Penile prosthesis implantation is a surgical option for treating erectile dysfunction (ED) in elderly individuals, particularly when other treatments, such as medication or lifestyle changes, prove ineffective. As ED becomes more prevalent with age due to factors like chronic health conditions, medications, and natural aging processes, penile prosthesis offers a reliable and long-lasting solution. This procedure involves the implantation of a device within the penis, allowing men to regain the ability to achieve an erection and improve their quality of life. While the procedure carries risks, it has shown high satisfaction rates among elderly patients and can significantly enhance physical and emotional well-being.

Is old age important for penile prosthesis implantation?

Old age can be an important factor when considering penile prosthesis implantation for ED, but it is not the sole determining factor. The decision to undergo this procedure typically depends on the individual’s overall health, quality of life, and the severity of their ED, rather than age alone.

However, as people age, they may experience a higher prevalence of ED due to conditions like diabetes, cardiovascular disease, or hormonal imbalances, which could lead to a greater likelihood of seeking surgical intervention. For elderly individuals, the decision to opt for penile prosthesis implantation is influenced by several considerations:

• Health Status: Older patients may have other medical conditions or be on medications that increase surgical risks. A thorough assessment of overall health is essential.
• Quality of Life: In older adults, sexual health can significantly impact emotional well-being and quality of life. Penile prosthesis can help restore sexual function, which may be a key factor in the decision.
• Life Expectancy: For older individuals, surgeons may weigh the expected lifespan and the long-term benefits of the procedure. If the patient is expected to live for many years, a prosthesis may be a good option.
• Surgical Risk: Older patients are often more prone to complications from surgery, so careful evaluation of surgical risk is essential.
• Patient’s Preferences: The elderly patient’s desire for a permanent solution to ED and their willingness to undergo surgery are significant factors.

Maximum age limit for penile prosthesis implantation

There is no strict maximum age limit for penile prosthesis implantation for ED. The decision to proceed with the procedure is generally based on an individual’s overall health, life expectancy, and ability to undergo surgery, rather than age alone.

However, certain factors related to aging may influence whether a patient is a good candidate for the procedure:

• General Health: Older adults may have other medical conditions (e.g., heart disease, diabetes, or kidney problems) that could increase the risk of complications during surgery or recovery. Surgeons typically assess the patient’s overall physical condition to determine if they can safely undergo the procedure.
• Surgical Risk: As people age, their bodies may take longer to heal, and they may face a higher risk of surgical complications, such as infection or wound healing issues. A thorough evaluation by the healthcare team is necessary to assess these risks.
• Life Expectancy: If a patient is in very advanced age and has a limited life expectancy, the benefits of a permanent solution to ED (like a penile prosthesis) may not outweigh the risks or the need for long-term maintenance. In these cases, less invasive treatments might be considered first.
• Patient’s Goals: In elderly patients, the decision to undergo penile prosthesis implantation also depends on personal preferences, quality of life goals, and the importance of restoring sexual function. For some, the desire to regain sexual activity might be a strong motivator, while others may not prioritize it at later stages of life.

Average age for penile prosthesis implantation

The average age for penile prosthesis implantation for ED typically ranges from 60 to 70 years old. However, this can vary depending on individual factors such as health status, severity of ED, and personal preferences.

Many men who seek this surgery are middle-aged to older adults, as erectile dysfunction becomes more common with aging, often due to factors like chronic health conditions (e.g., diabetes, cardiovascular disease), medications, or age-related declines in testosterone levels.

While the procedure is generally more common in men over 50, younger men in their 40s or even late 30s may also opt for penile prosthesis implantation if they have severe, persistent ED that does not respond to other treatments like medications or therapy.

In summary, while the average age is in the 60s to 70s, penile prosthesis implantation can be considered for men at various ages, depending on their health, circumstances, and the degree of ED.

Optimum age for penile prosthesis implantation

There isn’t a specific “optimum” or “ideal” age for penile prosthesis implantation for ED, as the decision is highly individualized. However, certain factors can help determine the ideal time for this procedure:

• General Health: The patient’s overall health is the most critical factor. Men who are in good health and have few comorbidities (such as heart disease, diabetes, or severe obesity) may be better candidates for surgery, regardless of age. The body’s ability to heal and recover from surgery is crucial, so a patient in their 40s or 50s with good health could be a suitable candidate, as long as their ED is severe and resistant to other treatments.

• Severity of ED: Penile prosthesis is often considered when other ED treatments, such as oral medications (like Viagra or Cialis), injections, or vacuum devices, have failed. Men who experience persistent, severe ED, and who are not responding to less invasive treatments, may benefit most from the procedure, often in their 50s, 60s, or even 70s.
• Life Expectancy and Quality of Life: The procedure is generally considered more ideal when patients are expected to live many years and value sexual health as an important part of their overall well-being. Men in their 60s or early 70s who are in good health and want to restore sexual function may see a significant quality of life improvement from the surgery.
• Psychosocial Factors: The emotional and psychological benefits of restoring erectile function can be significant. Men who are psychologically affected by ED and are motivated to regain sexual function may decide to undergo the procedure earlier, such as in their 50s or early 60s.

Penile prosthesis implantation after 70 years

Penile prosthesis implantation can be recommended for men over 70 years old, but the decision depends on several factors related to the individual’s overall health, the severity of their ED, and their quality of life goals. While age alone is not a strict contraindication, it is important to carefully assess the following:

• Overall health
• Life expectancy and quality of life
• Psychological factors
• Surgical risks
• Failure of other ed treatments

In summary, penile prosthesis implantation can be recommended for men over 70, especially if they are in good health, have a desire to restore sexual function, and have realistic expectations about recovery and potential risks. The decision should be based on a comprehensive evaluation by a healthcare professional who will consider the patient’s overall health, the impact of ED on their life, and their preferences.

Which type of penile prosthesis is better older men?

For older individuals with ED, the type of penile prosthesis recommended typically depends on their overall health, lifestyle, and preferences. There are two main types of penile prostheses: inflatable prostheses and malleable (or semi-rigid) prostheses

Which is better for older individuals?

• Malleable prostheses are often preferred for older individuals, especially those with limited hand function, mobility issues, or health conditions that make handling the pump of an inflatable prosthesis challenging. It provides a simpler, more straightforward solution with a lower risk of complications.
• However, if the patient is active, in good health, and prefers a more natural-feeling erection, an inflatable prosthesis might be considered.

Ultimately, the choice depends on the patient’s health, lifestyle, and personal preferences. A thorough consultation with a urologist will help determine the most suitable type of prosthesis based on these factors.

Summary

Penile prosthesis implantation is a surgical treatment for ED in older individuals, especially when other treatments like medications or injections have failed. This procedure involves implanting a device in the penis to allow for controlled erections, improving sexual function and overall quality of life. While age itself is not a barrier, factors such as overall health, comorbid conditions, and life expectancy are important considerations. Older adults who are in good health and have significant ED may benefit from this long-term solution, enhancing both physical and emotional well-being. Careful evaluation by healthcare providers ensures that the risks are manageable, leading to high satisfaction rates in many elderly patients.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE