Department of Urology

Penile Prosthesis

Overview

Penile prostheses are mechanical devices that are implanted and concealed completely within the body. The goal of penile prosthesis surgery is to provide rigidity of the penile shaft to allow for normal penetrative sexual intercourse.  For most men, penile prosthetic surgery is only considered after more conservative treatments have failed.  Initial satisfaction rates exceed 90% for both men and their partners.

Prior to penile prosthesis surgery, a careful history and physical examination are necessary to confirm the nature of the erectile dysfunction, prior treatments, and to identify any additional sexual dysfunction such as loss of desire, inability to ejaculate, or premature ejaculation. Penile implant surgery will not affect these other aspects of sexual function. Physical examination is focused on the genitalia to identify characteristics of the penis, scrotum or pelvis that may impact surgery.  Specific characteristics of importance are penile length and stretchability, previous surgical scars, and any penile fibrosis or scarring which may complicate the implant surgery. There are two main categories of penile implant:

Malleable Penile Prosthesis

A malleable penile prosthesis is always the same length and firmness. The largest and longest device which can be accommodated by a man’s penile dimensions will be inserted via a small incision at the base of the penis in the penis-scrotal junction. Concealment is achieved by bending the malleable rods downward. Sexual intercourse is possible by bending the  rods in the desired direction. Implantation is straight forward, usually requiring one to one and a half hours of surgery, and can be performed as an outpatient.

Inflatable Penile Prosthesis

Inflatable penile prosthesis uses fluid to achieve rigidity. This fluid is shifted from a reservoir placed near the urinary bladder into two paired cylinders placed within the erectile bodies of the penis through an incision at the junction of the penis and scrotum. Fluid movement is controlled by a pump, which is placed in the. The main advantage of the inflatable penile prosthesis is complete flaccidity and concealment when the device is deflated. Additionally, when the device is inflated, excellent girth is achieved, with full rigidity and a sense of change in penile size similar to a natural erection. Importantly, the head of the penis will not become rigid with this device, as it is merely supported by the device.

Description

This procedure is performed under epidural or general anesthesia. An incision is made at the junction of the penis and the scrotum and occasionally a second incision is made just above your pubic bone dependent upon prior surgeries. In most cases, three components of the device are inserted: the erectile cylinders within the penis, the pump device in the scrotum, and the fluid reservoir behind the pubic bone. This procedure may result in the loss of 100-200cc of blood and does not require a blood transfusion. It normally takes about 1-3 hours, depending on the type of prosthesis being inserted.

Preoperative Considerations

For men who have failed other treatment options, such as PDE5 inhibitors (Viagra, Levitra, Cialis), and have either failed penile injection therapy or not comfortable with this option, penile implant surgery provides an excellent chance for sexual rehabilitation.  This is an irreversible procedure and results in irreversible changes to the erectile tissue. After this procedure, erection is not natural and the penis may become shorter and narrower. It might also require additional surgery in the future for prosthetic infection or mechanical failure.

Postoperative Care

You will be in the recovery room for 2-4 hours after the procedure and will spend 0-1 night in the hospital. You may be able to eat soon afterwards, depending on your body’s reaction to the anesthetic. You may 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 be shown how to change the bandage. This should be done every day for 5 days.

Also, it is necessary to keep the penis dry for 2 days. You may shower the second day after the operation, but you should attempt to keep the incision(s) dry. You will be given a prescription for pain medication and antibiotics to take home, however the best painkiller is an ice pack. You should put the ice pack on the penis intermittently the first day. Most patients will have painful erections at night. If you put an ice pack on the penis, the pain will be relieved in a few  minutes.

You should be to return to work in 1-2 weeks, depending on the type of prosthesis and the type of work you perform. All the sutures on the skin will dissolve in about 4 weeks. Sexual intercourse is not advisable for 6 weeks and avoid ALL strenuous activity that might result in contact with the prosthesis or its components.  We will activate your device and demonstrate its use to you at your follow-up visit in 5 to 6 weeks.

Long Term Care

On average, inflatable prostheses function effectively for 7-10 years, with the semi-rigid prosthesis lasting a little longer.

Additional Reading

Penile Prosthesis Surgery- Instructions
Penile Prosthesis Surgery- Procedure

Physicians

Thomas J. Walsh, MD, MS
Hunter Wessells, MD