penile prosthesis surgery

What is involved in the penile prosthesis surgery ?

Penile prosthesis surgery, also known as penile implant surgery, is a procedure performed to treat erectile dysfunction (ED) in men who have not responded to other treatments such as medication or vacuum erection devices. The surgery involves the insertion of a prosthetic device into the penis, allowing the patient to achieve an erection for sexual activity.

There are different types of penile prostheses, including inflatable and malleable implants. Inflatable implants consist of two cylinders implanted within the penis, a reservoir of fluid placed in the abdomen, and a pump placed in the scrotum. Malleable implants are semi-rigid rods that are manually bent into an erect position for intercourse.

Penile prosthesis surgery has a high success rate and can significantly improve the quality of life for men with severe erectile dysfunction. However, it is essential for patients to discuss the risks and benefits of the procedure with their healthcare provider to determine if it is the right option for them.

Penile prosthesis

penile prosthesis main points

Key Points:

Penile prosthesis

  • Penile prosthesis (implants) are utilized for the treatment of erectile dysfunction (impotence).

  • They also find applications in medical conditions like acute ischaemic priapism and Peyronie’s disease, particularly when associated with erectile dysfunction.

  • The procedure involves implanting a device into the penis, effectively replacing the body’s natural erectile mechanism.

  • Removal of penile implants is possible, but it results in permanent and complete erectile dysfunction, making the decision irreversible.

  • Implants come in two types: malleable (permanently semi-rigid) or inflatable penile prosthesis (IPP), offering the flexibility to switch between a flaccid or erect state.

  • While the implants can be felt within the body, they are not visible externally.

  • After the surgery, patients can typically expect to go home either on the day of the procedure or the following day.

  • Sexual intercourse is generally discouraged for at least four weeks post-implant surgery, unless the surgeon provides specific advice to the contrary.

additional points

Before the procedure, a comprehensive counseling session with the surgeon and specialist nurse will provide insights into the available types of penile implants, demonstrating their appearance and functionality. Typically lasting 10 to 15 years, these implants may require replacement afterward. There are three primary types:

  • Malleable: Consists of flexible rods for permanent rigidity with a "bendy" quality for concealment. They are quick and easy to insert and suit men with complex medical issues or limited hand dexterity.

  • Three-piece Inflatable: Involves paired cylinders in the penis, a scrotal pump, and an abdominal fluid reservoir. Activation of the pump fills the cylinders, and a release button restores a flaccid penis. Although more complex, they offer versatility with a small risk of mechanical issues.

  • Two-piece Inflatable: Features pre-filled cylinders requiring a scrotal pump but lacking a fluid reservoir. Ideal for those with pelvic or abdominal surgery, they maintain better rigidity when deflated compared to three-piece devices.

A penile implant provides the ability to achieve and maintain an erect penis for sexual activity. However, it does not alter the size and width of the penis like a natural erection would. Additionally, the head of the penis may not achieve the same rigidity as in a natural erection. It's essential to consider this irreversible procedure as a last resort and thoroughly discuss alternative treatments with your urologist before opting for penile prosthesis .

surgery

What occurs on the day of the procedure?

A/Prof Homi Zargar will discuss the surgery once again to ensure your understanding and obtain your consent.

Details of the procedure:

  • Preparation:

  • Shave and clean the area with antiseptic for 5 to 10 minutes to minimize infection risk.

  • Receive an injection of antibiotics after careful allergy checks.

  • Anesthesia Options:

    • Procedure usually conducted under general anesthesia or, occasionally, under spinal anesthesia.

  • Incision and Positioning:

    • Make a small cut either just below the penis-scrotum junction or just above the penis-lower abdomen junction.

    • A single incision usually suffices, but occasionally, a second incision in the abdomen is needed to position the reservoir.

  • Procedure Steps:

    • Break down tissue in the erectile cylinders of the penis (corpora cavernosa) to measure space for implant size determination.

    • Create a space in the scrotum for the pump (if using an inflatable device), usually between testicles.

    • Place a fluid reservoir alongside the bladder or beneath the muscle in the lower abdomen through a separate incision.

    • Fill inflatable devices with fluid, expel air from cylinders and connecting tubing, and test inflation while the patient is asleep.

    • Leave a small drain in the wound, and a catheter may be used overnight.

  • Post-Operation Care:

    • Wrap the penis in a firm dressing to reduce swelling and bruising.

    • On the day after the operation, remove the catheter and drain.

    • Remove the dressing yourself two days after the procedure.

    • If using an inflatable device, deflate it before leaving; initial deflation may be uncomfortable but should not deter you.

After-Effects and Risks of the Procedure:

  • Bruising and swelling of the penis: Almost all patients.

  • Infection of the device (revision, priapism/fibrosis, or complex procedures): Between 1 in 10 and 1 in 16 patients (6% to 10%).

  • Malfunction/mechanical failure of inflatable implants within 10 years: 1 in 20 patients (5%).

  • Erosion of the device requiring further surgery: Between 1 in 20 and 1 in 50 patients (less than 5%).

  • Floppiness or "drooping" of the glans (head of the penis) towards the legs: Between 1 in 10 and 1 in 50 patients.

  • Infection of the device (following first-time implantation): Between 1 in 50 and 1 in 100 patients (1% to 2%).

  • Inadvertent injury to the bladder, bowel, or adjacent blood vessels, or perforation of the corpora during insertion: Between 1 in 50 and 1 in 250 patients.

  • Anaesthetic or cardiovascular problems possibly requiring intensive care: Between 1 in 50 and 1 in 250 patients (your anaesthetist can estimate your individual risk).