Erectile Dysfunction

Inflatable Penile Prosthesis

Erectile dysfunction is very common in men. Please refer to our page on erectile dysfunction for more information about this issue.

A penile implant, also known as an inflatable penile prosthesis, is a device that is place inside your penis to allow you to achieve an erection.  You may be a candidate for this device if you have erectile dysfunction that does not respond to other medications, or had significant side effects from these medications.

The device is implanted surgically and is composed of 3 main parts:

  • 2 cylinders: placed in the shaft of the penis. These cylinders fill with fluid when you are interested in having an erection
  • A balloon or reservoir: holds the fluid for the cylinders when your device is not in use. This reservoir sits behind the muscles of the abdomen.
  • A pump: a device that sits in the scrotum which allows you to move fluid from the balloon into the cylinders and achieve an erection.

How it Works

When you squeeze the pump in your scrotum, fluid will move from the reservoir into the cylinders. It will likely take several pumps to obtain a good erection. It becomes more challenging to pump as the penis gets more rigid; this is normal.

When you want to deflate the cylinders, you will press the small button of the pump and gentle squeeze the penis to encourage fluid to move from the cylinders back into the reservoir.

Risks of the Procedure

  • Bleeding
  • Infection
  • Device failure
  • Pain
  • Injury to the urethra

After the Procedure

You will be in hospital overnight with a urinary or foley catheter draining your bladder. You will receive antibiotics as well as pain medication and fluids.

Your catheter will be removed before you go home.

Post-Surgical Discharge

  • Your device will be partially inflated for 4 weeks. Do not attempt to inflate or deflate your device in this period.
  • You will be sent home with antibiotics, pain management, and a stool softener.
  • You may shower when you get home. No baths, hot tubs, or swimming for 2 weeks.
  • No heavy lifting/straining/strenuous activities for 6 weeks

Follow-Up

At 4 weeks, you will be seen in clinic to be taught how to operate the device. You will then begin cycling the device on a daily basis.

How to Cycle your Device

  • Inflate the penis until you achieve a rigid erection
  • Maintain erection for 15 minutes
  • Deflate device
    • NOTE: it is very important to full deflate the cylinders. Fluid remaining in the cylinders for long periods can result damage to the tissue overlying the device.
  • Repeat for 2-4 weeks

You can start using your device after 6 weeks. We advise that you wait until you no longer have pain with full erection.

Additionally a downloadable patient guide to ED is available here.

Information regarding the implants themselves is available directly from the manufacturers: Coloplast and Boston Scientific.

Trimix Intracavernosal Injection

Trimix intracavernosal injection is a combination of medications used for erectile dysfunction. These medications are injected directly into the side of the penis.

Trimix is a combination of 3 separate medications

  • Papaverine
  • Alprostadil
  • Phentolamine

Risks of Intracavernosal Injections:

  • Pain
  • Bleeding
  • Bruising
  • Priapism (see below)

Trimix should be stored in the refrigerator and away from light.

How to Inject

  1. Gather your supplies.
    • Medication vial
    • 1 syringe
    • 2 alcohol wipes
    • Sharps container
  2. Wash your hands.
  3. Wipe the top of the medication vial with an alcohol swab.
  4. Remove the cap from the needle on the syringe. Make sure that the needle does not come into contact with anything other than the medication vial.
  5. Withdraw air into the syringe. You want to withdraw approximately the same volume of air which you are going to be withdrawing from the vial.
  6. Insert the needle into the plastic stopper on the top of the medication vial. Push down on the stopper to inject the air into the vial.
  7. Turn the vial upside down and withdraw the correct amount of fluid (see below for correct dosage titration). You may need to withdraw more fluid initially to help clear out the air bubbles.
  8. Once you have the correct dose, withdraw the needle from the vial.
  9. Find a comfortable position either laying down or sitting.
  10. Grasp the head of your penis, and pull it out on stretch.
  11. Locate the area of your penis where you plan to inject. If you imagine your penis like a clock, you want to avoid 6 o’clock and 12 o’clock.
  12. Aim to inject either at 3 o’clock or 9 o’clock.
  13. Wipe the planned injection site with the alcohol swab.
  14. With the penis on stretch, insert the needle all the way into the erectile tissue of the penis.
  15. With the needle in position, push down on the syringe quickly. DO NOT move the needle while you are injecting.
  16. Once you have injected the medication, remove the needle and place pressure on the site for 2-3 minutes to prevent bruising.
  17. Place the syringe in the sharps container.

Finding the Correct Dose

This is a very important aspect of trimix injection teaching. Your urologist will give you an initial dose of the medication to start with. You will also be instructed how to titrate up the dose of your medication.

Important Information

  • DO NOT take more medication than prescribed
  • DO NOT use more than 1 injection in 24 hours
  • DO NOT give yourself another injection if the medication dose does not work
  • You can inject up to 3 times per week, as long as there is more than 24 hours between doses.

Please refer to the erection scale below

Example

  • Joe was given his first dose in the clinic of 0.1 mL (10 units). This gave him an erection of 2/10.
  • Joe was instructed to increase his dose by 0.1 mL per treatment.
  • His second injection was 0.2 mL (20 units). This gave him an erection of 4/10.
  • Joe’s third injection was 0.3 mL (30 units). This gave him an erection of 7/10.
  • Joe’s fourth injection was 0.4 mL (40 units). This resulted in a 10/10 erection.
  • Joe’s dose for his trimix is 0.4 mL (40 units). He should continue to use this dose in the future.

What happens if my erection won’t go away?

This is called priapism, or an erection that lasts too long.

The pharmacy will provide you with a medication to try and counteract the trimix therapy. This is called pseudoephedrine HCl. If your erection is firm and lasts >3 hours, you should take 4 (30 mg) tablets of pseudoephedrine.

If your erection lasts more than 4 hours, you need to be seen at the emergency department. This is an emergency. Tell the emergency room staff that you have had an erection lasting more than 4 hours and that you have used trimix injection therapy. You will be seen on an urgent basis.