INFLATABLE PENILE PROSTHESIS

A penile prosthesis represents one of the many options that a patient may be offered for the treatment of organic erectile dysfunction. Approximately 20,000-30,000 such devices are implanted annually in the United States. The penile prosthesis has remained a popular choice because of progressive improvement in prosthetic design. The patient typically has tried and failed penile intracavernous injection therapy or the vacuum erection device prior to being offered the surgical option of prosthesis placement. Other forms of therapy such as penile arterial revascularization and venous ligation surgery are only applicable to a highly select group of men, and the long-term success rates are variable.

Figure 1. The inflatable AMS 700CX penile prosthesis. (Courtesy of American Medical Systems, Minnetonka, MN.)

Penile prostheses may be malleable (bendable) or inflatable and are manufactured by several different companies (see table 1). We prefer the multi-component inflatable penile prostheses made by American Medical Systems and the Mentor Corporation, because of high levels of patient satisfaction. Unlike malleable prostheses, the inflatable prostheses may increase in length and girth. The two-piece inflatable prosthesis also provides excellent results and may be more appropriate in some men with extensive abdominal surgery. Using models available in the clinic, Dr. Lipshultz or Dr. Kim will demonstrate the use of the prostheses. All of these prostheses have a limited manufacturerís warranty policy in the case of malfunction. American Medical Systems now offers a life-time warranty (i.e., replacement of components free of charge for the device only).

The components of the inflatable penile prosthesis include the (1) penile cylinders, (2) reservoir, and (3) pump. The penile cylinders are placed within the paired penile corporeal bodies and produce a produce a noticeable increase in size when inflated.

The reservoir contains the fluid that gets transferred to the cylinders during inflation. Because the reservoir is placed deep in the pelvis next to the bladder, you cannot feel or see this part of the prosthesis. Finally, the pump rests within the scrotum and contains an inflation and deflation mechanism. If you have strong preference on which side you would like the pump, let your surgeon know prior to surgery.

Although several surgical placement incisions exist, we prefer the penoscrotal approach. A 3 cm incision is made vertically between the penis and the scrotum on the underside of the penis and leaves no visible scar. This approach also provides excellent surgical exposure and avoids any possible injury to the nerves of the penis. The operative time for surgery is usually less than 2-3 hours. We prefer a general anesthetic, although an epidural anesthetic may be used. You will typically spend one night, or infrequently two nights, in the hospital. A urethral catheter positioned in your bladder will be removed in the morning the day after surgery. An ice pack is placed over the genitalia to minimize swelling. All skin sutures are absorbable and do not need to be removed.

Complications, as with any other surgery, may include bleeding and infection. These problems are rare and are minimized with meticulous intraoperative hemostasis and by the use of intravenous antibiotics prior to and after surgery. Even rarer complications include prosthesis malfunction and damage to the corporeal bodies. Although the penile prosthesis contains silicone, no case of proved immunologic disease (similar to breast implants) has ever been reported.

The length of the penis is not changed with this procedure. The corporeal bodies within the penis are of a fixed, measurable length and cannot be changed. The largest possible cylinders are always placed, maximizing the individualís penile size.

POSTOPERATIVE INSTRUCTIONS

1. The dressings may be removed the second day after surgery. Continue the scrotal support for about 5-7 days after surgery.

2. A general diet may be consumed.

3. Driving is permitted one week after surgery, but only if you are pain-free when off medications.

4. You may return to work, on average, 2 weeks after surgery.

5. Activity during your convalescence should be light. Walking around is fine. Do not lift objects heavier than 10 pounds, perform sit-ups/push-ups, use StairMaster/NordicTrack devices, or similar activities involving abdominal straining for at least 2 weeks.

6. Showering is permitted the second day after surgery. Keep the incision clean and dry after showering. Avoid baths and whirlpools for 2 weeks.

7. Medications include:

a. Tylenol #3 :Take 1-2 pills up to every 4-6 hours only if you are having pain. Otherwise, plain Tylenol is recommended. You should not drive or operate heavy machinery while taking this narcotic medication.

b. Keflex :Take 1 pill every 6 hours for 14 days. This antibiotic will help infection. Do not take this medication if you are allergic to penicillin.

c. Colace :Take 1 pill twice a day. This stool softener may be taken to prevent constipation.

8. Call Dr. Lipshultz or Dr. Kim (713-798-4001) if you notice:

a. Increasing swelling, tenderness, redness, or pain.

b. Fevers greater than 101F.

c. Copious drainage from the incision.

9. The first follow-up visit is at approximately 2 weeks. At this visit, the prosthesis will be tested. The second follow-up visit is at approximately 6 weeks after surgery. After this visit, the penile prosthesis may be used.