Surgical Implantation Of Penile Prosthesis

WHAT YOU SHOULD KNOW:

  • Surgical implantation of a penile prosthesis is surgery to treat erectile dysfunction (ED) or impotence. A penile prosthesis is a device that is implanted or placed in the penis. This implant makes it possible for the penis to have and keep an erection. Normally, the penis has spongy tissues that surround a tube through which urine and semen pass. When a man gets sexually stimulated and excited, blood fills his penis, and it becomes erect and firm. An erect penis may make a man able to perform sexual intercourse (sex). More stimulation may lead to an ejaculation where semen is passed out of the penis. Erectile dysfunction or impotence is where the penis fails to become erect enough for sexual intercourse or fails to ejaculate.



  • In surgical implantation of a penile prosthesis, an inflatable or semi-rigid rod implant may be inserted in the penis. An inflatable implant is a fluid-filled device that can easily be hidden and feels the most natural. It has a pump, cylinder (container), and reservoir (storage area). Squeezing the pump allows fluid to flow from the reservoir to the cylinders, which causes the penis to become erect. A release valve or bar allows the penis to deflate. A semi-rigid implant is bendable and may be controlled by bending the penis up or down to give an erection. Your caregiver will make one or more small incisions (cuts) to insert the implants. An incision may be made on the penis, just above the penis where it joins the pelvic area, or just under the penis where it meets the scrotum. An incision may be made on the abdomen (stomach) and the scrotum, depending on the penile implant that is chosen. An implant will help create an erection, but the device will not increase sexual drive or fix other problems related to having sexual intercourse. You and your caregiver will decide on what type of penile implant is right for you. With surgical implantation of a penile prosthesis, your impotence may be treated and your quality of life improved.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • Surgical implantation of a penile prosthesis is usually a common and safe surgery, though there are always risks with having surgery. Your prostate, other parts of the urinary tract, blood vessels, or nerves may get injured during surgery or after surgery from the implants. This may cause you to have problems passing urine or having an orgasm. You may also have swelling, pelvic pain, or a numb feeling in your penis. You may bleed more than usual or get an infection. You may need more surgery to remove or replace the implants if you get an infection or the implant fails to work properly. If the implants are removed and not replaced immediately, your penis may decrease in length and scar tissue may form. This may make it more difficult for you to have another penile implant. The implants, such as the one in your abdomen, may move from the place where they were originally placed. You may have pain, irritation, or problems with erosion (tissues around the implant may break down). Even after having the implant placed, there is a chance that you may still have problems with sex. Your penis may be curved, or not look the way that you expected it to look like after surgery.

  • Without treatment, your erectile dysfunction (ED) may not be treated. You may develop or continue to have sexual problems, such as not being able to have an erection or ejaculate. Ask your caregiver if you are worried or have questions about your surgery, condition, or care.

WHILE YOU ARE HERE:

Before your surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • Gown: A hospital gown is used so that caregivers can easily check and treat you. Caregivers will show you how to put on your gown. When you feel better you may be able to wear your own gown or pajamas.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.

  • Monitoring:

    • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

    • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

    • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

  • Anesthesia: This medicine is given to make you comfortable. You may not feel discomfort, pressure, or pain. An adult will need to drive you home and should stay with you for 24 hours. Ask your caregiver if you can drive or use machinery within 24 hours. Also ask if and when you can drink alcohol or use over-the-counter medicine. You may not want to make important decisions until 24 hours have passed.

  • If you are given general anesthesia, an endotracheal tube (ET) connected to a breathing machine may be put into your mouth or nose. The tube is used to keep your airway open and help you breathe during your surgery.

During your surgery:

  • Soap, water, and antiseptics are used to clean your abdomen and genital area. The hair on your abdomen and genital area is shaved. Sheets are put over you to keep the surgery area clean. Caregivers may put your legs up in stirrups (leg holders). A catheter (thin tube) is put into your bladder to help drain your urine.

  • Your caregiver makes incisions (cuts) depending on the type of implant to be placed. In placing an inflatable implant , an incision is first made on the top side of the penis. Your caregiver measures and places the correct length of cylinders in the penis. Next, an incision is made in the scrotum and the pump is inserted. Lastly, a small incision is made on the abdomen and the reservoir will be implanted. Once the devices are placed, your caregiver uses small tubes to connect them. Your caregiver tests the implant by inflating and deflating it before closing the incisions with sutures (threads). Thin rubber tubes may be put into your skin to drain blood from your incisions. The incisions are covered with bandages. A tight pressure bandage may be placed over the incision on the scrotum to prevent bleeding.

  • With a semi-rigid implant , Small incisions are made where the implants are inserted. These may be either above the penis where it joins the abdomen, or under the penis where it joins the scrotum. Two openings are made in the penis. Special tools are used to hold the skin and make the openings. Your caregiver inserts the two semi-rigid tubes separately inside the penis. He may also put thin rubber tubes into your skin to drain fluid from around your incisions. The incisions are closed with sutures and covered with bandages.

After your surgery:

  • You will be taken to a recovery room until you are awake. Caregivers will watch you closely for any problems. If you had general anesthesia, the ET tube will be removed after you are awake and can breathe well on your own. Do not get out of bed until your caregiver says it is OK. When your caregiver sees that you are OK, you will be allowed to change clothes and go home. If your caregiver wants you to stay in the hospital, you will be taken back to your hospital room.

  • The bandages used to cover your stitches help keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your wounds. The catheter inserted in your bladder may be left there for one more day to drain your urine. The thin rubber tubes (drains) will be taken out by your caregiver when the incision stops draining. Ask your caregiver for information on how to take care of your catheter, drains, and wounds.
  • Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.

  • You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

  • Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.

  • A Foley catheter is a tube put into your bladder to drain urine into a bag. Keep the bag below your waist. This will prevent urine from flowing back into your bladder and causing an infection or other problems. Also, keep the tube free of kinks so the urine will drain properly. Do not pull on the catheter. This can cause pain and bleeding, and may cause the catheter to come out. Caregivers will remove the catheter as soon as possible to help prevent infection.

  • Medicines: You may need any of the following:

    • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

    • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.

    • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.

      • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.

      • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

  • Monitoring: Caregivers may check for a pulse in your arms, wrists, legs, or feet. This helps caregivers learn if you have problems with blood flow after your surgery. You may also have any of the following:

    • Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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