Impotence is a relatively common sexual dysfunction. According to statistics, the prevalence of impotence in men over 40 years old is over 40%, and one tenth of them are moderate to severe impotence. Moderate to severe impotence is mainly manifested as difficulty in penetration during intercourse or inability to maintain until the completion of intercourse after penetration, which seriously affects the quality of life and the relationship between husband and wife. 1.How should impotence be treated in general? The preferred treatment for impotence is still medication, which is usually referred to as the first-line treatment. However, the overall efficiency of various drugs is about 70%, and for moderate to severe impotence, the efficiency of drug treatment is low, less than 50%. Other treatments include penile cavernous body injection therapy, negative pressure erection aid and extracorporeal shock wave therapy, which are generally called second-line treatments. The overall effectiveness of second-line treatments is uncertain and inconvenient to use, including injection therapy and abnormal penile erection, as well as repeated injections that can lead to fibrosis of the penile corpus cavernosum. Therefore, second-line treatment has great limitations and most of them are difficult to adhere to the treatment. 2.What are the surgeries to treat impotence? Surgeries for impotence include various vascular surgeries such as vein ligation, arterial anastomosis, and penile pacemaker implantation. Among them, vascular surgery is affected by various factors, sometimes the effect is not very satisfactory and it is easy to recur, so the international attitude towards various vascular surgery for impotence is negative. 3. What is a penile pacemaker? A penile pacemaker (commonly known as a penile prosthesis) is currently an internationally recognized and effective method for treating moderate to severe impotence. The penile pacemaker has been developed for more than 40 years, from a simple single-piece set in the past to a three-piece set at present. Among them, after the single-piece set is implanted, the penis is always in an erect state and the concealment is not good. （The three-piece expandable prosthesis is the most advanced one and consists of three main parts: two hollow cylinders placed in the penis, a pump placed in the scrotum, and a water reservoir placed in the pelvis. There are connecting tubes to connect the above three parts, which are filled with saline. By pressing the pump buried in the scrotum 3 to 5 times, the saline enters the cylinder inside the penile sponge and the penis shows erection. After the completion of sexual intercourse, the switch on the pump is touched and the saline water flows back to the reservoir through the connecting tube and the penis is in its normal state again. (The three-piece penile pacemaker is shown below.) After the three-piece penile pacemaker is implanted, the penis can be erected by operation during intercourse according to one’s wish, and can be weakened by operation after intercourse, thus simulating natural erection and weakness. (Figure below) 4. Patients for whom a penile pacemaker is suitable Current data show that patients have a high level of satisfaction with their sexual life after surgery. Therefore, pacemaker implantation surgery is the third-line treatment recommended by various international guidelines. It is mainly suitable for patients with severe impotence who have had poor or ineffective results with regular medication. In addition, some patients who cannot tolerate the side effects of medication despite the effectiveness of medication also need to undergo surgery. After the surgery, the patient can operate on his own and get an erection, so that he can get an erection when he wants to, so that he can really return to nature and do what he wants to do! The various surgeries related to impotence are all minimally invasive. Although the surgery is simple to say, it requires a very high environment in the operating room of the hospital. If the environment of the operating room does not meet the requirements, the chances of infection of the patient will increase, and the greater the possibility of failure of the surgery. Especially in the case of pacemaker implantation surgery, it is important not to have infection, otherwise it will lead to failure of the surgery. 5.What kind of anesthesia is usually used for surgery and do I need to be hospitalized? Generally, semi-somatic anesthesia, also known as epidural anesthesia, can be used. This type of anesthesia is a continuous injection from the crestal spine and the patient can be awake during the surgery. General anesthesia can also be used as needed, and the patient is usually hospitalized for about 7 days.