Dr. Pravin Rao, director of reproductive medicine and surgery at the Johns Hopkins Brady Urological Institute, said penile implants, called prostheses, are safe for patients who are in good health -- even those with diabetes, as long as the disease is "controlled."
The risk rate is lower than 3 percent, according to Rao, who did not treat Milla.
"Usually, it's the last report option for men who just don't want to use other treatments as options," he said. "Sometimes, the individual wants a permanent solution and wants the spontaneity."
Penile implants are among a "long algorithm of options" for those with erectile dysfunction, according to Rao. Urologists start with pills like Viagra -- the least invasive approach –-- to vacuum erection devices and injection therapy.
But sometimes those treatments fail because of the quality of the tissue in the penis or poor blood flow.
The most common reason for ED is chronic disease that affects the vessels in the penis -- most often diabetes, hypertension, smoking or high cholesterol. Nerve damage, caused by spinal cord injuries, diabetes or radical prostate cancer surgery, can also trigger ED.
A poor candidate for a prosthesis is someone who is not in overall good health and may be at risk under anesthesia or not be able to withstand the blood loss of surgery.
"The number one concern is infection, and that's why we make sure their overall health and immune status are good and their diabetes is under control," said Rao.
When infection does occur, the prosthesis must be immediately removed to clear the infection.
"Personally, I have heard of amputation, but not seen one," said Rao. "We have definitely seen prostheses taken out due to erosion. The wrong size is chosen or there is poor wound healing."
The prosthesis is an inflatable device that is inserted in the two tubes of the penis. The balloons can be filled up with fluid, creating an erection. A small pump is placed in the scrotum with a reservoir of fluid that connects to the tubing.
"When we first place it, we don't have it activated to create a full erection," said Rao. "Then after letting it heal for six weeks, [the patient] comes in and we teach them how to use the pump by squeezing it."
Patients are told not to have sex during that recuperative period.
Rao said that penile implants are "very successful and infection is not the norm."
Some studies of patients with diabetes and those without the disease had the same rate of infection. "But," he said. "We have to be prudent about picking the patient."