Erectile dysfunction affects over 30 million men in the United States, and for most of them, oral medications like Viagra or Cialis are enough to restore normal function. But medications don’t work for everyone. Men with severe ED caused by diabetes, vascular disease, prostate surgery, or Peyronie’s disease often reach a point where pills no longer produce reliable results and self-injection therapy has either stopped working or isn’t tolerable. That’s typically when the conversation turns to a penile implant. Dr. Jon Lazare at Lazare Urology in Brooklyn is one of the few urologists with extensive experience placing the three-piece inflatable penile implant, and he walks patients through the decision carefully, covering exactly how the device works, what the surgery involves, and what recovery actually looks like.
Who Is a Candidate for a Penile Implant?
A penile implant is not a first-line treatment. It’s the final step in a progression of therapies that starts with the least invasive options. The typical pathway begins with lifestyle changes (exercise, weight management, addressing cardiovascular risk factors), followed by oral PDE5 inhibitors like sildenafil or tadalafil. When those aren’t effective, penile self-injection therapy using medications like alprostadil or trimix is the next option. Injections work well for many men, but some find them painful, inconvenient, or eventually less effective over time.
A man becomes a candidate for a penile implant when these earlier treatments have failed or are no longer viable. Common scenarios include men whose ED is caused by poorly controlled diabetes that has damaged the blood vessels and nerves necessary for erection, men who’ve undergone radical prostatectomy for prostate cancer and haven’t recovered erectile function, and men with significant Peyronie’s disease where curvature and plaque formation make other treatments ineffective.
The implant is also appropriate for men who technically respond to other therapies but find them impractical for maintaining a normal sex life. A man who has to plan sexual activity around injection timing, deal with unpredictable results from oral medication, or manage side effects that diminish the experience may reasonably decide that a permanent, on-demand solution is the better path.
Good candidates are generally in stable health and able to undergo surgery with anesthesia. A pre-operative medical clearance from your primary care physician or cardiologist is required, including blood work, an EKG, and potentially a chest X-ray. Men with active urinary tract infections or uncontrolled diabetes will need to address those issues before surgery can be scheduled.
How the Three-Piece Inflatable Implant Works
The three-piece inflatable penile implant is the most commonly placed type and the one Dr. Lazare uses at Lazare Urology. It consists of three components: two inflatable cylinders, a fluid reservoir, and a pump.
The two cylinders are surgically placed inside the corpora cavernosa, the paired chambers within the penis that normally fill with blood during a natural erection. The reservoir, which holds sterile saline, is positioned behind the abdominal wall in the space near the bladder. The pump is placed inside the scrotum, where it sits between the testicles and is easily accessible but not visible.
When a man wants an erection, he squeezes the pump in the scrotum a few times. This transfers saline from the reservoir into the cylinders, producing rigidity that closely mimics a natural erection in both appearance and firmness. When he’s finished, pressing a release valve on the pump sends the fluid back to the reservoir, and the penis returns to a relaxed, flaccid state.
The result is full control over when an erection occurs and how long it lasts. There’s no waiting for a pill to take effect, no injection, and no time limit. Orgasm and sensation remain completely normal because the implant doesn’t affect the nerves responsible for either.
What the Surgery Involves
Dr. Lazare performs penile implant surgery in his certified in-office operating room, staffed by a board-certified anesthesiologist. The procedure is done under sedation, meaning the patient is asleep and comfortable throughout.
The surgery typically takes between 45 minutes and an hour. A single incision is made, usually at the base of the penis or on the scrotum, through which all three components are placed. The incision is closed with dissolvable sutures. Because the procedure is performed in Dr. Lazare’s office rather than a hospital operating room, patients avoid the overhead costs and scheduling delays associated with hospital-based surgery.
Infection is the primary surgical risk with any implant procedure, and strict sterile protocols are followed to minimize it. Antibiotic irrigation of the surgical field, antibiotic-coated implant devices, and pre-operative antibiotic administration all contribute to infection rates that are very low, generally under 2% in experienced hands.
Recovery: A Realistic Timeline
Recovery from penile implant surgery is manageable, but it requires patience. The first week is the most uncomfortable. Swelling and bruising in the scrotal and penile area are normal. Ice packs and prescribed pain medication help keep discomfort under control. Most men take about a week off work, though those with physically demanding jobs may need closer to two weeks.
During the first four to six weeks, the implant is left in a partially inflated position to promote proper healing and positioning of the cylinders. Sexual activity is off limits during this period. Dr. Lazare will schedule a follow-up visit, typically around four to six weeks post-surgery, to teach the patient how to use the pump and activate the device for the first time.
The initial activation visit is a hands-on tutorial. The patient learns how to locate the pump, inflate the cylinders, and release them. It takes a bit of practice, but most men get comfortable with the mechanics within a few days of regular cycling. Full, unrestricted sexual activity is generally cleared at the six-week mark.
By the three-month point, the swelling has fully resolved, the device feels natural, and most patients report that the implant has become a seamless part of their routine. Partners typically cannot tell the implant is present.
The 90% Satisfaction Rate
The three-piece inflatable penile implant has one of the highest satisfaction rates of any prosthetic device in medicine. Studies published in the Journal of Sexual Medicine and the Journal of Urology consistently report satisfaction rates at or above 90% among both patients and their partners. Men describe the ability to have an erection whenever they want, for as long as they want, as transformative after years of unreliable or absent erectile function.
The mechanical reliability of modern implants is also strong. Current-generation devices from manufacturers like Coloplast and Boston Scientific are designed to function for 15 to 20 years, and many last longer. If a component does eventually wear out, a revision surgery to replace the device is a well-established procedure.
Dissatisfaction, when it occurs, is most commonly related to expectations around size. The implant restores rigidity, but it does not increase penile length or girth beyond what was present before ED began. Some degree of penile shortening can occur in men who have gone years without erections, as the erectile tissue contracts over time. Dr. Lazare discusses this candidly during the consultation so patients have realistic expectations going into surgery.
Scheduling a Penile Implant Consultation at Lazare Urology
If oral medications and injection therapy haven’t given you reliable results, a penile implant may be the right next step. Dr. Lazare’s experience with the three-piece inflatable device, combined with the convenience and privacy of an in-office surgical suite, gives patients a streamlined path from consultation to recovery without the complexity of navigating a hospital system.
Contact Lazare Urology at (718) 568-7516 to schedule a consultation. The visit is confidential, and Dr. Lazare will review your history, discuss whether an implant is appropriate for your situation, and answer every question you have about the procedure, the device, and what life looks like afterward.
