When erectile dysfunction (ED) does not respond to lifestyle changes, oral medications or injection therapy, surgery becomes a genuine, evidence backed option, not a last resort taken in desperation. Surgical treatment for erectile dysfunction covers a small but highly effective group of procedures, from penile implants to vascular surgery, designed to restore reliable erectile function when other treatments have failed. In this blog, DirectMeds will provide you with everything you need to know about surgical treatment for erectile dysfunction in Australia, the statistics behind their success, the risks involved and how to know if surgery is the right next step for you.
What Is Surgical Treatment for Erectile Dysfunction?
Surgical treatment of erectile dysfunction is defined as surgical procedures that restore the ability to achieve an erection by correcting either the blood flow to your penis (through procedures to repair blood vessels) or the mechanical aspect of getting an erection (through implanting a device into the penis). Unlike injections and medications that act upon the body at the time they are used and rely on the body's existing physiology, surgical interventions for ED are substantially longer lasting and considered a third-line intervention. Patients should be advised to attempt other forms of treatment before considering surgical interventions for ED.
ED surgical treatment options can be divided into two major categories: prosthetic surgery (penile prostheses/implants) and vascular surgery (procedures designed to improve or fix the blood supply to the penis). To effectively treat erectile dysfunction, the underlying cause must be accurately diagnosed; this is true of both prosthetic and vascular surgery.
When Is Surgery Recommended for Erectile Dysfunction?
Doctors only consider surgical options for treating erectile dysfunction after patients have not been successful at trying all conservative therapeutic options first or if a surgical option is guaranteed to produce a much higher quality of life. Common indications for surgical treatment include the following:
- Drugs that work by inhibiting Phosphodiesterase-5 (PDE5), such as sildenafil (Viagra) or tadalafil (Cialis), have not provided satisfactory erections after an adequate trial.
- Patients who have not responded or had poor responses to penile injection (intracavernosal) therapy or cannot tolerate or are not suitable candidates for this type of therapy.
- Erectile dysfunction (ED) is caused by anatomic or vascular problems (e.g., Peyronie's disease, significant arterial damage or venous leakage).
- ED due to trauma to the pelvis, surgery for prostate cancer or injury to the spinal cord, which did not improve after three or more months of non surgical treatments.
- A man with a confirmed organic (physical) cause of ED who wants to find a permanent, drug free solution.
A urologist will typically evaluate the suitability of a person for surgical ED treatment with a combination of blood tests, penile Doppler ultrasound (which images blood flow to the penis), and an extensive review of that person’s diagnostic tests and medical history.
Types of Surgical Treatment for Erectile Dysfunction
There are three major surgical treatment options available for erectile dysfunction: penile implants (also known as penile prosthesis), penile revascularization (arterial bypass), and venous ligation. They have different mechanisms and are intended for different patient populations.
1. Penile Implant Surgery (Penile Prosthesis)
Penile prosthesis (penile implant) surgery is the most popular and dependable type of surgical erectile dysfunction (ED) treatment. During penile implant surgery, the doctor implants a penile prosthesis into the corpora cavernosa or erectile tissue of the penis. After implantation, the man can create an erection manually whenever he wants. Because it doesn’t need to rely on blood flow, nerve function, or hormone levels, a penile prosthesis can be the solution when all other surgical and non-surgical ED treatments fail.
- Inflatable implants (2-piece/3-piece): These are the most commonly utilized device types. The man uses the pump to fill the reservoir with fluid, and this will inflate the penis and create an erection. The man can then deflate the penis by using the release valve on the pump. Studies of 3-piece inflatable penile implants show that they have 87% mechanical reliability at 5 years.
- Malleable implants (semi-rigid rods): These implants consist of bendable rods that keep the penis semi-rigid, so men will typically bend the rods to a position that will allow them to have sex. Malleable implants are mechanically more durable than inflatable implants but do not have the same discretion as inflatable implants. They also represent a very small percentage of the total number of implants performed.
Implant Type | How It Works | Best Suited For |
Three-Piece Inflatable | Pump in the scrotum inflates cylinders for a natural erection and deflates after use | Men want the most natural look, feel, and function |
Two-Piece Inflatable | Combined reservoir/pump system with a simpler internal mechanism | Men with limited scrotal or abdominal space for a separate reservoir |
Malleable (Semi-Rigid) | Bendable rods provide constant rigidity that is manually positioned | Men with limited hand dexterity or who prioritise mechanical simplicity |
2. Penile Revascularization Surgery
Penis revascularization or arterial bypass surgery provides a healthy artery (as an example, usually the inferior epigastric artery) to go around a blocked or damaged artery and provide natural blood flow to the penis. Revascularization is the only surgical option to treat ED and provide natural (unstimulated, drug-free) erections without the use of an implantable device. Revascularization has a specific population for whom it is effective.
According to PubMed, success of the results from revascularization surgery over time (more than 10 years post-surgery) is affected by the age as well as the reason for the ED of the patient who has the surgery. In 1 study of patients who underwent revascularization surgery, there was a 48% success rate but 10 years post-surgery, men aged less than 28 had a success rate of 73% and men older than 28 had a success rate of 23%. More recent results have shown that if careful selection is done for the patients who receive revascularization, then the success rates for the procedure are 92.1% and 73.8% for patients with pure arterial ED and mixed vasculogenic ED, respectively. Because of this, revascularization is typically performed on younger men with isolated arterial injury that usually occurs after trauma to the pelvic/perineal area and seldomly becomes necessary in older men with widespread vascular disease.
3. Venous Ligation Surgery
Venous ligation surgery aims to fix a "venous leak" and the ligation of the veins that are responsible for escaping blood from the penis too quickly. Once a common surgical option for treating ED, venous ligation surgery is now not being used in most urologists' practices today because of the disappointing long term outcomes associated with the surgery. Male Infertility states that the cited rate of success for the surgery is between 30% and 50%, with the majority of men who had this surgery experiencing a recurrence of their ED due to developing new venous channels over a period of time. As a result of the overall level of disappointment with venous ligation surgery, most urologists do not recommend it as a first-line treatment for ED today.
Comparing Surgical Treatment Options for Erectile Dysfunction
Surgical Treatment | Effectiveness | Invasiveness | Best Candidate |
Inflatable Penile Implant | Very High (90% to 95% satisfaction) | High (surgical, permanent) | Men who have failed all other ED treatments |
Malleable Penile Implant | Very High (mechanically simple, durable) | High (surgical, permanent) | Men needing a simpler, lower-maintenance device |
Penile Revascularization | Variable (23% to 92%, highly age-dependent) | Moderate–High (microsurgery) | ED in Younger men with isolated, trauma-related arterial ED |
Venous Ligation Surgery | Low–Moderate (30% to 50%, short-term) | Moderate | Rarely recommended today; limited, selected cases only |
Benefits of Surgical Treatment for Erectile Dysfunction
- High rates of success: The high level of patient satisfaction reported from getting a penile implant (90% to 95%) makes it one of the most effective ED treatments, as per Houston Methodist.
- Permanent solution: Penile implants are the first treatment option that does not require the use of medication before engaging in sexual activity.
- Spontaneity: A man has an erection immediately on demand with a penile implant, allowing him to experience the level of sexual intimacy with his partner that he has not been able to do so for some time.
- Works for men who did not gain any benefit from all other treatment methods: Men who suffer from ED due to diabetes, post-prostectomny and vascular causes that have not responded to any other form of treatment can be treated successfully with a penile implant.
- High mechanical reliability: Most modern three-piece inflatable penile implants achieve an overall prosthetic reliability of 87% over five years of mechanical use.
Risks and Complications of Surgical ED Treatment
As with any surgery, ED procedures carry risks. Understanding them is an essential part of informed decision-making before choosing surgical treatment for erectile dysfunction.
Risk / Complication | Approximate Rate | Notes |
Infection (primary implant surgery) | 1% to 3% | Rises to 10% to 18% in revision or repeat implant surgery |
Mechanical failure/device wear | Under 13% at 5 years | Three-piece inflatable implants exceed 87% reliability at 5 years |
Bleeding or hematoma | Low, typically under 5% | Usually managed conservatively without further surgery |
Penile shortening or numbness | Variable, commonly reported | More likely with implant surgery than with vascular procedures |
Revascularization treatment failure | Up to 52% to 77% in older or non-selected patients | Success is far higher in carefully selected younger men with isolated arterial damage |
Recovery After ED Surgery: What to Expect
- Day of Surgery: Most penile implants are done as an outpatient or short stay and may take under an hour.
- First 24 to 48 Hours: Mild swelling, bruising, and tenderness are all expected. Most men can resume light day-to-day activities during this period.
- 2 to 6 Weeks: While the tissue inside is healing, men should avoid vigorous activity, heavy lifting and sexual intercourse.
- 6 Weeks and Beyond: Most men will have been medically cleared to engage in sexual intercourse after this time, and by this point, the majority of men will have attained their maximum erectile potential.
- Vascular Repair Recovery: Recovery following penile revascularization is typically longer than for other types of repairs, with full erectile improvement taking up to 10 to 12 months in some cases.
Surgical vs Non-Surgical Treatment for Erectile Dysfunction
Factor | Non-Surgical Treatment (Pills, Injections, VEDs) | Surgical Treatment (Implants, Vascular Surgery) |
Invasiveness | None to minimal | Moderate to high |
Permanence | Requires ongoing use | One-time procedure, long-term solution |
Onset of effect | Minutes to hours per use | Permanent once healed |
Typical effectiveness | 60% to 90% depending on method | 90% to 95% satisfaction (implants) |
Best for | Mild-to-moderate ED, first-line treatment | Severe ED unresponsive to other treatments |
What is the Cost of Surgical ED Treatment in Australia
The expenses associated with surgical treatment of erectile function in Australia vary widely by both procedure type, prosthetic type, theater/procedure costs and the surgeon's fees, in addition to whether you may be eligible for a Medicare rebate. Penile implant surgery occurs at the higher end of the scale due to the reusability aspect of the prosthetic; vascular procedures will vary based on their complexity. As there can be such a wide variance with regard to service delivery, personal circumstances, etc., pricing should be determined by speaking directly with an AHPRA-registered physician or urologist, who will provide you with a specific quote based on your diagnosis and the procedure of choice. The average cost of erectile dysfunction treatment ranges from:
Penile Implant Type | Estimated Cost Range (AUD) |
Malleable (semi-rigid) implants | $10,000 to $15,000 |
Inflatable implants (2-piece or 3-piece) | $16,000 to $35,000+ |
Total typical cost range (all types) | $15,000 to $35,000+ |
How DirectMeds Can Help
Most men with erectile dysfunction should not initially undergo surgery. Most men will achieve improvement with a medical approach. You can speak with an AHPRA-registered doctor online through DirectMeds to obtain a thorough evaluation of your erectile dysfunction and to determine if medication, lifestyle modifications or surgery is best for you, all from the comfort and confidentiality.
- Complete a 2-minute free online ED assessment
- Consult an AHPRA-registered doctor within approximately 5 minutes
- Receive an individualized treatment plan for your specific erectile dysfunction or receive a referral if appropriate for surgery
- If you receive a prescription for medication, the medication will be delivered to your home in a secure package by TGA approved companies
- Comprehensive and ongoing support from your doctor
FAQs About Surgical Treatment for Erectile Dysfunction
What is the most effective surgical treatment for erectile dysfunction?
Penile prosthesis (implant) surgery is generally considered the most effective type of erectile dysfunction surgery, with patient satisfaction ranging from 90 to 95 percent (i.e., better than any of the currently available erectile dysfunction treatments, whether surgical or non-surgical).
Is erectile dysfunction surgery permanent?
While penile prosthesis surgery is designed to be a permanent solution, the actual prosthesis may need to be replaced after a long period of time. The outcomes of vascular surgery for ED are not likely to be as permanent and are likely to be less permanent if the patient is older in age or has a widespread vascular disease process.
How painful is penile implant surgery?
For the first one to two weeks following surgery, the majority of men have mild to moderate bruising, swelling and discomfort; this will first be alleviated by prescribing pain medications to use after surgery. It is important to discuss any significant pain that persists after this time frame with your physician.
Who is a good candidate for surgical ED treatment?
Men who have not had success with oral medications or injectable medications and have proven organic causes of ED and/or also have structural problems, including severe vascular damage and/or significant Peyronie's disease, are typically good candidates for the surgical option for ED.
Will a penile implant feel and look natural?
Contemporary three-piece inflatable implants are engineered in such a manner as to closely replicate the size, rigidity and limpness of a natural erection. Most partners and patients indicate that the device feels like a natural erection; individuals may feel different from one patient/partner to the next.
What are the risks of surgical treatment for erectile dysfunction?
Primary implant surgery has a 1-3% risk of developing an infection, long-term breakage or malfunction of the mechanical device, bleeding, and/or potential changes in sensation and length of the penis. Selecting an experienced surgeon will decrease the risk of complications from surgery.
Can erectile dysfunction surgery be reversed?
When erectile implant surgery is performed, the erectile tissue in the penis is removed. This means that after the removal of the penile implant is when natural or drug assisted erections can no longer occur, so the surgery is for patients who have tried every other option.
How do I know if I need ED surgery instead of medication?
Only a qualified doctor can determine if you require surgery or if medications could treat your ED through diagnostic testing. If you have tried oral medications and injection therapy with no success or if your ED is caused by some kind of physical problem with your anatomy, your doctor may refer you to a urologist to discuss your treatment options.
