What does the procedure involve?
This procedure involves insertion of artificial implants (prostheses) into the penis to allow men to achieve erections for sexual intercourse. Penile prostheses are usually reserved for men who have tried and failed other medical treatments such as tablets, injections, vacuum devices or pellets.
It may also be used in men with other conditions in which erections have been affected, such as following priapism (prolonged, painful erections) or Peyronie’s disease (curvature of the penis). The entire device is implanted into the body and is not otherwise visible.
What are the alternatives to this procedure?
Although surgery is reserved for patients who have tried other treatments, you should discuss the merits of any treatment which you may not have tried with your surgeon. You may not be suitable for certain treatments, as a result of specific medical factors.
What should I expect before the procedure?
You will usually be admitted on the day of your operation. It is a good idea to have a shower or bath at home before coming to the Freeman. After admission, you will be seen by members of the medical team which will include the Consultant, the anaesthetist, and your nurse. You will change into a gown and you will be pushed to the operating room on a trolley. The anaesthetist will then put you to sleep, usually by an injection in the back of your hand.
What happens during the procedure?
A catheter will be inserted through the penis into your bladder at the start of the operation. The prosthesis may be either a malleable (self-bending) one or an inflatable one which requires mechanical pump activation. Although not all patients are suitable for both types, this will have been discussed in detail with you before the procedure. The incision is usually made at the junction of the penis and scrotum. A second incision may be used to insert the balloon reservoir, which is part of the inflatable prosthesis, into the abdomen. Although this can be done through the first incision, your surgeon may feel is safer to perform this through a separate incision, especially if you have had previous abdominal surgery.
What happens immediately after the procedure?
If an inflatable prosthesis has been used, it may be left in the inflated position overnight to reduce the risk of bleeding, but will be deflated before you are discharged home. You may experience discomfort for a few days after the procedure but painkillers will be given to you to take home. Absorbable stitches are normally used which do not require removal.
The catheter will usually be removed on the morning following surgery. Once the you are passing urine normally, you will be able to go home. You may have a wound drain (to prevent any collection of blood at the operation site) which will also be removed on the morning following surgery.
The average hospital stay is 1 day after surgery. When you are discharged, you will be asked not to inflate the prosthesis for 6 weeks. You will be asked to return to the Andrology Clinic where we will teach you to inflate and deflate it (this is known a “cycling” the prosthesis). Sexual intercourse is not advisable for at least 6 weeks after the operation.
Are there any side-effects?
Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.
There will be temporary swelling and bruising of the penis lasting several days. The risk of infection is 2-3% and this may require removal of the whole device. There can be nerve injury with temporary or permanent numbness of the head of the penis. There may be mechanical failure of the device (this can occur many years later) requiring further surgery. This may involve replacement of all or part of the device. Rarely, there can be injury to the bowel or bladder during insertion of the balloon component within the abdomen. Erosion of the prosthesis can occur rarely – this is where a part of the device may break out of its normal position and appear at another site.
What should I expect when I get home?
There will be marked swelling on the penis and scrotum for a few days. This may last up to 10 days and will then subside but do not be alarmed because it is expected.
What else should I look out for?
If you develop a high temperature, increased redness, throbbing or drainage at the site of the operation, please contact your GP or ward 1 at Freeman.
Are there any other important points?
A follow-up appointment in the Andrology Clinic will generally be arranged approximately 6 weeks after the operation. You will receive this appointment either whilst you are on the ward or shortly after you get home. You will also receive an appointment for the Consultant’s clinic 3 months following surgery.
