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Penile Prosthesis Insertion by Jill Buchanan

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

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.

Penile Implant

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, injections
Certain diseases such as diabetes , vascular disease
Physical injuries such as spinal cord injury
Certain surgeries that have made having an erection impossible

This procedure has a success rate of about 90%-95% five years after insertion. Most men rate the erection as shorter than their natural one. A penile prosthesis does not change the sensation on the skin of the penis or the ability to reach orgasm or ejaculate.

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
Erosion (tissue around the implant may break down)
Mechanical failure

Factors that may increase the risk of complications include:

Obesity
Smoking , 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 (eg, blood and urine tests, psychological tests) to rule out problems that might be treated with medicines

Leading up to the procedure:

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Anti-inflammatory drugs (eg, aspirin)
- Blood thinners, such as clopidogrelor warfarin
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 catheter (thin tube) will be inserted into the penis to make sure that the bladder remains drained of urine.

There are two types of implants available:

Inflatable (hydraulic) 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 medicine 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
Examine you
Give you antibiotics and pain medicines

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 medicines (eg, acetaminophen) or those your doctor prescribes
- 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, dizziness, general ill feeling
New symptoms such as nausea, vomiting, constipation , abdominal swelling
Pain or difficulty with urination
Cough, shortness of breath, or chest pain

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:

Erectile dysfunction. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated December 4, 2012. Accessed December 17, 2012.
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.
Penile prostheses for erectile dysfunction. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=11 . Updated January 2011. Accessed December 17, 2012.

Last reviewed November 2012 by Adrienne Carmack, MD

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