Penile Prosthesis Insertion Overview

With this procedure, a device is implanted into the penis. This device can produce an erection-like state. It enables a man to have sexual intercourse.

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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 clopidogrel (Plavix) or warfarin (Coumadin)
• 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 receive antibiotics about one hour before surgery. A catheter (thin tube) will be inserted into the penis to ensure that the bladder remains fully drained of urine.

There are two types of implants available:

• Inflatable (hydraulic) implant—consists of two cylinders, a pump, tubing, and may have a reservoir
• Malleable implant—consists of 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, the fluid that is used for inflation will be inserted into a reservoir in 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 .
• Avoid taking a bath. You can shower. Gently wash the incision area with mild soap.
• 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 vigorous 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.

RESOURCES:

American Urological Association 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:

Glickman Urological Institute, Cleveland Clinic website. Available at: http://www.clevelandclinic.org/urology . Accessed November 10, 2009.

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. American Foundation for Urologic Disease website. Available at: http://www.urologyhealth.org/adult/index.cfm?cat=11&topic=111 . Accessed November 10, 2009.

University of Michigan, Department of Urology at the Michigan Urology Center website. Available at: http://www.med.umich.edu/urology . Accessed November 10, 2009.