Penile Implant – Diagnostics and Decision-Making

Who Should Decide – and Why Experience Matters So Much Here

The decision to proceed with a penile implant should never be based on a single test alone. It requires a physician experienced both in treating severe erectile disorders and in the implantation technique itself.

UGRS, as a specialised tertiary medical centre, is frequently consulted for an assessment – including by patients who have already received a recommendation elsewhere and are seeking a second opinion.

Step 1: The Medical History Interview

We record:

• Since when and how severe the erectile dysfunction has been
• Which treatments have already been tried
• Previous surgeries – particularly prostate operations
• Pre-existing conditions – diabetes, cardiovascular disease, neurological disorders
• Whether induratio penis plastica (IPP) is present at the same time
• The subjective burden and personal expectations

Step 2: The Physical Examination

During the physical examination, the penis is checked for changes – palpable plaques, scarring, or signs of structural changes in the erectile tissue. If IPP is suspected, ultrasound is used as a supplementary tool.

Step 3: The SKAT Injection

The SKAT injection is the most important diagnostic tool for assessing erectile function. A vasodilating medication is injected directly into the erectile tissue – it maximally dilates all the vessels and tests whether the body is still able to build up an erection.

What the SKAT Injection Shows

• Full erection despite the injection: vessels are intact – the cause is likely nerve-related (typical after prostate surgery)
• No or weak response: vascular ED – blood flow is no longer sufficient
• Unchanged picture in IPP patients: damage to the erectile tissue caused by plaque

What the SKAT Injection Does Not Show

Nerve damage after prostate surgery cannot be directly demonstrated by the test – it is inferred indirectly when the vessels are functioning but no adequate erection occurs. Damage to the erectile tissue caused by IPP is likewise not directly detectable.

Why Interpretation Requires Experience

The same test result can mean different things in different patients. In cases of nerve damage after prostate surgery, combined findings of IPP and vascular problems, or long-standing ED with changes to the erectile tissue, a very experienced physician is needed to correctly interpret the result.

Step 4: Supplementary Diagnostics

• Doppler ultrasound: assessment of blood flow dynamics in the penis during erection
• Penile ultrasound: visualisation of plaques in IPP, assessment of erectile tissue structure
• Neurological assessment: if central or peripheral nerve damage is suspected

What the Diagnosis Provides – and What It Does Not

A complete diagnostic work-up answers the decisive questions: What is the cause of the ED? Are other treatment options realistic? And if an implant makes sense: which system, which size, which surgical technique?

The decision to proceed with a penile implant is always a personal one as well – based on the findings, the individual situation, and expectations. This decision always rests with the patient.

Schedule a Consultation

If you would like a well-founded assessment of your situation, come in for a consultation. We are also the right point of contact for second opinions.

The first step isn't a procedure – it's a conversation.