Penile Implant Surgery – How Is It Performed?

Penile Implant Surgery – How Is It Performed?

Penile Implants are commonly used devices, which are selected depending upon the age of the patient, infection risk, past medical and surgical history and patient’s own personal preferences. Placing penile Implant is an invasive and a costly procedure as opposed to the medications and penile pumps. Fortunately, most patients report satisfactory results after the surgery.

What Are Different Types Of Penile Implants?

There are two primary types of penile implants; these are:

1. Inflatable implants:

These are most commonly employed variety of implants and are available in the inflated or deflated forms; depending upon the needs. These are of two types:

• 3-piece Implants: These contain a fluid-filled chamber placed under the abdominal wall, a release valve placed inside the scrotum, two cylinders placed inside the penis and a pump. Whenever required, the pump is pressed, which pushes the fluid from the chamber into the inflatable cylinders, causing the penis to become erect. Afterwards, the release valve is opened which draws the fluid back into the chamber. It provides the most natural and rigid erection, and flaccidity when deflated. However, it requires an extensive surgery.
• 2-piece implants: This variety have a similar mode of action. The only difference is that the fluid reservoir is implanted inside the scrotum as part of the pump. It provides a less firm erection than a 3-piece model, but also requires a less extensive surgery. The core benefits are optimal flaccidity when deflated and requirement of a less manual dexterity than a 3-piece one.

Some inflatable implants come with a layer of antibiotics, to reduce the risk of infection.

2. Semi-rigid Implants:

These are firm devices, which make the penis sprung out when sexual intercourse is needed, while at other times, it can be bent back towards the body. It is easier to implant and easier to use than other types. And since it has less number of parts than an inflatable implant, it is therefore less likely to malfunction. However, the demerits of this type are that it keeps the penis slightly rigid at all times, which may put a constant strain inside the penis causing injuries, and it may be difficult to hide under the clothing.

Operative Details:

Pre-Op Preparations

A consult with a doctor or urologist is required. After the patient tells about the need for a penis implant, the doctor will follow these steps:

• History taking: The doctor will review the patient’s medical history, past surgical history and drug history.
• Physical examination: The patient will undergo a thorough physical examination including a urological examination. The doctor will determine the nature and degree of ED and decide whether the operation is necessary or not. He will also check how skillful the patient is with his hands.
• Informed consent: Consent is taken from the patient after completely going through the procedure, merits, risks and complications of the surgery.

Intra-Operative Details

A general or spinal anesthesia is given before the surgery. Intravenous antibiotics are injected and surgical area is shaved completely.

The surgeon makes an incision below the penile head, at the base of the penis or in the abdomen. He then stretches the spongy tissue inside the penis, and chooses a correctly sized implant. If a 2-piece inflatable device is to be inserted, the valve and pump both are placed inside the scrotum, but if a 3-piece implant is used, a fluid reservoir is put under the lower abdominal wall through another incision. After that the surgical incisions are stitched up. The entire surgical process takes about 45-60 minutes.

Post-Surgical Care

Pain-relievers and antibiotics are prescribed after the surgery for about a week. The patient is advised to keep the penis pointing upwards on the lower abdominal wall, to prevent downward bending.

After about 4-6 weeks, the patient can resume strenuous activities and sexual activity. The patient is also advised to perform full inflation and deflation of the penile implant twice daily for practice.

References

• Carson, C. C. (2013). Penile implants: newer devices provide improved function, safety and satisfaction. Trends in Urology & Men’s Health, 4(1), 29-31.
• Shamloul, R., & Ghanem, H. (2013). Erectile dysfunction. The Lancet, 381(9861), 153-165.
• Le, B., McVary, K., McKenna, K., & Colombo, A. (2016). A Novel Thermal-Activated Shape Memory Penile Prosthesis: Comparative Mechanical Testing. Urology.