Background Information:

What are the other Names for the Procedure?

• Penile Prosthesis Implantation

What is the Penile Implant surgical procedure?

• Erectile dysfunction (ED) is characterized by a man’s inability to develop or sustain an erection during sexual intercourse
• In a Penile Implant procedure, a medical device is inserted within the penis to allow men who have erectile dysfunction, to develop an erection
• It is also known as a Penile Prosthesis Implantation procedure

What part of the Body does the Procedure involve?

A Penile Implant procedure involves the penis.

Why is the Penile Implant surgical procedure Performed?

A Penile Implant procedure is performed for the following reason:

• For men who have erectile dysfunction

What are some Alternative Choices for the Procedure?

Currently, no comparable alternate choices exist for the Penile Implant procedure.

What are the Recent Advances in the Procedure?

Current advances in the Penile Implant surgical procedure have brought about more successful outcomes.

What is the Cost of performing the Procedure?

The cost of Penile Implant procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Penile Implant surgical procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

http://www.mayoclinic.org/tests-procedures/penile-implants/basics/what-you-can-expect/prc-20013140 (Accessed on 11/10/2014)

Prior to Penile Implant surgical procedure:

How is the Penile Implant surgical procedure Performed?

The Penile Implant surgical procedure is performed in the following manner:

• The procedure may be performed under general or spinal anesthesia
• A catheter (tube) is inserted into the urethra (the urinary tube)
• An incision is made on the base of the penis and spongy tissue (two columns called corpora cavernosa) identified. Cylinders are implanted in the spongy tissue.
• Depending on the type of prosthesis used, a pump and valve are inserted in the scrotum (the bag-like sac that contains the testicles) either with/without a fluid reservoir in the abdomen
• The incision is then sutured

Where is the Procedure Performed?

A Penile Implant procedure is performed in a hospital.

Who Performs the Procedure?

A urologist performs the Penile Implant procedure.

How long will the Procedure take?

The Penile Implant surgery may take up to an hour.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Penile Implant surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Penile Implant procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Penile Implant surgical procedure?

Before a Penile Implant procedure, the patient has to undergo certain tests, such as:

• Routine blood and urine analysis
• Chest X-ray
• Ultrasound imaging

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What Penile Implant surgical procedure?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Penile Implant surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Spinal anesthesia by injection or general anesthesia by injection and inhalation is administered for a Penile Implant procedure.

How much Blood will you lose, during the Procedure?

There is not much blood loss associated with an uncomplicated Penile Implant procedure.

What are the possible Risks and Complications during the Penile Implant surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack-years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Penile Implant surgery are:

• Excessive bleeding
• Infection in the surgical wound
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Penile Implant surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Penile Implant surgical procedure:

What are the possible Risks and Complications after the Penile Implant surgical procedure?

The possible risks and complications that may arise after a Penile Implant are:

• Excessive bleeding
• Infection in the surgical wound
• Urinary retention
• Rejection of the penile implants
• Skin or urethra erosion
• Mechanical failure of the penile implant

What is the Prognosis after the Surgery?

The prognosis after a Penile Implant surgery is usually good.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain that worsens and swelling around the surgical wound
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness, such as nausea, vomiting, abdominal swelling, or prolonged constipation
• Pain or difficulty while urinating
• Problems associated with the functioning of the penile implant
• Signs of an infection
• Fever, feeling sick
• Dizziness
• Muscle aches, headaches
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Penile Implant surgical procedure?

At home, the following post-operative care is recommended, after a Penile Implant procedure:

• Slowly resume regular/daily activities as early as possible, which aids in a faster recovery
• Resume showering and keep the wound clean and dry. Gently wash the surgical wound with an unscented soap
• The penis might have to be positioned by pushing it up onto the abdomen during healing, to prevent it from gaining any unwanted curvature
• Complete the course of prescribed medication, under advice of the physician
• Take antibiotic medications to help combat or prevent infection, as advised by your physician
• Avoid all activities that are physically strenuous for about 2 weeks after surgery, or follow the physician’s advice
• Resume driving only after 1-2 days of being discharged from the healthcare facility, or when advised by your physician
• Avoid sex till complete healing has taken place (under advise by the physician)

How long does it normally take to fully recover, from the Procedure?

It may take anywhere between 4-6 weeks after the Penile Implant procedure to resume any strenuous physical activity (including sexual activity).

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision.
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued.
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Penile Implant surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• A hospital
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue was sent for analysis)
• A urologist

The patient is advised to inquire and confirm the type of billing, before the Penile Implant procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA