Penile Implant

Penile Implant

When other treatment options are unsuccessful, penile implant surgery can provide excellent patient and partner satisfaction. Both malleable (bendable) and inflatable devices can be implanted to allow penile rigidity and satisfactory sexual intercourse. The patient considering prosthesis implantation and when possible his partner, should be aware of the different types of prosthesis, risks of infection and erosion, mechanical failure and resulting re-operations, differences from the normal flaccid and erect penis including the possibility of penile shortening, and the potential reduction in the effectiveness of other therapies if the device is subsequently removed.

Penile implant surgery can be very effective, provided that precautions are taken to avoid infection. Prosthesis surgery is contraindicated if systemic, skin, or urinary infection is present. Antibiotics should be provided pre-operatively, and the surgical site should be shaved immediately prior to surgery. Patients are hospitalized overnight and sent home on seven days of post-operative antibiotics. Using these and other precautions, the implant infection rate is less than 5%.

Overview

Prior to surgery for penile implantation, a careful history and physical examination are necessary.� This confirms the nature of the erectile dysfunction, and identifies 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 in order to identify any skin or urinary infection which would be a contraindication to surgery.� Additional features include the length and stretchability of the penis, previous surgical scars, and any penile fibrosis or scarring which may complicate the implant surgery.� There are two main categories of penile implant.

1. Malleable penile implant (Figure 1)
2. Inflatable penile implant (Figure 2)

Malleable and inflatable penile implants share many risks and benefits.� Below will be found brief descriptions of the two operations followed by shared risks and complications.

Malleable Penile Prosthesis

A malleable penile prosthesis is always the same length.� 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 rods downward.� Sexual intercourse is possible by bending the malleable rods in the desired direction.� Implantation requires one to one and a half hours of surgery. �

Inflatable Penile Prosthesis

Figure 2. Inflatable Penile Prosthesis

Inflatable penile prostheses use fluid to achieve rigidity.� This fluid is shifted from a reservoir placed next to the bladder into two paired cylinders placed on either side of the penis through an incision at the base of the penis at the penis-scrotal junction.� Fluid movement is controlled by a pump, which is placed in the scrotum next to either the left or right testis.� 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 an erection.� Of note, the head of the penis may not become rigid with this device, as it is merely supported by the device.� Inflatable penile prosthesis implantation takes one and a half to two hours to insert, and generally patients remain in the hospital overnight with a small closed suction drain placed adjacent to the device.� This is removed the first day after surgery.

Risks and Complications

The most serious complication is infection of the penile implant.� This happens up to 5% of the time depending on the nature of the implant, previous surgical history, and other factors which can influence the rate of infection.� Bleeding is rare, but maybe manifest as haematoma or bruising of the scrotum.� Mechanical failure occurs in approximately 5% of cases within the first 5 years after surgery.� Ultimately, like any mechanical device, failure depends on the amount of use and wear-and-tear on the device.� The penis will never be longer than it was before surgery, and usually there is a mild amount of shortening.� Some inflatable devices may undergo temporary inflation, termed auto-inflation.� This usually only lasts for several months and eventually goes away.

Resources

AMS Website

This fact sheet complements the discussion during your consultation, which will apply your individual circumstances to the above facts.