Penile Prosthesis Insertion
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.
Reasons for Procedure
A penile prosthesis insertion is for men wanting to obtain an erection, including those who have:
- Not responded to other treatment options (eg, pills, suppositories, vacuum devices, injections)
- Certain diseases (eg, diabetes]]>, vascular disease)
- Physical injuries (eg, spinal cord injury)
- Certain surgeries that have made getting 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.
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, which may include:
- Scar tissue formation
- Erosion (tissue around the implant may break down)
- Mechanical failure
Factors that may increase the risk of complications include:
- ]]>Smoking]]>, ]]>alcoholism]]>
- Poor overall health
- Poor nutrition
- Use of certain drugs
- Bladder disease requiring a catheter
- Bleeding disorders
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:
- Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.
There are two types of anesthesia that your doctor may use:
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
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.
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.
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
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.
Call Your Doctor
After you leave the hospital, contact your doctor if any of the following occurs:
- Redness, swelling, increasing pain, excessive 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 (eg, fever, chills, headache, muscle aches, dizziness, general ill feeling)
- New symptoms (eg, nausea, vomiting, constipation]]>, abdominal swelling)
- Pain or difficulty with urination
- Cough, shortness of breath, or chest pain
American Urological Association Foundation
Men's Health Network
Canadian Diabetes Association
Men's Health Centre
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.
Last reviewed November 2009 by ]]>Adrienne Carmack, MD]]>
Please 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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