Penile Prosthesis
Figure 1: A 3 piece inflatable penile prosthesis.
What are the indications for implantation of a penile prosthesis?
A penile prosthesis is an effective treatment for men with erectile dysfunction who do not respond to less invasive therapy. They can also be used in treat peyronie's disease (penile curvature) and penile fibrosis from priapism.
The procedure should be regarded as an end-stage irreversible surgery in that the medications and injections will not work after penile prosthesis surgery is performed.
What pre-operative work up is needed?
Your urologist will organise any necessary urine and blood tests at your consultation prior to your procedure. It is important that any urine and skin infections around the genital areas are completely treated. If you have diabetes, your urologist will liaise with your GP / specialist to ensure it is well controlled to reduce risk of infection after the operation. You MUST stop smoking before your prosthesis surgery.
You will be given an antibiotic wash, which you should use to clean your abdomen and genital area for 3 days before the operation. You should not shave or clip any hair in your genital area – this will be done by the urologist at the time of surgery.
If you take any blood thinning medication such as aspirin, warfarin, plavix (clopidogrel) and anticoagulants, you should discuss this with your urologist, as they may need to be stopped temporarily.
Please ensure you return any admission forms given to you to be filled out back to the hospital.
What happens on the day of the procedure?
You will be admitted the evening prior to your procedure and given intravenous antibiotics early in the morning of surgery. You will be given fasting instructions prior to your admission (usually for 6 hours prior to the procedure). You should bring a list of your medications with you to the hospital. After you are admitted, your urologist will see you in the morning to discuss the surgery. An anaesthetist will see you to discuss the general anaesthetic before you are taken to the operation theatre. You may be provided with a pair of TED stockings to wear to prevent blood clots from developing and passing into your lungs.
What does the procedure involve?
Figure 2: An implanted 3 piece inflatable penile prosthesis.
Penile prostheses are of two types – malleable (rigid metal implants) or inflatable (these are pumped up to achieve erection when necessary). They are designed to provide enough rigidity to your penis for sexual activity. They do not affect your desire to have sex (libido) or your sensation of orgasm.
After a general anaesthetic, you are given some intravenous antibiotics to reduce the chance of infection. The genital area is shaved and cleaned with antiseptic for five to 10 minutes to minimise the risk of infection. A small cut is made at the junction between your penis & scrotum and we need to make a second incision in your abdomen to position the reservoir.
The tissue inside the erectile tissue of the penis is broken down to create space for the cylinders of the prosthesis. The space is measured and an appropriate size implant placed. The inflatable pump is placed in your scrotum between your testicles. A fluid reservoir is placed this either alongside the bladder or beneath the muscle in your lower abdomen through a separate incision. The inflatable devices are filled with fluid, air is expelled from the cylinders & connecting tubing, and inflation is tested whilst you are asleep. You will likely have a small drain left in the wound and you will have a catheter to drain urine from your bladder overnight. An antiseptic solution and a bandage dressing are used to cover the wound.
You will stay in hospital overnight for more intravenous antibiotics the next morning. Your drain and catheter will be removed the next morning, the cylinders completely deflated and you will be discharged with the dressing intact and on oral antibiotics for 1 week.
Are there any risks or side‑effects of implantation of a penile prosthesis?
Swelling and bruising of the penis lasting a few days 80-100%
Minor ooze of the wound 10-20%
Minor infection of the incision requiring antibiotics 5-10%
Infection / bleeding needing removal of prosthesis after first time implantation 2-5%
Infection needing removal of prosthesis after subsequent implantations or complex surgery 5-10%
Malfunction of the prosthesis 5-10% over 5-10 years
Erosion of the device needing further surgery 5-10%
Floppiness of the head of the penis 5-10%
Permanent altered or reduced sensation in the penis 5-10%
Persistence tenderness / discomfort at the surgical site 3-5%
Failure to be completely satisfied with the cosmetic result 3-5%
Injury to corpora or other organs during implantation 1-2%
Major cardiovascular or anaesthetic problems - rare
What should I expect on discharge when I get home?
You will experience some swelling, discomfort and sensitivity at the operative site for a couple of weeks, which should settle with time and with paracetamol and/or ibuprofen. Take your antibiotics as prescribed for a week. Keep the dressing on for 5 days during which time you should avoid getting the area wet. After 5 days, you can soak the area in water and remove the dressing. The skin sutures are self-dissolving (takes 2-4 weeks) and do not need to be removed.
A penile implant will NOT increase the size and width of your penis in the same way a natural erection would. In addition, the head of your penis may not become as rigid as it would with a natural erection.
After 5-7 days, you can begin light activities again. You should only return to strenuous activity, heavy lifting and driving when you are completely pain free and when your GP is happy with your progress (at least 4 weeks). You should refrain from sexual activity for a minimum of six weeks.
If you develop swelling, fevers or significant pain and redness at the circumcision site you should contact your GP.
What follow-up will I need?
Your urologist will see you in the clinic in 1-2 weeks for a wound check and at 6 weeks to activate the implanted penile prosthesis.
If you have abdominal, groin or perineal surgery at any future time, you MUST tell any surgeon that you have inflatable penile implants. Failure to do so may put parts of the implant at risk of damage during any later surgery.