A penile implant procedure ended up forcing patient Daniel Metzgar having to live with a permanent erection for 8 months, according to his attorney Michael C. Heyden at a medical malpractice suit being heard at New Castle County Superior Court, Wilmington, Delaware, USA.

Truck driver Metzgar, 44, complained that the permanent erection made it difficult for him to go about his daily business. Riding his motorcycle became more difficult as did retrieving his morning newspaper, Heyden claimed.

In December 2009, Metzgar had a three-piece inflatable implant fitted.

The procedure was carried out by urologist Dr. Thomas J. Desperito. His attorneys argued on Monday's opening statements that bad medical results following penile prosthesis (implant) is a (known) risk, even when the surgeon is not at fault.

Dr. Desperito's lawyers said the patient should have realized something was not right four months after the procedure when his scrotum swelled "to the size of a volleyball". The surgeon's attorneys say Metzgar did not report anything until April the following year

According to Metzgar, the surgeon had told him to expect some inflammation, so he therefore concluded at the time that the severe swelling was part of the healing process.

According to Colleen D. Shields, the surgeon's lawyer, the patient came to see Desperito and complained of an infection and an erection that would not go down. Desperito, according to Shields, told Metzgar the implant needed to be taken out. Four months went by and Metzgar never contacted or came back, Shields claims.

Metzgar then claimed that he did not have the $10,000 Desperito said would be needed before the surgery could be done, because he had lost his health insurance since the initial operation. Shields responded by saying that Desperito would not have dealt with money issues, and dismissed that claim.

The penile implant was removed in August 2010 after his scrotum was punctured by tubing from the device while on a trip to Niagara Falls. Apparently, Metzgar's family was with him at the time; they drove him back and he underwent surgery immediately.

Metzgar has since undergone another procedure with a different doctor where he received a replacement prosthesis. His penis is now 50% smaller because of the scar tissue caused by the first procedure; this has undermined his level of sensation, he says.

Metzgar and Donna, his spouse, are seeking unspecified damages against the surgeon and his medical group.

Metzgar, who has been a long-term diabetic, had tried several therapies to treat his erectile dysfunction before considering the inflatable penile implant. None of them worked. He claims the procedure made him feel less of a man.



What are penile implants?

Penile implants, also known as penile prostheses, are devices that are placed inside the penis to allow a man with ED (erectile dysfunction) to achieve and sustain an erection.

Urologists only recommend surgery if nothing else has worked, or if a young man has had serious injury to the pelvic area.

To have the implant fitted, the patient has to undergo an involved surgery. There is a risk that the device will not work, or that an infection develops after surgery. However, with new materials, surgical procedures and designs, results have been improving. The majority of patients with penile implants are satisfied with the results, as are the majority of their partners.

There are three types of penile implants:
  • Semi-rigid implants - two malleable rods are implanted surgically within the erection chambers of the penis. The penis will be in a permanently semi-rigid state. The patient can bend the penis downwards or straight out, so that it is not obtrusive when the man is not having sex. In this "semi-rigid" state, the penis is rigid enough for penetration. However, the erection achieved with inflatable implants is harder.

  • Inflatable implants - there are two types: 1. Two piece Inflatable Penile Implant. 2. Three Piece (Multi-component) Inflatable Penile Implant. The three piece produces a more natural erection, and when the man is not having sex, the penis is not erect (in both cases). With the 3-piece implant:

    - There is a pump (button) which is placed inside the scrotum.
    - A reservoir (small container) is placed in the abdomen.
    - Two cylinders are implanted in the erection chambers of the penis.

    When the button is squeezed, the reservoir empties out into the cylinders, creating an erection. At the base of the pump there is a deflation valve (press it and the erection deflates).
As mentioned before, the inflatable implant usually provides a harder erection compared to the semi-rigid implant.

In a small number of cases (between 1% to 5%), mechanical problems with the devices may develop within five years.

Risks, side effects and complications associated with penile implants

There is a risk of surgical, medical and device-related problems or complications:
  • Infection
  • Erosion of the implant through the skin, urethra, small bowel intestine and colon
  • Injury to a vein or artery of lower extremity
  • Mechanical failure of the implant
  • There may be severe pain (temporary) in the surgical area
  • After surgery, the patient loses the ability to have a spontaneous erection (however, this is not usually an issue because the procedure is aimed at people with erectile dysfunction)
  • Some complications related to anesthesia, such as contracting pneumonia or phlebitis (if surgery is done under general anesthetic). There is a risk of complications from existing heart problems, as with all surgical procedures
  • Further surgery if there is a complication or dissatisfaction with the implant


Written by Christian Nordqvist