencing. They are also a mood killer. Aren't injections contraindicated if a patient has scar tissue in his penis?
“Not really. You can apply the injections from the opposite side.”
How big a risk of infection does having a penile implant pose?
“In primary cases, 2-3%.”
Is it true that infection can take up to a year to start?
“Extremely rare. The great majority of infections start in the first few weeks.”
How long does a penile implant last? US doctors tell me 4-5 years.
“We have patients who have had a penile prosthesis implant for more than 20 years. Reported articles state that the mechanical failure rate of inflatable penile implants is 10-15% after 10 years and in those cases the company gives a new implant free of charge.”
Will my girlfriend be able to get on top of me without breaking the implant?
“Of course.”
Can rough sex break a penile prosthesis implant, such as hard thrusting?
“No.”
Can you over inflate and thereby break a penile prosthesis?
“No.”
Is sex the same or better with the penile prosthesis implant?
“Usually better. Sex lasts longer.”
Will my wife be able to know I have a penile prosthesis implant?
“If she touches the testicular sack deeply — yes.”
What do your patients say about their penile implant? I hear some say it makes them uncomfortable.
“Only in the first 2-3 months. After that, you don't have the feeling that you have something inside you.”
What is the rigidity like after getting a penile prosthesis implant?
“Erection can often be improved if the implant is gently placed — the cavernosal tissue becomes compressed and less blood is necessary for achievement of a strong erection.”
Do implant patients feel like they are not in control of their penis?
“No.”
Are patients overall satisfied with their penile implant?
“More than 80% are very satisfied.”
How many times a day will I be able to use my new penile prosthesis implant?
“As much as you want. No time limit.”
Will I suffer any nerve loss or sensation after getting a penile prosthesis implant?
“No.”
How much size will I lose with an implant? Doctors in the USA tell me that a penile prosthesis makes one shorter.
“Only if a short implant is placed and if you completely lose your natural erection. Also there is a new AMS 700 LGX implant which has longitudinal extension and was created to prevent this problem.”
If I have to get re-implantation of a penile prosthesis someday, will I lose more size and function and firmness?
“No. Re-implantation is very simple and does not create the mentioned consequences.”
If my penis is 14.5 cm erect and I opt to have a penile prosthesis implant choosing Dr Perovic's procedure, how much size can I gain?
“Usually, 2.5-3 cm.”
What is the maximum length increase a patient of yours has got from lengthening and penile prosthesis implantation?
“Four centimeters (1.6 inches). The longer the penis, the longer the extension possible.”
Will a penile prosthesis implant make my flaccid penis bigger than in the past?
“Yes.”
If I choose a penile implant, will Dr Perovic show me how to use the device?
“Of course.”
If I have arterial insufficiency, can you perform penile re-vasculation bypass?
“Yes, but it is usually …”
Is this effective?
“… not effective.”
Does Peyronie's Disease cause vascular insurgency of the penis?
“Only in 10-15% of patients (usually those who are older than 50).”
Does Peyronies always cause a curve?
“No, there are rare cases affecting all of the Albuginea and consequent penile shortening. Also, even more rare are cases of only penile shrinkage without shortening.”
If there is scar tissue in your penis is it always Peyronie's Disease?
“Usually, but not always. Sometimes penile fracture can give a similar, localized scar.”
My doctors did not say I have Peyronie but I have reduced function, firmness, elasticity, and erections are shorter. What is this then? Can Dr Perovic repair this?
“It may be Peyronie's or it may be ED (Erectile Dysfunction).”
Does Dr Perovic's method of Peyronie's treatment restore lost length and girth? Can he recover the length I lost PLUS some more?
“Usually, yes. It depends on how badly affected is the neurovascular bundle and urethra.”
Am I a rare case? The psychological impact of erectile dysfunction is taking a huge toll on my self-esteem.
“Erectile dysfunction is rare for your age.”
Are my feelings normal?
“Yes. It is a typical reaction in normal persons for your self-esteem to be affected.”
Why don't American doctors have the expertise of Dr Perovic? Thank you Dr Perovic for taking my questions.
“They are not brave enough for a radical surgical approach due to lack of experience and strict medical laws in the USA that don't give surgeons freedom to work in a different way than the 'Standards of Care'. Creativity is also extremely important, as well as a very broad field of work — we do all possible surgeries in urethro-genital reconstruction from newborns to the most elderly, both male and female.
You are welcome.”
Are Total Phalloplasty patients generally satisfied with their penile prosthesis implants?
“All patients have been satisfied with the function of the penile implants. In some cases, implantation of a semi-rigid prosthesis is recommended for three months after the phalloplasty to prevent phallic retraction. It can be removed and replaced later with an inflatable prosthesis.”
Are the possible complications and rates of infection for Perovic Total Phalloplasty patients the same as for natal men?
“There are three primary possible complications, including prosthesis infection in 4-5% of patients. The rate of infection significantly decreased after introduction of antibiotic-coated inflatable penile implants by American Medical Systems. About 7% of patients with a semi-rigid prostheses experience protrusion but those with an inflatable prosthesis less then 3%. In rare instances, inflatable devices fail. In these cases, as well as in all cases of infection, the producer provides a new prosthesis without additional charge.”
One Perovic Total Phalloplasty Stage 3 FtM patient I know suffered implant protrusion and returned to Belgrade for Dr Perovic to correct the problem. Why did that happen? What percentage of Total Phalloplasty Stage 3 patients experience implant protrusion?
“Prosthesis infection is a complication well known to all transgender people. The rate is higher in a Total Phalloplasty neophallus than in normal penises. In radial forearm phalloplasty, it is about 15-30%. In a Perovic Total Phalloplasty neophallus it is less than 10% because the neophallus is bigger and has more space for placement of prosthesis without tension. The main causes of infection in a neophallus are: 1) small space for placement of implants; 2) less than ideal vascularity and less than ideal quality of tissue. It is very hard to predict despite all measures that we take before, during and after implantation.
When the complication occurs, the usual scenario is infection starts first and after a few days protrusion also. They are most often coupled. All of these procedures regarding total phalloplasty are extremely complex and difficult and infections and protrusion are the most common complications. There is no surgery without complication.
The most important thing is that all of our patients will eventually have good phalluses with a urethra and prosthesis inside.”
What is a vascular graft? Can you explain it's relationship to the penile implant I'm going to get?
(Note: Professor Sava Perovic has significantly reduced the 3% standard rate of penile implant prosthesis protrusion by using a hi-tech vascular graft to enclose the device before insertion.)
“A vascular graft is an artificial pipe material made and used for replacement of injured blood vessels. Vascular surgeons use it for reconstruction of blood vessels. It has very good characteristics and we envelope penile prostheses (penile implants)in it to form a good and strong capsule around the prosthesis as well as to prevent possible prosthesis protrusion. Prosthesis protrusion is a possible complication, but mostly with implantation of a semi-rigid prosthesis or when an inflatable prosthesis is implanted inappropriately. In order to prevent this, we envelope the prosthetic cylinders in the vascular grafts and then implant it in the neophallus.”
What types and brands of penile prosthesis devices can Dr Perovic implant in FtM patients?
“We implant all kinds of prosthesis devices: inflatable (two or three components) and semirigid, both AMS and Mentor (now Coloplast). We have great experience in this field.”
(Note: Semi-rigid prostheses pose greater risk of protrusion as a result of the permanent pressure of the prosthetic tips. The Perovic Surgical Team highly recommends an inflatable prosthesis enveloped in a vascular graft. Envelopment of the prostheses in a vascular graft greatly decreases risk of penile implant protrusion.)
Can you perform implant surgery on someone 65 with diabetes and slightly high blood pressure?
“These are the usual patients for penile implants.” (Yes.)
Will 'standard' erectile dysfunction correction using implantation of an inflatable, 3-piece penile prosthesis give a man a shorter erect penis than his original length?
“We don’t know his original length, but we always put in the maximal possible implant and we will measure the penis before and after implant.” (Should not make it shorter but it might without the lengthening procedure.)
What is the minimum neophallus length and girth required for safe Stage Three Total Phalloplasty in which a patient gets the penile prosthesis implanted?
“It depends mostly on his BMI (Body Mass Index) — the greater the BMI the thicker the phallus. Minimum length in thin persons could be five inches and with a circumference of 4½ to five inches.”
Would five inches long and 4¼ inches in circumference be viable?
“Minimum 4½ inch girth.”
Would five inches long and a 4½ inch girth create a neophallus of normal appearance?
“If he is a thin person, yes.”
Does penis size impact on the type of penile prosthesis that can be used?
“More or less – no.”
Would choosing a shorter and thinner neophallus make it necessary to use a semi-rigid prosthesis instead of a 2-piece or 3-piece inflatable prosthesis?
“Not necessarily.”
One of the doctors on your Perovic Surgical Team told me to start cycling the prosthesis about two weeks after penile implant surgery. When that time comes, for how long should I leave the AMS 700 LGX penile prosthesis implant inflated?
“You should keep it inflated for 3-4 hours every day, increasing the level of inflation every day.”
What is 'cycling the penile prosthesis'? How do I do that?
“Inflate and deflate your prosthesis a few times per day.”
Should I start 'cycling the prosthesis' exactly 14 days after surgery?
“That depends on what surgery was performed, but usually 2-3 weeks after your operation.”
Are there any negative consequences of 'cycling the penis prosthesis' too soon or too long after surgery?
“If you do it too soon, yes — penile shortening after implantation. If you wait a bit too long — NO negative consequences.”
Dr Rados Djinovic said wait about two months or eight weeks after my penis implant surgery before I have sexual intercourse. Is that sufficient time or should I wait longer?
“It is sufficient.”
When can men with penile implants have sex for the first time after their surgery?
“6-8 weeks later.”
What factors would make it advisable for a guy with an AMS penile implant to wait longer than 6-7 weeks after surgery before having sex?
“If grafting was performed — waiting eight weeks is better.”
Is there a minimum number of times I should pump the MS pump of my penile prosthesis in order for it to be enough to reach a full erection?
“Because you have 21 cm (8.3 inch) long cylinders on your AMS 700 LGX penile prosthesis implant, you should pump a full 8-10 times.”
(Note: AMS 700 LGX cylinder length varies.)
I have a questions about using a penis implant. How many times or how many minutes must must patients pump AMS penile implant prosthesis models (or Mentor penile implants) to reach the maximum possible erection?
“The smaller the prosthesis, the fewer number of times you need to pump. For example:
How much of an erection is safe and advisable after penis implant surgery? How erect can I make myself and on what day after surgery? It is really difficult to be patient. Thank you for this penis implant info.
“After surgery we leave penis implants inflated about 60%. About 2-3 weeks later, you should start cycling the penile pump implant. You should inflate your AMS prosthesis for 3-4 hours every day. In the beginning, inflate it less. Slowly increase the amount of inflation slightly day by day. This is important to enable creation of a large capsule and prevent its shrinkage.”
Are the AMS 700 Ultrex, CRX, CX or LGX all the same price?
“Yes.”
Is the AMS Ultrex the same model as the LGX?
“No.”
What are the minimum requirements from a patient in order to schedule surgery for a penile prosthesis implant?
“The patient must have ED and want a penile implant and he must be informed about penile implants. Here is the official AMS site. A medical history is not as good as receiving some medical document from a doctor. Photos are often good, particularly for younger patients. And patients should not be too young. A penile prosthesis should rarely be implanted in patients younger that 50 years old.”