Overview

How Is a Penile Implant Procedure Performed?

How Is a Penile Implant Procedure Performed?

This procedure is carried out to correct sexual dysfunction if it is not treatable by other forms of treatment or if you prefer this treatment over others.

Performed under spinal or general anesthesia, in this procedure an incision is made at the junction of the penis and the scrotum, the pubic area (two fingers above the base of the penis), or close to the head of the penis, depending on the type of prosthesis being used. Malleable rods and articulating rods are placed in the penis only.

Two-piece inflatable prostheses have a penile component and pump and reservoir part for placement in the scrotum. Three piece-inflatable prostheses have penile/scrotal (pump) components and pelvic/abdominal (reservoir) components.

This procedure results in loss of 50 cc of blood and does not require blood transfusion. It takes about two hours depending on type of prosthesis being inserted.

Post Operative Care

You will spend two to four hours in recovery. You may/may not be able to eat depending upon your body's reaction to the anesthetic. You will also have a urinary catheter to drain the bladder, which will be removed the next day.

If you have a drain, it will also be removed the next day. The dressing is removed the next day. You may take sponge baths not showers. You may either stay in the hospital overnight or may go home (but will need to come to clinic the following day) and will be able to go back to work in one to two weeks depending on the type of prosthesis.

You will be given pain medications and antibiotics to take at home. You should not engage in sexual intercourse for four weeks and avoid all strenuous activity that might result in contact with the prosthesis or its components. An inflatable prosthesis should be cycled at least once a week and should be deflated at all other times to prevent a constricting fibrous capsule to form around the pump/reservoir component.

Results

Initial success rate is 90 percent. On average, inflatable prostheses function effectively for 10–15 years and semi-rigid a little longer.

Considerations

  • This is an irreversible procedure and results in extensive changes to erectile tissue.
  • After this procedure erection is not the same as the erection when you were younger and the penis may become shorter and narrower.
  • It might require surgery in the future for its complications, including its removal. Replacement is not guaranteed.
  • It does not affect abilities to achieve climax or ejaculation.
  • Prophylactic antibiotics may be considered for future surgery on other organs such as dental work.

Possible Side Effects and Complications

  • Infection is the most serious complication, and the rate is 1–3 percent. It may manifest early (in 10 days or so) or late (in several months or years). The infection rate is higher if you have scar tissue in the penis from Peyronie's disease or previous implantation.
  • Device malfunction is about five percent in five years (much higher after five years). Malfunction includes self-inflation, leakage of fluid, difficult deflation, device failure, and the like.
  • Perforation of the prosthesis may occur at the back of the penis behind the scrotum, into the urethra, or at the head of the penis. If perforation of the urethra occurs during surgery, the operation may have to be stopped. If it occurs later, the device will have to be removed or replaced and the site of perforation repaired.
  • The tubings of a three-piece prosthesis may be injured in future abdominal or scrotal surgery. Always inform other providers that you have an implant in place!
  • Pain may persist for several weeks or even months following surgery.
  • Tissue loss (necrosis) may occur in patients with vascular disease (diabetes) or patients undergoing extensive reconstruction of the penis for scarring or Peyronie's disease.
  • There may be substantial interference with urination with a semi-rigid prosthesis.
  • Other complications include numbness near the incision which may take several months to resolve; swelling and bruising (blue and black), which may take several weeks to resolve; and some scarring near the incision, along with other possible complications.

Alternatives to Penile Implants

Pills such as Viagra, a urethral insert such as MUSE, injection treatment into the penis, and vacuum suction device with/without injection treatment are alternatives that you, with your doctor, could consider.

Surgical Instructions

You can expect:

Day of procedure

  • Bruising and some mild bleeding from the incision site
  • Possible bruising and pain at the i.v. site Possible pain, burning in the urethra and/or bladder
  • You will have a small catheter in place to help you empty your bladder after surgery
  • Possibly see pink-tinge in urine

24 hours after

  • Pain/swelling may be worse today than yesterday
  • May still have urinary symptoms
  • Bandage may have caked blood
  • Possible trouble initiating the urinary stream

48 hours after

  • Pain/swelling may be worse today than yesterday
  • May still have urinary symptoms
  • Bandage may have caked blood
  • Possible trouble initiating the urinary stream

72 hours after

  • Swelling and bruising of penis may be more than the previous days
  • Possible pain/sensitivity of the scrotum/testicles
  • Possible pain in the lower abdomen if a reservoir was placeda

Miscellaneous: You will leave the pump in the “down” (deactivated) position for 6 weeks.


What you should do now:

Day of procedure

  • Do NOT drive a car, make important personal or legal decisions, or be left alone without assistance.
  • Take it easy and avoid unnecessary activity
  • ICE IS YOUR BEST FRIEND: apply a cold pack (never directly on the skin) intermittently (20 minutes at a time) for 48 hours.

24 hours after

  • The drain usually comes out the day after the operation
  • May clean yourself with a washcloth but do not shower for 2 days after the operation
  • ICE IS YOUR BEST FRIEND: apply a cold pack (never directly on the skin) intermittently (20 minutes at a time) for 48 hours.

48 hours after

  • Remove the dressing if present.
  • Do not drive, especially if you are having discomfort and/or are taking narcotic pain medications (vicodin, percocet, tylox, etc)
  • ICE IS YOUR BEST FRIEND: apply a cold pack (never directly on the skin) intermittently (20 minutes at a time) for 48 hours.

72 hours after

  • Continue to change dressing once daily
  • You may take a bath today, many patients say that being in the bath is the best pain-killer and you may bathe up to 3x a day.

Miscellaneous: Gently pull downward on the pump daily to make sure it stays in a good position in the scrotum. The bath is a good place to do this, since the scrotum will be more relaxed.

Avoid heavy lifting or active exercise (walking is encouraged) for 2 weeks.

NO sexual activity (sex or masturbation) for 6 weeks.

It is best if you wear brief or similar snug underwear and have the penis facing “up” (towards the abdomen) for a month after surgery. This will help give the penis the best angle when you are ready to use the prosthesis.


Diet:

Day of procedure

  • Make sure you keep hydrated: drink 8 glasses of water a day.
  • Eat bland food (toast, broth, etc)
  • Avoid alcoholic beverages

24 hours after

  • If you feel like it, eat a normal diet
  • Avoid alcoholic beverages

48 hours after

  • Continue normal diet and good fluid intake

72 hours after

  • Continue normal diet and good fluid intake

Medication:

Day of procedure

  • Resume your prescribed medications EXCEPT for aspirin or “blood thinners” (coumadin, warfarin, heparin, etc)
  • Take your new prescribed medications

24 hours after

  • Take your regular medications.
  • May resume blood thinners if this has been ok’d at clinic visit.
  • Continue pain medications if needed. May take Tylenol extra-strength INSTEAD of prescribed medications if desired

48 hours after

  • Take your regular medications.
  • May resume blood thinners if this has been ok’d at clinic visit.
  • Continue pain medications if needed. May take Tylenol extra-strength INSTEAD of prescribed medications if desired

72 hours after

  • Take your regular medications.
  • May resume blood thinners if this has been ok’d at clinic visit.
  • Continue pain medications if needed. May take Tylenol extra-strength INSTEAD of prescribed medications if desired

Miscellaneous: Narcotic pain medication may cause constipation, itching, nausea/vomiting, “wooziness”. Make sure you are having regular bowel movements (may use Metamucil, milk of magnesium, etc) and that you do NOT drive if taking narcotic medications.


Contact:

Call Dr Brant’s clinic if:

  • Pain is not adequately controlled with medication
  • Cannot urinate for more than 8 hours
  • Strong chills or fever (>101.5 degrees farenheit)
  • Increasing pain at the operative site, especially more than a week after surgery
  • Drainage/pus from the operative site or near it, especially if parts of the prosthetic can be seen through the skin

The clinic hours are M-F, 8am-5pm.

There is a Urologist on-call 24 hours a day, 7 days a week for issues that cannot wait until the office is open

If you feel you have a problem that is an emergency, call 911 or go to a local Emergency Room