How Is an Inflatable Penile Implant Used? Activation and First Use

An inflatable penile implant is a device placed entirely inside the body and preferred in men with erectile dysfunction who have not benefited from other treatments. No part of it is visible from outside; the patient operates the device using a small pump placed inside the scrotum. Although the topics discussed most when the surgical decision is made are the technique and the healing period, the subject that most affects patients' daily lives is how the device is used.

This article covers how an inflatable penile implant works, at what stage after surgery it starts to be used, what happens at the activation appointment, the steps for inflating and deflating the device, and the difficulties that may arise in the first weeks.

How does an inflatable penile implant work?

Inflatable implants generally consist of three main parts connected by thin tubing:

• Cylinders: Two components placed inside the erectile tissue of the penis, providing rigidity when filled with fluid.
• Pump: A small unit placed inside the scrotum in a position the patient can reach comfortably with the fingers.
• Reservoir: The part holding the fluid that fills the system, placed in the abdominal area.

The system works like a closed circuit. When the pump is squeezed, fluid from the reservoir passes into the cylinders and the penis becomes rigid; when the deflation button is used, the fluid returns to the reservoir and the penis returns to its flaccid state. Because the device is placed entirely inside the body, it is not expected to be noticeable under clothing.

Malleable implants, by contrast, have no pump or reservoir; the penis is positioned by hand. This is the most obvious difference between the two types in terms of use.

Can the device be used immediately after surgery?

No. A period of time is allowed after surgery for the tissue to heal and the swelling to subside, and the device is not used during this time. Attempting to inflate it early is both painful and places unnecessary strain on healing tissue.

The waiting period varies with the patient's rate of healing, the condition of the tissue and the surgical approach used; the surgeon specifies this at follow-up appointments. During this period the patient is expected to avoid straining the area, use the recommended medication and attend follow-up regularly.

In some patients the device may be left partially inflated in the early period, or gentle operation at set intervals may be requested. The purpose is to help the healing tissue space adapt to the implant. Such instructions are individual and should not be applied on the patient's own initiative.

What happens at the activation appointment?

Once healing has reached a sufficient level, the patient is invited to an appointment where use of the device is taught. This consultation generally includes the following steps:

• Examination: Wound healing, the state of the swelling and the position of the pump are assessed.
• Showing the pump: The patient is shown where the pump sits within the scrotum and how to grip it.
• First inflation: The device is operated for the first time with the surgeon present, and the patient tries the procedure with their own hands.
• Teaching deflation: Where the deflation button is and how to use it is demonstrated.
• Answering questions: Questions about the timing of return to sexual activity and about daily use are addressed.

For most patients this appointment is the most anticipated stage of the process. Making the first attempt with the surgeon present provides a far more comfortable learning environment than trying alone at home.

How is the implant inflated and deflated?

Although use varies slightly between models, the basic principle is the same. To inflate, the lower part of the pump is squeezed repeatedly with the fingers; each squeeze transfers a quantity of fluid from the reservoir to the cylinders. The movement is repeated until the desired rigidity is reached.

To deflate, the release button on the pump is held down for a set time while the penis is gently straightened downwards. Once the fluid returns to the reservoir, the penis returns to its flaccid state. Incomplete deflation can leave the penis partially filled, in which case the procedure is repeated.

In the early period it is advised to carry out these movements unhurriedly, in a calm setting. Once learned, the procedure becomes an automatic movement taking a few seconds.

What difficulties can arise during first use?

Learning to use the device is a process requiring several attempts for most patients. The most common situations are:

• Not being able to find the pump: If swelling has not fully subsided, gripping the pump can be difficult; this usually resolves on its own as the swelling decreases.
• Not reaching sufficient rigidity: Usually because the pump has not been squeezed enough times.
• Not deflating fully: Not holding the release button long enough is a frequent cause.
• Tenderness: Sensitivity in the area may persist in the first weeks and decreases with time.
• Apprehension: Fear of damaging the device can make the first attempts harder; implants are, however, manufactured to withstand daily use.

All of these difficulties are an ordinary part of the learning process. If difficulty persists despite repeated attempts, the technique can be demonstrated again at the next follow-up.

How long does it take to learn to use the device?

This period varies between individuals. Some patients use the device comfortably at the activation appointment, while others feel confident after a few weeks of regular practice. Manual dexterity, finger strength, how quickly the swelling subsides and the patient's level of apprehension all affect this.

In patients with limited manual dexterity, model features that make the pump easier to operate can be considered during preoperative planning. It is therefore important to mention rheumatic conditions, reduced hand strength or similar circumstances during consultations.

Regular use is the most important factor in speeding up learning. Operating the device at set intervals supports both the patient's adaptation and the tissue's accommodation to the implant.

What should be considered in daily use?

Once learned, an inflatable implant is a device that does not restrict daily life. Even so, a few points stand out in use:

• Deflating after use: Deflating the device after intercourse prevents continuous pressure on the tissue.
• Using it without force: Excessive force on the pump is not needed; the movement should be controlled and steady.
• Position of the pump: The pump may shift slightly over time; a marked change in position is assessed at follow-up.
• Follow-up: Attending the recommended appointments is meaningful for long-term monitoring even when the device works without problems.

Other frequently asked topics about daily life with an implant, such as sport, travel, airport security and imaging investigations, require separate discussion.

When should a doctor be consulted?

Most difficulties with using the device are part of the learning process; some situations, however, warrant an unscheduled appointment:

• Increasing pain, redness, warmth or discharge at the surgical site
• Fever
• Inability to inflate or deflate the device
• An unexpected change in the shape of the penis or a marked change in the position of the pump
• Difficulty passing urine

Not all of these findings indicate a serious problem; in implant surgery, however, early assessment matters because it allows an issue to be resolved with a simpler intervention.

Using an inflatable penile implant is a process that begins once healing after surgery is complete and is learned with the surgeon's guidance. Being shown how the device is operated at the activation appointment, being patient during the first attempts and using it regularly turn it into comfortable, routine use for most patients within a short time. Assoc. Prof. Dr. Zülfü Sertkaya practises in urology and andrology in Istanbul; training in the use of a penile implant and the follow-up process are carried out with individual planning and confidentiality.

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