Surgery and Devices:

Vacuum Erection Devices

Vacuum erection devices, also called vacuum constriction devices, can generally be used by all men with erectile dysfunction. Patients must receive thorough instructions in the proper use of such devices. They typically work as follows:

• The man places the penis inside a plastic cylinder.
• A vacuum is created, which causes blood to flow into the penis, thereby creating an erection.
• Once an erection is achieved, the man places an elastic ring around the base of the penis to retain the erection. The ring should remain in place for no more than 30 minutes.

Lack of spontaneity is this method's major drawback.

Penile Implants

Penile implants are an option for men who cannot take medication or for who less invasive treatments do not work. In general, they work well in restoring sexual function, and men are usually satisfied with the results.

Two types of surgical implants are used for the treatment of erectile dysfunction:

• A hydraulic implant consists of two cylinders placed within the erection chambers of the penis and a pump. The pump releases a saline solution into the chambers to cause an erection, and removes the solution to deflate the erection.
• A penile prosthesis is composed of two semi-rigid but bendable rods that are placed inside the erection chambers of the penis. The penis can then be manipulated to an erect or non-erect position.

Erectile tissue is permanently damaged when these devices are implanted, and these procedures are irreversible. Although uncommon, mechanical breakdown can occur, or the device can slip or bulge. In addition, a less than optimal quality of erection may result. Infection is a rare, but serious, complication.

Vascular Surgery

In rare cases, penile vascular surgery may be considered as treatment for erectile dysfunction. Two types of operations are available: revascularization (bypass) surgery, and venous ligation. Some insurance carriers consider these procedures experimental and will not pay for them.

According to the American Urologic Association, men who smoke or who have the following conditions are not candidates for penile vascular surgeries:

• Insulin-dependent diabetes
• Widespread atherosclerosis
• Consistently high blood cholesterol levels
• Injured nerves or damaged blood vessels

Revascularization. The revascularization procedure usually involves taking an artery from a leg and then surgically connecting it to the arteries at the back of the penis, bypassing the blockages and restoring blood flow. Penile arterial revascularization is appropriate only for young men (under age 45) who have blood vessel injury at the base of the pain that was caused by events such as blunt trauma or pelvic fracture.

Venous Ligation. Venous ligation is performed when the penis is unable to store a sufficient amount of blood to maintain an erection. This operation ties off or removes veins that are causing an excessive amount of blood to drain from the erection chambers. Long-term success rates for this procedure are less than 50 percent.