Mohamed Issam Zabad is a dedicated specialist in urology who, through his solid training and extensive clinical experience in Germany and internationally, has developed outstanding expertise in the treatment of urological conditions. At the urological practice “Bliesurologen” in Neunkirchen/Saar, he treats patients of all ages with a wide spectrum of urological disorders. His particular focus is on providing sensitive, individually tailored care using state-of-the-art procedures and technologies. Zabad has specialized in several highly advanced fields of urology, including reconstructive andrology, intimate surgery, urogynecology, and the treatment of urinary incontinence.
He has in-depth expertise in endourological stone therapy as well as in minimally invasive urological surgery. In surgery of the external genitalia and penile surgery, Zabad combines functional restoration with a high level of aesthetic precision. His role as Managing Senior Consultant and Head of the Section for Incontinence and Urogynecology at Klinikum Idar-Oberstein SHG underscores his authority in this central area of urology. The clinic’s certification as a counseling center by the German Continence Society reflects the high quality of the therapies carried out under his leadership.
Through his work, he significantly advances the specialization of urology in southwestern Germany. Zabad is also active in the cross-regional healthcare network: as Managing Director of the German-French Medical Care Center in Saarbrücken, he contributes both his organizational skills and his medical expertise. This combination of clinical excellence, international networking, and interdisciplinary leadership makes him a key figure in modern urological care in the region. His professional journey, which began at Misr University for Science and Technology in Cairo and took him via stations in Syria ultimately to Germany, shapes his ability to treat patients from diverse cultural backgrounds with empathy and individualized care.
On the subject of erectile dysfunction and the possibility of penile prosthesis implants, the editorial team of the Leading Medicine Guide spoke with Mohamed Zabad in greater depth.
Erectile dysfunction (ED) is a common yet often stigmatized health condition that can affect men of all ages, significantly impairing not only physical but also psychological quality of life. When conservative therapies such as medication, injections, or vacuum pumps do not provide sufficient improvement, implantation of a penile prosthesis can offer an effective and lasting solution.
Modern penile prostheses enable reliable erections, restoring a fulfilling sex life. They are considered a safe and well-established option for treatment-resistant erectile dysfunction—particularly when causes such as diabetes, nerve damage, or prior prostate surgery are present. In experienced hands, the surgical procedure can be highly successful and lead to a significant improvement in quality of life.
Erectile dysfunction (ED) can arise from a variety of causes. Most often, vascular problems are involved, such as impaired blood flow due to arteriosclerosis or venous insufficiency. Neurological conditions, including nerve damage caused by diabetes or spinal cord injuries, can also affect erectile function. Hormonal factors, particularly testosterone deficiency, play a role as well, as do psychological issues such as stress, anxiety, or depression. In addition, certain medications, such as beta blockers or antidepressants, may negatively affect sexual function. Alcohol, drug use, and smoking are further contributing factors.
“Erectile dysfunction is a complex condition with many different causes. Most often it is related to circulatory problems, but nerve damage, hormonal changes, or psychological burdens such as stress and depression may also play a role. When a patient comes to my consultation with this concern, I always begin with a thorough personal conversation. It is very important to me to approach the subject with sensitivity and respect, as many patients feel ashamed and need time to build trust.
That is why I conduct such discussions step by step and never under time pressure. After the initial conversation, a physical and urological examination follows, as well as additional diagnostic procedures if needed, such as Doppler or duplex sonography to assess blood circulation. A comprehensive laboratory evaluation, particularly hormone levels, is also carried out. All these steps are taken in close consultation with the patient and adapted to his individual situation. I often provide accompanying informational materials—brochures, questionnaires, or videos—that the patient can review or complete at home at his own pace. This helps process the information and better prepare for follow-up appointments.
Special attention is also paid to risk factors such as alcohol and nicotine. While moderate consumption may not have an immediate impact, regular or excessive use is clearly proven to have negative effects on erectile function. Doping or hormone abuse, for example among bodybuilders, is also becoming an increasing issue. Artificially administered hormones such as testosterone can suppress the body’s natural hormone production.
In the long term, this not only leads to hormone deficiency but in the worst case can cause serious secondary conditions such as kidney disease. Diagnosis and treatment of erectile dysfunction is a process requiring both medical precision and human empathy. My goal is always to work with the patient to find a feasible path that meets his individual needs,” explains Mohamed Zabad at the start of our conversation.
That is why I conduct such discussions step by step and never under time pressure. After the initial conversation, a physical and urological examination follows, as well as additional diagnostic procedures if needed, such as Doppler or duplex sonography to assess blood circulation. A comprehensive laboratory evaluation, particularly hormone levels, is also carried out. All these steps are taken in close consultation with the patient and adapted to his individual situation. I often provide accompanying informational materials—brochures, questionnaires, or videos—that the patient can review or complete at home at his own pace. This helps process the information and better prepare for follow-up appointments.
Special attention is also paid to risk factors such as alcohol and nicotine. While moderate consumption may not have an immediate impact, regular or excessive use is clearly proven to have negative effects on erectile function. Doping or hormone abuse, for example among bodybuilders, is also becoming an increasing issue. Artificially administered hormones such as testosterone can suppress the body’s natural hormone production.
In the long term, this not only leads to hormone deficiency but in the worst case can cause serious secondary conditions such as kidney disease. Diagnosis and treatment of erectile dysfunction is a process requiring both medical precision and human empathy. My goal is always to work with the patient to find a feasible path that meets his individual needs,” explains Mohamed Zabad at the start of our conversation.
Before surgical measures are considered, conservative therapies should first be exhausted.
“Treatment usually begins with lifestyle changes—these include a balanced diet, regular exercise, weight reduction in cases of overweight, and giving up harmful habits such as smoking or excessive alcohol consumption. These changes are essential not only with regard to sexual function but also for general health. Often these measures alone can already lead to noticeable improvement. If these first steps are not sufficient, medication-based therapies are introduced.
The most commonly used are so-called PDE-5 inhibitors such as sildenafil—better known under the brand name Viagra. These medications improve blood flow in the penis and can therefore support erectile function. What is important here is individual adjustment: dosage, timing of intake, and possible combinations with other medications should be coordinated closely with the physician in order to achieve optimal results.
If these measures also do not achieve the desired effect, further conservative options are available. These include, for example, vacuum pumps that mechanically induce an erection, as well as hormone therapies in cases of proven testosterone deficiency. In certain cases, injection therapies may also help, where medications are injected directly into the erectile tissue. These usually lead reliably to an erection, but their use requires explanation and they are not suitable for every patient,” explains Mohamed Zabad, adding:
“If all conservative therapies have been exhausted without sufficient effect, a surgical procedure can be considered in particularly severe cases—for example, the implantation of a penile prosthesis. If a patient continues to suffer from erectile problems despite taking medications such as Viagra, this is usually an indication of an underlying severe dysfunction of the erection mechanism. This may be due to pronounced circulatory disorders or irreversible nerve damage. In such cases, medication options are often not sufficiently effective, and further diagnostic clarification and individualized therapy concepts are necessary.”
Treating underlying conditions such as diabetes or high blood pressure is also essential. Only when all these measures fail to produce sufficient results are surgical interventions, such as the implantation of penile pump systems or vascular surgical procedures, considered.
The prerequisites for a penile prosthesis are clearly documented, therapy-resistant erectile dysfunction, exhausted conservative treatment options, a stable physical condition without infection risks, and the patient’s willingness to accept the surgical risks and consequences. Only then is the surgical procedure regarded as a reasonable last treatment option.
First, the diagnosis of ED must be unequivocal and confirmed through comprehensive diagnostics. This means that organic causes such as vascular disorders, neurological diseases, or hormonal deficiencies have been carefully investigated and, as far as possible, treated. Psychogenic factors should also be assessed and, if necessary, addressed through psychotherapeutic measures. Only when these conservative therapies do not bring the desired success is a surgical solution appropriate.
“When it is clear that conservative measures no longer produce sufficient results, I usually begin at the relevant appointment by providing the patient with initial information about prosthetics. I show anatomical models in my office, for example, or let them watch educational videos so the patient can get a first impression in peace.
It is important to me that nothing is rushed—I always say: take your time, think it over, and bring your questions to the next appointment. At the next consultation, we then take more time to discuss everything in detail. When it comes to discussing the possible prostheses, I of course explain the differences between the variants. Basically, there are two main forms: semirigid prostheses and hydraulic implants.
The medical indication is similar in both cases—the difference lies in how they work. Hydraulic prostheses are the variant most commonly used today. They provide a very natural erection, are not visible from the outside, and can be completely deactivated. This is a great advantage for many patients. They are technically somewhat more demanding, but in terms of functionality and satisfaction, they are very convincing.
Semirigid prostheses, on the other hand, are simpler in design, require no active operation, and are therefore sometimes better suited for older or motor-impaired patients. However, they are permanently rigid, which is less discreet in everyday life. In countries with limited resources, they are therefore used more often, also for cost reasons. What is always important is that the patient understands what is involved and feels comfortable with the decision. That is why I take the time to explain everything step by step and to find the best way together,” says Mohamed Zabad.
Semirigid vs. hydraulic penile prostheses
Semirigid prostheses consist of flexible rods that are permanently somewhat firm. They are easy to handle, robust, and less expensive, but appear less natural since the penis never fully flaccid. Hydraulic prostheses allow for controllable, natural erections and complete flaccidity by means of a pump in the scrotum. They offer a more discreet result and higher patient satisfaction but are technically more complex and more expensive.
The implantation of a penile prosthesis is a surgical procedure that is considered safe today when performed by experienced urologists in an appropriate clinical setting.
On the procedure itself, Mohamed Zabad explains: “Today, the surgery, when performed by experienced hands, is a safe routine procedure with a very high success rate. We work with modern, antibacterial prostheses and standardized methods. For the trained surgeon, it is a clearly structured procedure. The surgery usually lasts between 60 and 120 minutes, depending on the initial situation—whether it is a first procedure or a recurrence case—and of course depending on the surgeon’s experience.
Satisfaction rates are now around 90 to 95 percent when the indication was correctly established and the appropriate materials were used. As for risks, the typical surgical complications as with any operation naturally exist. In the past, infection risk was a major issue, but today it has been greatly reduced thanks to modern surgical techniques, better prosthesis materials, and targeted preparation. What is important: the surgery itself accounts for maybe 30 to 40 percent of overall success—the rest is preoperative preparation and consistent aftercare. When all this is right, there are generally no particular problems.
Patients usually remain in the hospital for two to four days—depending on whether, for example, comorbidities such as diabetes are present or whether drainage was necessary. They can then go home. The only important thing: during the first six weeks, they should take it physically easy, avoiding strenuous activity. And yes, after about four to six weeks, sexual intercourse is usually possible again.”
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During the implantation of a penile prosthesis, surgical access to the erectile tissue is created through a small incision—either directly at the base of the penis or in the groin area. These erectile tissues, which normally fill with blood during an erection, are carefully opened to create space for the prosthesis components. In the case of a hydraulic prosthesis, the system consists of three parts: two cylinders inserted into the erectile tissue, a small fluid reservoir placed in the lower abdomen, and a pump implanted in the scrotum. This system later enables the patient to trigger an erection mechanically by activating the pump, which transfers fluid from the reservoir into the cylinders. After inserting all components, the surgical incisions are carefully closed. Immediately afterward, a close-fitting dressing is applied to minimize swelling and promote uncomplicated healing.
A penile prosthesis generally does not affect sexual sensation and orgasmic ability, since the prosthesis itself primarily restores the mechanical ability to achieve an erection. Sensory perception of the penis, which is transmitted through nerves in the glans and shaft, usually remains intact because the prosthesis is implanted into the erectile tissue and does not directly affect the skin, nerve endings, or glans.
Mohamed Zabad describes the further steps after surgery: “Patients come for regular follow-up after the procedure. I usually do the first checkup after about two weeks, primarily to assess the wound. Another appointment follows in four to six weeks, during which we discuss activation of the prosthesis together. At that point, I explain exactly how to operate the pump and also provide accompanying instructional materials. Six weeks later—about twelve weeks postoperatively—another follow-up appointment is scheduled, where patients share their experiences and feedback.
The feedback is very positive. Over the years, I have found that nearly all patients—around 98 percent—are very satisfied, both with the functional result and with the impact on their quality of life. Many come together with their partners, which I find very important. Erectile dysfunction never affects the patient alone but always also the relationship, and often the partner is actively involved in the decision-making and recovery process. I also frequently receive very positive feedback from this side,” he adds:
“Regarding function, I am often asked whether orgasm and sexual sensation are still possible with the prosthesis. And yes, they are. The prosthesis replaces only the mechanical ability to achieve an erection. Sensory ability and the ability to orgasm usually remain fully intact since the nerve pathways are not affected. It is important to clarify this in advance to avoid false expectations. As for durability, one can say that a penile prosthesis typically remains functional for about ten to fifteen years. After that, replacement may be necessary. Compared to the initial implantation, this procedure is usually smaller and less complicated—provided it is performed by an experienced surgeon.”
Erectile dysfunction is definitely a medical condition and not a cosmetic issue. It is not about creating something “beautiful” or “plastic,” but about treating a serious functional disorder.
“When the indication is clear and all conservative therapies have been exhausted, implantation of a penile prosthesis is considered a standard benefit fully covered by health insurance—provided, of course, that all medical prerequisites are met. And regarding the subject of gender reassignment, it is indeed true that prosthesis implantations can be part of that process. However, it is important to know that this is not an immediate step but usually requires several surgical phases. The prosthesis is often a later, important part of the overall treatment plan, which must be carefully planned and supervised,” says Mohamed Zabad.
The Bliesurologen practice in Neunkirchen – Saar / Klinikum Idar-Oberstein stands out for its empathetic care, modern diagnostics, and individualized therapy approaches. Patients particularly appreciate the discreet and respectful atmosphere. With over 17 years of extensive urological experience, Dr. Zabad ensures a high level of professional and surgical expertise.
“In our clinic, we implant about 10–20 penile prostheses per year. Last year it was around 11 procedures, and by mid-year this year we were already at about 11 to 12. This makes us one of the few centers in southwestern Germany that regularly perform these procedures with great experience.
In general, there are not many who perform such operations. This is not because the procedure is extremely difficult, but because it requires specialized expertise. Not every urologist or surgeon performs such prosthesis implantations, which is why patients are often referred to specialized centers. In recent years, we have built up a great deal of experience in this field and now perform these procedures routinely,” emphasizes Mohamed Zabad, bringing our conversation to a close.
Many thanks, Dr. Zabad, for the fascinating insight and valuable information!
