ABOUT PENILE PROSTHESIS IMPLANT
Insertion of a penile prosthesis is primarily an operation to implant a device for the treatment of erectile dysfunction.
WHY IS A PENILE PROSTHESIS REQUIRED?
Many men may require a penile prosthesis due to issues with erectile dysfunction, priapism, Peyronie’s disease or incontinence.
Erectile dysfunction can be related to pre-existing medical conditions, trauma or an outcome following surgery for another condition.
Insertion of a penile prosthesis is often considered a final treatment option for men who have unsuccessfully tried other treatment options. For erectile dysfunction this may be the use of oral medications, penile injections or a vacuum erection device.
TYPES OF PENILE PROSTHESIS
There are three types of implants
- Malleable – two flexible rods are inserted up each side of the penis.
- Two-piece inflatable – Two prefilled cylinders are inserted into each side of the penis and pump in the scrotum. The cylinders do not deflate as much as a three-piece implant.
- Three-piece inflatable – Two cylinders are placed into the penis, a pump in the scrotum and a reservoir of fluid in the abdomen. This is the most commonly used implant. You are able to manually fill the cylinders to create a rigid erection using the pump and then deflate the cylinders to return the penis to its flaccid state.
WHAT DOES SURGERY FOR INSERTING A PENILE PROSTHESIS INVOLVE?
Insertion of a penile prosthesis is performed under general anaesthetic (completely asleep).
You will be required to not eat or drink for a period of time prior to your surgery.
To insert the implant, an incision is made at the front of the scrotum, just below the penis. Sometimes, a second incision is also required in the lower abdomen.
Two cylinders will be inserted up each side of the penis. These are measured to length during surgery. You cannot gain any length during this procedure.
If required, a pump is placed into the scrotum. The reservoir of fluid is placed into the lower abdomen, next to the bladder. This is often done using the same incision, but occasionally a second incision in the lower abdomen is required.
You cannot see the implant after surgery, but you will be able to feel it.
You will be given antibiotics and fluids through a vein during the procedure.
A urethral catheter will be inserted through the urethra to the bladder to drain urine. Sometimes a drain in the scrotum is also required. These will be removed prior to discharge from hospital.
On discharge from hospital the prosthesis will be partially inflated. This allows the tissues surrounding the cylinders (parts of the prosthesis that goes up each side of the penis) to heal in a way that gives you the best functional outcome.
WHAT IS THE RECOVERY AFTER THE INSERTION OF A PENILE PROSTHESIS?
The insertion of a penile prosthesis usually requires one or two nights stay in hospital following surgery.
You will go home with the prosthesis partially inflated. It is important to leave it like this until you return for your appointment when you will be taught how to use the device
Due to the location of this surgery there is quite a bit of discomfort, swelling and bruising. It is very important that you take it easy for the first few weeks, wear supportive underwear and ice the area initially following the surgery.
As you will be going home with a partial erection, this can make it challenging going to the toilet. Some gentlemen find it necessary to pass urine into a container rather than the toilet.
You can return to sedentary work approximately 2 weeks after the operation. If your job involves physical work, please discuss this with your doctor.
You cannot do any heavy lifting or strenuous work for 6 weeks following surgery.
Do not resume sexual intercourse until you have been told you can. This is usually after your follow up appointment.
You can resume driving once you are comfortable enough to be able to do an emergency stop. This is usually about 4 weeks following surgery.
WHAT ARE THE RISKS OF PENILE PROSTHESIS SURGERY?
Common risks (1/2 – 1/10)
- Bruising and swelling of the penis and scrotum.
Occasional risks (1/10 – 1/50)
- Malfunction or mechanical failure of inflatable implants within 10 years, which requires further surgery.
- Erosion of the device requiring further surgery
- Infection of the device requiring removal.
Rare risks (1/50 – 1/250)
- Inadvertent injury to your bladder, bowel or adjacent blood vessels, or perforation of the corpora during insertion (which may prevent insertion)
The risks of anaesthesia have not been listed here.
WHAT ARE THE ALTERNATIVE TREATMENT OPTIONS?
The insertion of a penile prosthesis is considered an “end stage” option. It is irreversible and therefore is considered permanent.
Prior to considering this surgery men should consider
- Oral medication
- Intracavernosal injections (injection of medication into the penis to create an erection)
- Vacuum erection devices
- Alternative ways of intimacy with your partner