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 (male sex organ). 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.

Getting Ready

The week before your surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver how many days before the surgery you need to stop having sexual intercourse (sex).
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• Tell your caregiver if you have other known diseases. These diseases may include diabetes (high blood sugar level), bleeding disorders, or heart or kidney problems. Tell your caregiver if you have ever had radiation therapy to your abdomen. Tell your caregiver if you have ever injected medicine into your penis to get an erection. If you have wounds or sores in the genital area, or an active (on-going) infection, you may need to be treated before having the surgery. Your caregiver may also need to know if you have had other surgeries in the past. These may include a penile prosthesis in the past, or surgery on your abdomen or lower genital tract.
  
  
• You may need to use germ-killing soap when bathing or washing your genital area starting 2 to 3 days before your surgery.
  
  
• Your caregiver may suggest that you have counseling about your surgery and condition. He may talk to you and your partner about your expectations, how to use the implant, outcomes, and possible problems with the surgery.
  
  
• You may need to have blood and urine tests. You may also need other tests, such as chest x-ray or electrocardiogram (ECG). Ask your caregiver for more information about these tests. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  
• You may be given a pill to help you sleep.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• If you wear contact lenses, do not wear them on the day of your procedure or surgery. Glasses may be worn.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine. You may be given an antibiotic medicine one hour before your surgery to prevent infection.
  
  
• Your bowel may need to be emptied and cleaned out before the surgery. Caregivers may give you a liquid medicine called an enema. This will be put into your rectum (rear end) to help empty your bowel. Your caregiver will teach you how to do this.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your surgery.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the surgery. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

Treatment

• You will be given medicine to help you relax or make you drowsy. You will be taken on a stretcher to the operating room and then moved onto a special bed. Caregivers may give you local, regional, or general anesthesia to numb the surgical area or put you to sleep. If you are given general anesthesia, an endotracheal tube (ET) may be put into your mouth or nose. It will help you breathe during your surgery. Soap, water, and antiseptics (germ-killing liquids) will be used to clean your abdomen and genital area. The hair on your abdomen and genital area will be shaved. Sheets will be put over you to keep the surgery area clean. Caregivers may put your legs up in stirrups (leg holders). A catheter (thin tube) will be put into your bladder to help drain your urine.
  
  
• Your caregiver will make incisions (cuts) depending on the type of implant to be placed. In placing an inflatable implant , an incision will be made on the top side of the penis. Your caregiver will measure and place the correct length of cylinder in the penis. Next, a pump will be inserted in an incision in the scrotum. Lastly, the reservoir will be implanted in a small incision in the abdomen. Small tubes are used to connect all the devices and the implant will be tested by inflating and deflating it. Thin rubber tubes may be put into your skin to drain blood from your incision. The incisions are closed with sutures (threads) and 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 will be made. These incisions may be either above the penis where it joins the abdomen, or under the penis where it joins the scrotum. Two openings will be made in the penis. Special tools will be used to hold the skin and make the openings. Your caregiver will insert two semi-rigid tubes separately inside the penis. Thin rubber tubes may be put into your skin to drain fluid from around the incisions. The incisions will then be sewn and covered with bandages.

After your surgery:

• You may 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.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your appointment on time.
  
  
• You have a fever.
  
  
• You have a skin infection or an infected wound near the area where surgery will be done.
  
  
• You have questions or concerns about your surgery.

Seek Care Immediately if

• You have new symptoms since the last time you saw your caregiver, or your symptoms are getting worse.
  
  
• You have problems passing urine, or it becomes red, very cloudy, and foul (bad) smelling.

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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.