Penile Prothetic Surgery

Description of Procedure

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. This procedure is performed under epidural or general anesthesia. 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 100-200 cc of blood and does not require blood transfusion. It takes about 1-3 hours depending on type of prosthesis being inserted.

Postoperative Care

You will spend 2--4 hours in recovery. You may/may not be able to eat depending upon your body's reaction to the anesthetic. You will 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 changed the next day and you will change the dressing daily for the next few days and 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 1--2 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 6 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.

Alternatives

Pills such as Viagra, urethral insert such as MUSE, injection treatment into the penis, and vacuum suction device with/without injection treatment.

Results

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

Certain Considerations Regarding Penile Prosthesis

POSSIBLE SIDE EFFECTS AND COMPLICATIONS INCLUDE:

Infection is the most serious complication, and the rate is 1-3%. 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 5% in 5 years, much higher after 5 years. Malfunction includes self-inflation; leakage of fluid, difficult deflation, device failure etc.

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 will 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.

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, etc.