Surgery is the oldest treatment for ED and at the present time it is the last recourse employed. It may be recommended for patients that to not respond to treatment with drugs.
Implantation of penile prostheses
Penile prostheses were introduced in the 1970 and since then several models have been developed. At present two types of prostheses are available: malleable (semi-rigid) and hydraulic.
Semi-rigid malleable prostheses (figure G) consist of two silicone cylinders surrounding a metal core. They are easy to put in place and simple to operate, but they maintain a constant rigidity that may be very uncomfortable.
The hydraulic prostheses consist of two or three pieces. The three pieces comprise two cylinders, a scrotal pump and a reservoir of liquid (figures H and I)). The implantation surgery is more complicated, but they may provide an erection very similar to the natural one, with good rigidity and increase in diameter and length. The operation is performed under regional anaesthesia and the patient is discharged after two days and may resume sexual activity after six weeks. It must be taken into consideration that there will be no increase in size of the glans and the penis will not achieve the length it formerly had, although the AMS700 LGX device may increase the length by 1 to 4 cm.
Arterial revascularisation surgery
This procedure is indicated only in young patients who are neither smokers nor diabetics, lack venous drainage and have a stenosis of the internal pudendal artery. The best results are obtained in young patients with arterial lesions secondary to pelvic or perineal injuries.