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Surgical treatment of erectile dysfunction

Stephen Lazarou, MD
Section Editor
Jerome P Richie, MD, FACS
Deputy Editor
Wenliang Chen, MD, PhD


Erectile dysfunction (ED) affects approximately 50 million American men each year. The introduction of oral phosphodiesterase inhibitors revolutionized the care of these patients, but surgery still has a clear role when these inhibitors and other approaches fail or are contraindicated.

The surgical management of erectile dysfunction, including implantation of penile prostheses and penile vascular (arterial and venous) reconstruction, is reviewed here. The correction of curvature abnormalities (ie, Peyronie's disease) and other aspects of erectile dysfunction are discussed elsewhere.

(See "Overview of male sexual dysfunction".)

(See "Evaluation of male sexual dysfunction".)

(See "Treatment of male sexual dysfunction".)

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Literature review current through: Nov 2017. | This topic last updated: Dec 13, 2017.
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  1. Batty GD, Li Q, Czernichow S, et al. Erectile dysfunction and later cardiovascular disease in men with type 2 diabetes: prospective cohort study based on the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) trial. J Am Coll Cardiol 2010; 56:1908.
  2. Jackson G, Montorsi P, Adams MA, et al. Cardiovascular aspects of sexual medicine. J Sex Med 2010; 7:1608.
  3. Schwartz BG, Kloner RA. Clinical cardiology: physician update: erectile dysfunction and cardiovascular disease. Circulation 2011; 123:98.
  4. Shin D, Pregenzer G Jr, Gardin JM. Erectile dysfunction: a disease marker for cardiovascular disease. Cardiol Rev 2011; 19:5.
  5. Jarow JP. Risk factors for penile prosthetic infection. J Urol 1996; 156:402.
  6. Lewis, RW, McLaren, R. Reoperation for penile prosthesis implantation. Probl Urol 1993; 7:381. (DOI: 10.1159/000067984) .
  7. Wilson SK, Carson CC, Cleves MA, Delk JR 2nd. Quantifying risk of penile prosthesis infection with elevated glycosylated hemoglobin. J Urol 1998; 159:1537.
  8. Bishop JR, Moul JW, Sihelnik SA, et al. Use of glycosylated hemoglobin to identify diabetics at high risk for penile periprosthetic infections. J Urol 1992; 147:386.
  9. Wolf, JS, Bennett, CJ, Dmochowski, RR et al. The best practice policy statement of urologic surgery antimicrobial prophylaxis. American Urological Association, 2008. auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/antimicroprop08.pdf (Accessed on February 11, 2010).
  10. Gross MS, Phillips EA, Balen A, et al. The Malleable Implant Salvage Technique: Infection Outcomes after Mulcahy Salvage Procedure and Replacement of Infected Inflatable Penile Prosthesis with Malleable Prosthesis. J Urol 2016; 195:694.
  11. Lue TF. Erectile dysfunction. N Engl J Med 2000; 342:1802.
  12. Morgentaler A. Male impotence. Lancet 1999; 354:1713.
  13. Montague DK, Angermeier KW. Penile prosthesis implantation. Urol Clin North Am 2001; 28:355.
  14. Khoudary KP, Morgentaler A. Design considerations in penile prostheses: the American Medical Systems product line. J Long Term Eff Med Implants 1997; 7:55.
  15. Scott FB, Bradley WE, Timm GW. Management of erectile impotence. Use of implantable inflatable prosthesis. Urology 1973; 2:80.
  16. Wilson SK, Cleves MA, Delk JR 2nd. Ultrex cylinders: problems with uncontrolled lengthening (the S-shaped deformity). J Urol 1996; 155:135.
  17. Henry GD, Wilson SK. Updates in inflatable penile prostheses. Urol Clin North Am 2007; 34:535.
  18. Lightfoot AJ, Rosevear HM, Kreder KJ. Inflatable penile prostheses: an update. Curr Opin Urol 2010; 20:459.
  19. Wilson, SK. Penile prostheses at the millennium. Contemporary Urology 2001; 13:35.
  20. Quesada ET, Light JK. The AMS 700 inflatable penile prosthesis: long-term experience with the controlled expansion cylinders. J Urol 1993; 149:46.
  21. Levine LA, Estrada CR, Morgentaler A. Mechanical reliability and safety of, and patient satisfaction with the Ambicor inflatable penile prosthesis: results of a 2 center study. J Urol 2001; 166:932.
  22. Garber BB. Mentor Alpha 1 inflatable penile prosthesis: patient satisfaction and device reliability. Urology 1994; 43:214.
  23. Carson CC, Mulcahy JJ, Govier FE. Efficacy, safety and patient satisfaction outcomes of the AMS 700CX inflatable penile prosthesis: results of a long-term multicenter study. AMS 700CX Study Group. J Urol 2000; 164:376.
  24. Wilson SK, Henry GD, Delk JR Jr, Cleves MA. The mentor Alpha 1 penile prosthesis with reservoir lock-out valve: effective prevention of auto-inflation with improved capability for ectopic reservoir placement. J Urol 2002; 168:1475.
  25. Knoll LD, Henry G, Culkin D, et al. Physician and patient satisfaction with the new AMS 700 momentary squeeze inflatable penile prosthesis. J Sex Med 2009; 6:1773.
  26. Salem EA, Wilson SK, Neeb A, et al. Mechanical reliability of AMS 700 CX improved by parylene coating. J Sex Med 2009; 6:2615.
  27. Henry GD, Kansal NS, Callaway M, et al. Centers of excellence concept and penile prostheses: an outcome analysis. J Urol 2009; 181:1264.
  28. McKim SE, Carson CC 3rd. AMS 700 inflatable penile prosthesis with InhibiZone. Expert Rev Med Devices 2010; 7:311.
  29. Wilson SK, Delk JR, Salem EA, Cleves MA. Long-term survival of inflatable penile prostheses: single surgical group experience with 2,384 first-time implants spanning two decades. J Sex Med 2007; 4:1074.
  30. Bettocchi C, Palumbo F, Spilotros M, et al. Patient and partner satisfaction after AMS inflatable penile prosthesis implant. J Sex Med 2010; 7:304.
  31. Hollenbeck BK, Miller DC, Ohl DA. The utility of lockout valve reservoirs in preventing autoinflation in penile prostheses. Int Urol Nephrol 2002; 34:379.
  32. Carson CC 3rd. Efficacy of antibiotic impregnation of inflatable penile prostheses in decreasing infection in original implants. J Urol 2004; 171:1611.
  33. Hellstrom WJ, Hyun JS, Human L, et al. Antimicrobial activity of antibiotic-soaked, Resist-coated Bioflex. Int J Impot Res 2003; 15:18.
  34. Wolter CE, Hellstrom WJ. The hydrophilic-coated inflatable penile prosthesis: 1-year experience. J Sex Med 2004; 1:221.
  35. Wilson SK, Zumbe J, Henry GD, et al. Infection reduction using antibiotic-coated inflatable penile prosthesis. Urology 2007; 70:337.
  36. Cakan M, Demirel F, Karabacak O, et al. Risk factors for penile prosthetic infection. Int Urol Nephrol 2003; 35:209.
  37. Gross AJ, Sauerwein DH, Kutzenberger J, Ringert RH. Penile prostheses in paraplegic men. Br J Urol 1996; 78:262.
  38. Dos Reis JM, Glina S, Da Silva MF, Furlan V. Penile prosthesis surgery with the patient under local regional anesthesia. J Urol 1993; 150:1179.
  39. Kaufman JJ. Penile prosthetic surgery under local anesthesia. J Urol 1982; 128:1190.
  40. Wilson SK, Cleves MA, Delk JR 2nd. Long-term followup of treatment for Peyronie's disease: modeling the penis over an inflatable penile prosthesis. J Urol 2001; 165:825.
  41. Furlow WL, Goldwasser B, Gundian JC. Implantation of model AMS 700 penile prosthesis: long-term results. J Urol 1988; 139:741.
  42. Wilson SK, Delk JR 2nd. Inflatable penile implant infection: predisposing factors and treatment suggestions. J Urol 1995; 153:659.
  43. Fishman IJ, Scott FB, et al. Rescue procedure: an alternative to complete removal for treatment of infected penile prosthesis. J Urol 1987; 137:202A.
  44. Henry GD, Wilson SK, Delk JR 2nd, et al. Penile prosthesis cultures during revision surgery: a multicenter study. J Urol 2004; 172:153.
  45. Hauri D. Penile revascularization surgery in erectile dysfunction. Urol Int 2003; 70:132.
  46. Peppas DS, Moul JW, McLeod DG. Candida albicans corpora abscess following penile prosthesis placement. J Urol 1988; 140:1541.
  47. Carson CC. Diagnosis, treatment and prevention of penile prosthesis infection. Int J Impot Res 2003; 15 Suppl 5:S139.
  48. DePalma RG, Olding M, Yu GW, et al. Vascular interventions for impotence: lessons learned. J Vasc Surg 1995; 21:576.
  49. Parsons CL, Stein PC, Dobke MK, et al. Diagnosis and therapy of subclinically infected prostheses. Surg Gynecol Obstet 1993; 177:504.
  50. Silverstein AD, Henry GD, Evans B, et al. Biofilm formation on clinically noninfected penile prostheses. J Urol 2006; 176:1008.
  51. Brant MD, Ludlow JK, Mulcahy JJ. The prosthesis salvage operation: immediate replacement of the infected penile prosthesis. J Urol 1996; 155:155.
  52. Henry GD, Wilson SK, Delk JR 2nd, et al. Revision washout decreases penile prosthesis infection in revision surgery: a multicenter study. J Urol 2005; 173:89.
  53. Mulcahy JJ. Surgical management of penile prosthesis complications. Int J Impot Res 2000; 12 Suppl 4:S108.
  54. Cookson MS, Phillips DL, Huff ME, Fitch WP 3rd. Analysis of microsurgical penile revascularization results by etiology of impotence. J Urol 1993; 149:1308.
  55. Vardi Y, Gruenwald I, Gedalia U, et al. Evaluation of penile revascularization for erectile dysfunction: a 10-year follow-up. Int J Impot Res 2004; 16:181.
  56. Montague DK, Jarow JP, Broderick GA, et al. Chapter 1: The management of erectile dysfunction: an AUA update. J Urol 2005; 174:230.
  57. Rao DS, Donatucci CF. Vasculogenic impotence. Arterial and venous surgery. Urol Clin North Am 2001; 28:309.
  58. Babaei AR, Safarinejad MR, Kolahi AA. Penile revascularization for erectile dysfunction: a systematic review and meta-analysis of effectiveness and complications. Urol J 2009; 6:1.
  59. Goldstein I. Overview of types and results of vascular surgical procedures for impotence. Cardiovasc Intervent Radiol 1988; 11:240.
  60. Machtens S, Gänsslen A, Pohlemann T, Stief CG. Erectile dysfunction in relation to traumatic pelvic injuries or pelvic fractures. BJU Int 2001; 87:441.
  61. Kawanishi Y, Kimura K, Nakanishi R, et al. Penile revascularization surgery for arteriogenic erectile dysfunction: the long-term efficacy rate calculated by survival analysis. BJU Int 2004; 94:361.
  62. Sarramon JP, Malavaud B, Bertrand N, Rischmann P. [Vascular microsurgery in the treatment of vasculogenic erectile dysfunction: clinical experience apropos of 115 operations performed according to 2 different surgical techniques]. Prog Urol 1999; 9:707.
  63. Trombetta C, Liguori G, Siracusano S, et al. Laparoscopically assisted penile revascularization for vasculogenic impotence: 2 additional cases. J Urol 1997; 158:1783.
  64. Munarriz R, Uberoi J, Fantini G, et al. Microvascular arterial bypass surgery: long-term outcomes using validated instruments. J Urol 2009; 182:643.