A penile implant (penile prosthesis) is a medical device surgically placed inside the penis to treat severe erectile dysfunction by providing rigidity for sexual intercourse. The device consists of cylinders placed within the corpora cavernosa. While generally successful, situations arise where the implant must be removed, a procedure known as explantation. This surgical removal is a major urological event that leads to specific and often permanent physical changes and functional limitations.
Primary Indications for Explantation
The decision to remove a penile implant is typically driven by device complications. The most serious indication is a prosthetic infection, which can occur shortly after surgery or years later. An infection requires urgent removal of all implant components—the cylinders, pump, and reservoir—to prevent severe systemic illness and preserve tissue integrity.
Another frequent reason for explantation is mechanical failure, where a component of the device breaks down or malfunctions. This failure can involve fluid leakage, pump mechanism failure, or breakage of the rods. While less urgent than infection, mechanical failure necessitates removal to restore function.
Less common indications include device erosion or intractable pain. Erosion occurs when a part of the implant wears through the surrounding tissue, sometimes protruding through the skin or into the urethra. This requires prompt removal to prevent further injury. Chronic, severe pain that cannot be managed conservatively may also necessitate explantation.
The Immediate Post-Operative Experience
The immediate recovery period following explantation involves acute symptoms. Patients should expect pain, swelling, and bruising in the genital and lower abdominal areas, managed with prescribed medication and cold compression. Scrotal swelling can be significant and may take several weeks to fully subside.
Wound care focuses on preventing infection at the incision site, often located at the base of the penis or in the scrotum. Patients must keep the area clean and avoid baths or swimming pools until the incision is completely healed, typically four to six weeks. Showering is generally permitted within 48 to 72 hours, taking care not to scrub the surgical site.
Activity restrictions are important for proper healing and preventing complications like hematoma formation. Heavy lifting, strenuous exercise, and sexual activity are avoided for approximately four to six weeks. Most patients can return to desk work or light daily activities within one to two weeks, adhering to a lifting limit often restricted to under 15 pounds.
Long-Term Anatomical and Functional Consequences
The primary long-term effect of implant removal without subsequent replacement is corporal fibrosis, or scar tissue formation within the corpora cavernosa. Once the cylinders are removed, the internal chambers begin to heal by forming dense, non-elastic scar tissue. This process replaces the smooth muscle cells necessary for natural erectile function.
This corporal scarring leads to a permanent reduction in the length and girth of the penis due to tissue contraction. Patients undergoing explantation without immediate replacement may lose a noticeable amount of penile length, sometimes two to four inches. This anatomical change is often irreversible and contributes to a firm, “woody” feeling within the shaft.
Functionally, the potential for spontaneous, natural erections is severely limited after explantation. The original erectile dysfunction, combined with the surgical trauma of placement and removal, causes irreversible damage to the underlying vascular architecture. The device removal effectively eliminates the possibility of achieving a functional erection without further intervention.
The anatomical changes also have a psychological impact, affecting self-esteem, body image, and intimacy. Although the ability to achieve orgasm and ejaculate is typically preserved, the change in appearance and permanent loss of erectile capability can lead to anxiety or distress. Psychological adjustment is a key aspect of the long-term consequences of explantation.
Pathways for Restoration and Next Steps
Following recovery, patients must consult a specialist regarding management of their erectile dysfunction. If explantation was due to mechanical failure without infection, an immediate replacement, often called a salvage procedure, is preferred. This minimizes the time the corporal tissue is empty, helping to preserve penile length and prevent severe fibrosis.
If explantation was due to infection, a delayed replacement is necessary, as a new device cannot be safely placed until the infection is resolved. This staged approach requires a waiting period, typically three to six months. During this time, the corporal bodies are empty, increasing the risk of severe scarring and shortening. Surgeons may use temporary spacers or rods to maintain the tissue space.
For patients who choose not to have a second implant, non-surgical options are generally ineffective due to the fibrotic changes. Oral medications, such as PDE5 inhibitors, and vacuum erection devices are rarely successful because the internal structures can no longer properly expand or engorge with blood. Focus then shifts to addressing the permanent functional state and psychological adjustment to the irreversible changes.