Penile Prosthesis Insertion

En Espaol (Spanish Version)

Definition

Penile prosthesis insertion is the implantation of a device into the penis to produce an erection-like state that enables a man to have sexual intercourse.

Penile Implant

Penile Implant

2008 Nucleus Medical Art, Inc.

Parts of the Body Involved

  • Penis
  • Scrotum
  • Abdomen

Reasons for Procedure

For men wanting to obtain an erection, including those who have:

  • Not responded to other treatment options such as pills, suppositories, vacuum devices, or injections
  • Certain diseases (eg, diabetes or vascular disease )
  • Physical injuries (eg, spinal cord injury)
  • Had certain operations (eg, cancer operations for the male)

Risk Factors for Complications During the Procedure

  • Obesity
  • Smoking
  • Cardiovascular disease
  • Chronic lung disease
  • Poor nutrition
  • Recent or chronic illness
  • Alcoholism
  • Use of drugs such as antihypertensives, muscle relaxants, tranquilizers, sleep inducers, insulin, sedatives, or cortisone
  • Use of mind-altering drugs
  • Diabetes

What to Expect

Prior to Procedure

In addition to conducting a physical exam, your urologist will obtain a complete medical, surgical, and sexual history.

Additional diagnostic testing is not standardized, however, your urologist may conduct several tests to reveal your hormonal balance and rule out deficiencies that might be treated with medications. These tests may include:

Blood testsUrine testsPsychological analysisTo prevent infection, your genital area will be shaved and thoroughly scrubbed; you will receive antibiotics about one hour before surgery. Anesthesia Penile prostheses are implanted under general anesthesia or with an epidural or with spinal anesthesia by injection . Description of the Procedure Depending on preexisting medical conditions, previous surgery and personal preference, you may receive either an inflatable or malleable-type implant. In all cases, antibiotics are administered during the procedure. A catheter (thin tube) will be inserted into the penis to ensure the bladder remains fully drained of urine. Inflatable (Hydraulic) This implant has two cylinders, a reservoir, a pump, and tubing. There are two types of inflatable prosthesis, a three-piece and a two-piece. In both types, a small incision (about two inches long) is made on the topside of the scrotum. The incision is made so that sutures are under the skin and absorbable. Three-piece The cylinders are inserted into the penis, the pump is inserted into the scrotum, and the fluid used for inflation is inserted into the abdomen. Two-piece The cylinders are inserted into the penis and a pump (with fluid) is inserted into the scrotum. This type is simpler to insert, but it takes up more space in the penis, so there is less room for expansion. Malleable (Nonhydraulic or Semi-rigid) This implant consists of two semi-rigid rods inserted into the penis. The penis is always rigid, but can be bent down, or folded up for intercourse. During the procedure, an incision is made just behind the head or near the base of the penis. An opening is made into each of the two long tubes of spongy tissue inside the penis, and one rod is inserted into each tube. The incisions are closed in such a way that no sutures need to be removed afterward. After ProcedureYou will be examined by a urologist and receive antibiotics the day after your operation. The catheter will be removed and you will be released with instructions on follow-up visits and a course of antibiotics.
How Long Will It Take?InflatableSurgery takes approximately 1-2 hours.MalleableSurgery takes approximately 30-60 minutes. Will It Hurt?Most men have pain after penile prosthesis implantation for about four weeks but receive prescription pain relievers to relieve discomfort. Dont take prescription pain medication for longer than seven days, and use only as much as you need. Possible ComplicationsInfectionScar tissue formationErosion (tissue around the implant may break down)Mechanical failure Average Hospital StayPenile prosthesis insertion is typically done as an outpatient surgical procedure, requiring an overnight stay in an ambulatory surgical center; it does not require admission to a hospital. Postoperative CareYou may use nonprescription drugs, such as acetaminophen, for minor pain. Also use an electric heating pad, heat lamp, or warm compress to relieve incisional pain.Refrain from all sexual activity for at least six weeks after surgery.Avoid vigorous exercise and heavy lifting (greater than five pounds) for six weeks after surgery.Do not drive for at least one week after returning home.Loose-fitting briefs or shorts may be more comfortable in the initial postoperative period.Do not take a bath until after your postoperative appointment. You may shower if you wish and you may wash the incision gently with mild unscented soap.Average time away from work is approximately ten days. OutcomePenile prosthesis insertion has a success rate of about 90%-95% five years after insertion, which means that if 100 implants were placed, about 90 of them would still be functioning in five years. Most men rate the erection as shorter than their normal erection. Penile prostheses do not change the sensation on the skin of the penis or a mans ability to reach orgasm or ejaculate.
Call Your Doctor If Any of the Following OccursPain, swelling, redness, drainage, or bleeding increases in the surgical areaYou develop signs of infectionheadache, muscle aches, dizziness, or a general ill feeling and feverYou experience new symptoms such as nausea, vomiting, constipation, or abdominal swellingYou have pain or difficulty with urinationNew, unexplained symptoms develop RESOURCES: American Urological Associationhttp://www.afud.org The Glickman Urological Institute at the Cleveland Clinichttp://www.clevelandclinic.org/urology CANADIAN RESOURCES: Men's Health Centrehttp://www.menshealthcentre.net ProCURE Alliancehttp://www.procure.ca References: American Foundation for Urologic Disease website. Available at: http://www.afud.org . Accessed September 2005. The Glickman Urological Institute at the Cleveland Clinic website. Available at: http://www.clevelandclinic.org/urology . Accessed September 2005. Montorsi F 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 et al. Serial assessment of efficacy and satisfaction profiles following penile prosthesis insertion. J Urol . 2001;165(5:1042A.
The University of Michigan, Department of Urology at the Michigan Urology Center website. Available at: http://www.med.umich.edu/urology . Accessed September 2005. Last reviewed June 2007 by Miguel Antelo, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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