Q&A with Dr. Andrew Kramer

Inflatable penile implant diagramSummary: The University of Maryland Medical Center is a high volume center for performing penile implant surgery for sexual dysfunction. Dr. Andrew Kramer, a urologic surgeon and director of Reproductive and Sexual Medicine at the University of Maryland Medical Center, specializes in penile implant surgery, performing hundreds of procedures each year. Here, he answers some frequently asked questions about the procedure and UMMC's expertise.

Briefly, what is a penile implant?

Penile implant surgery is an option for men who suffer from erectile dysfunction but who have not gotten results from other types of treatments. It is a surgical procedure where we implant a prosthesis directly inside the penis and scrotum to allow a man to achieve an erection.

How does a penile implant work?

A penile implant is a device that is placed surgically, either through one incision in the scrotum or through an incision in the lower abdomen, right above the penis. The device is either inflatable or non-inflatable. Typically the device is filled with salt water (saline), and the patient has a pump, which is hidden in the scrotum. By gently pressing on that pump, the salt water travels through a reservoir that is placed next to the bladder and travels into the device itself, which is in the penis. The device in the penis has two chambers, which go into the erectile chambers of the penis. When these are inflated, and the water inflates the device, then the patient achieves an erection. When they are finished, then they can deflate the device.

What special expertise is offered at UMMC and what sets this center apart?

The University of Maryland Medical Center is high volume treatment center for penile implant surgery. When it comes to any surgical procedure, experience matters. The more of a particular procedure a center performs, the better the outcomes are for patients. We have one of the busiest practices in the Mid-Atlantic region for penile implant surgery.

Since we are an academic medical center, we have the infrastructure to handle complicated cases. We also have access to the latest, most state-of-the-art devices and medications to ensure that our patients get the very best results possible. We have a dedicated operating room team that specializes in this type of surgery. Our experience means that we do the same repetitive motions over and over so that they become smooth and seamless. We can prepare the device efficiently, pharmacy has antibiotics ready the night before, recovery room staff is used to caring for these patients. Overall the entire process is very streamlined. This means a shorter time for patients in the operating room (about 20 minutes). In addition, our patients recover faster, and infection is minimized to the absolute lowest anywhere in the country.

Our team of professionals dedicated to this procedure is experienced in dealing with complex cases, such as post-radical prostatectomy patients, difficult post-infection cases, high-risk patients (such as transplant patients, immunosuppressed patients, or patients on Coumadin or other medications.) These are typical cases for us.

How does a patient know when an implant is a good option for him?

At the University of Maryland, we treat patients with all types of erectile dysfunction, from men who may have had radical prostatectomies (or removal of their prostate), to young patients who have experienced some type of trauma, to older patients who may have been told they shouldn't worry about it or are too old for certain treatments. We treat all stages of this disease with a broad range of options. These may range from pills and injections to vacuum devices, suppositories and surgery.

As with any medical condition, we always try to treat patients with the simplest and least invasive treatments possible, and the same goes for erectile dysfunction. So, before considering any surgical procedure, we do a comprehensive evaluation of the patient to rule out systemic problems or other diseases that can cause impotence. There is a range of treatment options, from oral medications like Viagra, to injections, vacuum devices, and suppositories. If these are found to be ineffective, a patient may consider having penile implant surgery.

One option for men who suffer from erectile dysfunction but who have not gotten results from other types of treatments is penile implant surgery. This is a surgical procedure where we implant a prosthesis directly inside the penis and scrotum to allow a man to achieve an erection.

Are there age or health limitations on who can have penile implant surgery?

We've performed the implant procedure on patients as young as 20 years old (trauma patients) and as old as 90. Patients who think they are too old or too sick to undergo penile implant surgery can get successful results in the hands of our experienced team. We have successfully performed the implant procedure on patients with complicating conditions such as diabetes, heart disease, organ transplants, etc.

Are there different types of penile implant surgery?

At the University of Maryland, we offer two approaches to penile implant, also known as sexual restorative surgery. One is the traditional method in which the device is placed through an incision in the scrotum. Another method is the infrapubic penile implant, in which the implant and reservoir are placed through an incision in the lower abdomen, right above the penis. In either approach, we minimize dissection in the penis and spare the patient's natural tissues.

You consider your penile implant operation to be minimally invasive. What is meant by that?

The operation is minimally invasive because it is done in 15-20 minutes, involves only one 3-4 cm incision, and can be done on an outpatient basis. This results in a very short recovery time and only a few days off from work. Dissection of the tissues inside of the penis is dramatically minimized from the way the procedure was done at many institutions over the past 20 years. This is especially well-suited for men who have had radical prostatectomies, where the procedure can be more complicated. The risks and potential complications have been dramatically reduced or eliminated with the simpler, more streamlined, and less invasive outpatient procedure.

What can a patient expect in having penile implant surgery?

The procedure takes about 20 minutes. The patient can go home the same day or the next day, whichever is more convenient.

What is the recovery process following penile implant surgery?

Recovery usually takes about 2-3 weeks. Patients are usually able to go back to work in 2-3 days. Most patients can resume sexual activity within one month.

Is the penile implant visible or detectable from the outside of the man's body once it has been implanted?

No. The device is completely internal and is hidden from view once it's implanted. The patient inflates and deflates the prosthesis by squeezing a small pump hidden inside the scrotum.

What would you tell patients with E.D. who may be considering, or are just curious about, penile implant surgery?

Penile implant surgery is an important decision. I would tell patients not to be embarrassed about the issue. Come in and find out what is available and then take the time to think things over and discuss it with your partner. No one is too old or too sick to be evaluated for this procedure. Medications are affordable and for the majority of patients, the surgery is covered by insurance.

I'm always happy to provide the names of patients of mine who are willing to talk about their experiences with you prior to starting any treatment.

For more information or to schedule a consultation, please call Dr. Andrew Kramer at 410-328-6087.