Penile Prosthesis Insertion

  • Definition

    This surgery implants a device into the penis. The device can produce an erection-like state. It enables a man to have sexual intercourse. A penile prosthesis does not change the sensation on the skin of the penis or the ability to reach orgasm or ejaculate.
    Penile Implant
    Penile Implant
    Copyright © Nucleus Medical Media, Inc.
  • Reasons for Procedure

    A penile prosthesis insertion is for men who want to have an erection, including those who have:
    • Not responded to other treatment options such as pills, suppositories, vacuum devices, and injections
    • Certain diseases such as diabetes or vascular disease
    • Physical injuries such as spinal cord injury
    • Certain surgeries that have made having an erection impossible
  • Possible Complications

    Complications are rare. But, no procedure is completely free of risk. If you are planning to have penile prosthesis insertion, your doctor will review a list of possible complications. These may include:
    • Bleeding
    • Infection
    • Scar tissue that forms
    • Break down of tissue around the implant
    • Mechanical failure
    Factors that may increase the risk of complications include:
    • Obesity
    • Smoking or alcoholism
    • Poor overall health
    • Poor nutrition
    • Use of certain drugs
    • Diabetes
    • Bladder disease that requires a catheter
    • Infection
    • Bleeding disorders
    • Paralysis
    • Prior pelvic or genital surgery
    Be sure to discuss these risks with your doctor before the procedure.
  • What to Expect

    Prior to Procedure
    Your doctor will:
    • Obtain a complete medical, surgical, and sexual history
    • Do a physical exam
    • Do tests to rule out problems that might be treated with medications
    Leading up to the procedure:
    • Talk to your doctor about your medications. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Anti-inflammatory drugs such as ibuprofen
      • Blood thinners
      • Anti-platelet medications
    • Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.
    Anesthesia
    There are two types of anesthesia that your doctor may use:
    • General anesthesia —blocks pain and keeps you asleep through the surgery; given through an IV in your hand or arm
    • Spinal anesthesia —numbs the area from the chest down to the legs; given as an injection in your back
    Description of the Procedure
    To prevent infection, your genital area will be cleaned. You will be given antibiotics about one hour before surgery. A thin tube called a catheter will be inserted into the penis to make sure that the bladder remains drained of urine.
    There are two types of implants available:
    • Inflatable implant—two cylinders, a pump, tubing, and may have a reservoir
    • Malleable implant—two semi-rigid rods inserted into the penis
    Inflatable Implant
    There are two types of inflatable implants: two-piece and three-piece. For both types, the doctor will make a small incision at the top of the scrotum. The incision will be made so that sutures are under the skin and can be absorbed.
    With the two-piece implant, the cylinders will be inserted into the penis. A pump with fluid will be inserted into the scrotum. This type of implant is simpler to insert. It takes up more space in the penis, leaving less room to expand.
    With the three-piece implant, the cylinder will be inserted into the penis. The pump will be inserted into the scrotum. Lastly, a reservoir containing the fluid that is used for inflation will be inserted into the abdomen.
    Malleable Implant
    The doctor will make an incision just behind the head or near the base of the penis. An opening will be made into each of the two long tubes of spongy tissue inside the penis. The doctor will insert one rod into each tube. Lastly, the doctor will close the incisions so that no sutures will be needed.
    How Long Will It Take?
    • Inflatable implant: 1-2 hours
    • Malleable implant: 30-60 minutes
    Will It Hurt?
    You will have pain for about four weeks. Ask your doctor about medication for pain.
    Average Hospital Stay
    This procedure is most commonly done in a hospital. You may need to stay one night or longer if you have problems. In some cases, it may be possible to leave the hospital on the same day as the procedure. Talk to your doctor to find out if this is an option for you.
    Post-procedure Care
    At the Hospital
    While you are recovering at the hospital, your doctor will:
    • Have the urine catheter removed
    • Give you antibiotics and pain medications
    At Home
    When you return home, do the following to help ensure a smooth recovery:
    • Be sure to follow your doctor's instructions .
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Take antibiotics as directed.
    • For pain relief, use:
      • Over-the-counter medications or those your doctor prescribes
      • A warm compress
    • Wear loose-fitting underwear while you recover.
    • Avoid sexual activity for at least six weeks.
    • Avoid difficult physical exercise and heavy lifting for six weeks.
    • Ask your doctor when you can return to work. You may need to wait 10 days.
    • Do not drive until instructed by your doctor.
  • Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Redness, swelling, increasing pain, increasing bleeding, or a large amount of fluid leaking from the surgical area
    • Increased swelling in your scrotum or penis
    • Blood in your urine
    • Signs of infection such as fever, chills, headache, muscle aches, lightheadedness, general ill feeling
    • New symptoms such as nausea, vomiting, constipation , abdominal swelling
    • Pain or difficulty with urination
    In case of an emergency, call for medical help right away.
  • RESOURCES

    Urology Care Foundation http://www.urologyhealth.org

    Men's Health Network http://www.menshealthnetwork.org

    CANADIAN RESOURCES

    Canadian Diabetes Association http://www.diabetes.ca

    Men's Health Centre http://www.menshealthcentre.net

    References

    ED: penile prostheses (erectile dysfunction). Urology Care Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=11 . Updated July 2013. Accessed August 13, 2013.

    Erectile dysfunction. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated August 8, 2013. Accessed August 13, 2013.

    Montorsi F, Rigatti P, Carmignani G, et al. AMS three-piece inflatable implants for erectile dysfunction: a long-term multi-institutional study in 200 consecutive patients. Eur Urol. 2000;37:50-55.

    Mulhall JP, Ahmed A, Branch J, Parker M. Serial assessment of efficacy and satisfaction profiles following penile prosthesis insertion. J Urol. 2001;165:1429-1433.

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