I’m Dr Sébastien Beley, urological surgeon and andrologist based in Paris. In this article, I will explain in detail the possibilities of installing a penile implant in patients who already have an artificial sphincter. This topic is particularly important for men with severe urinary and erectile dysfunction, especially following prostate surgery or prostate cancer treatment.

Understanding devices: penile implant and artificial sphincter

Before discussing the cohabitation of a penile implant and an artificial sphincter, it’s essential to understand the purpose of these two medical devices.

• Artificial sphincter: This device is mainly used to treat urinary incontinence, often following prostate surgery. It acts like a ring around the urethra to control urine output.
• Penile implant: This device is designed to treat severe erectile dysfunction that does not respond to conventional drug treatments. The implant restores erectile function by inserting cylinders into the cavernous bodies of the penis.

Is it possible to install a penile implant and an artificial sphincter in the same patient?

The answer is yes, it’s perfectly possible to have both devices. However, the manner and timing of their installation are crucial to minimize risk and optimize results.

Option 1: Simultaneous installation of both devices

The penile implant and artificial sphincter can be fitted during the same operation. This approach may seem practical, particularly for patients who have to travel a long way to have the operation, and who wish to limit the number of operations.

However, this option has several drawbacks:

• Significant edema: After surgery, significant swelling (edema) may develop in the bursa and penis, making it difficult to activate the devices.
• Functional difficulties: Edema can cause pumps to stick together or come into painful contact with the testicles, making them difficult to handle.
• Increased risk of acute urinary retention: This problem may occur more frequently with a combined procedure.
• Higher risk of infection: The increased complexity of surgery can increase this risk.

Because of these factors, I generally advise against this method, except in very specific cases, such as patients who absolutely must limit their interventions to a single phase.

Option 2: Two-stage installation

The method I recommend is to proceed in two stages, spacing out the interventions to allow better healing and adaptation of the tissues.

Two scenarios are possible:

1. Penile implant after artificial sphincter: If you already have an artificial sphincter, you should wait at least three months before installing the penile implant. This allows a pseudocapsule to form around the sphincter sleeve, a new layer of tissue that protects the sphincter from external compression by the implant’s cylinders.
2. Penile implant before artificial sphincter: If you don’t already have either device, I recommend starting with the penile implant. This strategy is designed to preserve the length and volume of the penis, as the prolonged absence of erection (often unavoidable after sphincter placement) can lead to penile retraction.

Why place the penile implant first?

Placing a penile implant before the artificial sphincter is fitted is an important preventive strategy.

Sphincter installation requires a prolonged healing period, often lasting several months, during which the patient will not benefit from natural erections or an implant. This period of sexual inactivity can lead to progressive retraction of the penis, reducing its length and volume.

What’s more, sphincter surgery, especially when performed transcavernally (i.e. around the urethra that passes inside the corpora cavernosa), can itself promote this retraction.

Therefore, starting with the penile implant helps maintain the structure and function of the penis. Although the implant may not be used immediately due to incontinence, it plays a key role in preserving the quality of sexual life.

Technical precautions for penile implant placement after an artificial sphincter

When the penile implant is inserted after the sphincter has been fitted, it is essential to minimize the pressure exerted by the implant’s cylinders on the sphincter sleeve. Too much compression could cause erosion of the sphincter at the urethra, leading to serious complications.

For this, I recommend :

• Use non-hydraulic cylinders at the sphincter to reduce volume and pressure.
• Use the thinnest possible extensions to limit external compression.

These technical precautions help preserve the integrity of the sphincter while restoring erectile function thanks to the implant.

What are the risks associated with combining the two systems?

The coexistence of a penile implant and an artificial sphincter is not without risks, and it’s important to be aware of them:

• Post-operative edema: As mentioned above, simultaneous insertion can lead to marked swelling, making it difficult to use the devices.
• Pain due to sticking pumps: The implant and sphincter pumps may stick to each other or to the testicles, causing pain when handling them.
• Risk of infection: More complex surgery increases this risk, which can compromise the success of implants.
• Risk of erosion: Excessive cylinder pressure on the sphincter can lead to urethral erosion.

These risks reinforce the need for careful planning of the surgical schedule and the adoption of appropriate techniques.

Advice for patients considering penile implants and artificial sphincters

If you are in a situation where you need to consider installing these devices, here are my recommendations:

1. Don’t hesitate to talk to your urologist: Each case is unique. Your doctor will be able to advise you on the best strategy for your situation.
2. Prefer two-stage placement: This minimizes complications and optimizes recovery.
3. Start with a penile implant if you have no device: This helps preserve penile length and volume.
4. Allow at least 3 months after sphincter placement before implanting: To ensure proper healing and protect the sphincter.
5. Choose suitable implants: thin, non-hydraulic cylinders in the sphincter to limit risk.

Conclusion: optimizing continence and sexual quality of life

In short, it is entirely possible for a patient to wear both a penile implant and an artificial sphincter. The key to success lies in careful planning of the surgical management.

Simultaneous insertion of both devices can be envisaged in very specific cases, but entails significant risks of edema, pain and infection. I therefore prefer a two-stage approach, with a preference for starting with the penile implant to preserve the structure of the penis and avoid its retraction.

If the sphincter is already in place, it is essential to wait at least three months before inserting the implant, to ensure optimal healing and protect the sphincter from external pressure.

This strategy aims to optimize both your urinary continence and your quality of sexual life, two dimensions that are essential to your overall well-being.

To learn more about male sexual health, erectile dysfunction, or advanced urological treatments, please feel free to browse my other articles and resources. Taking care of your health is the first step towards a fulfilling life.