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Medications

Surgery for Erectile Dysfunction (Implants)

A penile implant (also called a penile prosthesis) is concealed entirely within the body, and requires some degree of manipulation before and after intercourse to make the penis erect or flaccid. There are different types of implants based on the manner of operation, naturalness of the erection and the number of components implanted. In a choosing a penile implant, considerations include medical condition, lifestyle, personal preference and cost.

Penile implants are surgical solutions and have the risks associated with surgery, including anesthesia reactions, infections, pain and other complications.  Each individual is different and therefore their recovery will be different as well. Typical recovery is between 4-6 weeks. Your physician will determine what you can and cannot do during this time. It is important to follow the recommendations that your physician gives to you to ensure the best outcome.  Following the routine outpatient procedure, a four to eight week recovery period is necessary before the implant is used.

Surgery for erectile dysfunction is not common, but it may be the best treatment in some cases. During surgery, an implant (also called prosthesis) is placed inside the spongy chambers of the penis. Then, the implant can be used to provide an erection.

Types of penile Implants

Choosing the penile implant that's best for you is very personal decision.  Because each type of implant offers unique features, you will want to discuss the choices with your partner in order to choose the most satisfying option.

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Non-Inflatable Implants

This type of implant is easy to use. Bendable rods can make the penis appear erect. When not in use, the rods can be bent downward. Some implants have joints that lock into position.

Advantages

Disadvantages

  • Easy for you and your partner to use

  • Good option for men with limited dexterity

  • Generally the simplest surgical procedure

  • Least expensive type of penile implant

  • Totally concealed in body

  • Remains firm when not erect

  • Must be bent down to conceal

  • Less appropriate for patient requiring repeated cystoscopy

 

 

 

 

 

 

 

Inflatable Implants

Two-piece Inflatable Implants - consist of a pair of cylinders inserted in the penis and a small pump bulb implanted in the scrotum.  To get an erection you simply squeeze and release the pump several times.

Advantages

Disadvantages

  • Simple to use

  • Fast and simple one-step deflation

  • Totally concealed in body

  • Natural flaccidity compared to non-inflatable implant

  • Requires some manual dexterity

  • Possibility of leakage or malfunction

  • Flaccidity not as natural as three-piece device

Three-piece Inflatable Implant - The most advanced type of inflatable implant available today is a medical device which consists of a reservoir implanted into the abdomen, a pump with an inflation/deflation valve placed in the scrotum and a pair of cylinders implanted in the penis. The entire device is totally concealed within the body. It allows the penis to look and feel either erect or flaccid. You pump fluid from a storage bulb to make the penis erect.

Squeezing the inflation valve on the pump causes saline solution to move from the reservoir into the cylinders. This replicates the body's natural process of flowing blood into the penis, and creates an erection as the cylinders are inflated. To deflate the device, you simply press the release valve on the pump. Using the device properly takes some skill and practice.

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3-piece inflatable implant

Advantages

Disadvantages

  • Acts and feels more like a natural erection

  • Expands the girth of the penis

  • When deflated, it feels softer and more flaccid

  • Totally concealed in body

  • Requires some manual dexterity

  • Possibility of leakage or malfunction

  • Possibility of unintentional erections

Risks and Complications

  • Infection

  • Bleeding

  • In rare cases, Failure or leakage of the prosthesis

  • Eliminates the possibility of return of natural erections

  • May require repeat surgery due to infections, erosions or mechanical problems with the device

  • In rare cases, may cause chronic pain

  • May cause permanent loss of ability to achieve an erection

  • May cause the penis to become shorter, curved, or scarred

Benefits

  • Offers a long-term solution to erectile dysfunction

  • Provides the ability to have an erection anytime you choose

  • Allows for greater spontaneity - have sex when the mood strikes

  • Enables you to maintain an erection as longs as you desire

  • Feels natural to you and your partner

  • Does not interfere with ejaculation or orgasm

 
 
 
 
SCHEDULING THE SURGERY

 

Our surgery scheduler will make these arrangements for you:

  • Pre-operative lab work, EKG and chest x-ray as needed

  • Schedule the surgery at the hospital

  • Secure insurance preauthorization's as required by your insurance

  • Schedule pre-op appointments with our nurses and physicians

  • You are responsible for inquiring with your insurance company if you have additional expenses.

 
SURGEON VISIT PRIOR TO SURGERY

 

This visit is usually within the two weeks prior to surgery. Your doctor will review the surgery and obtain your surgical consent. This visit usually does not involve any physical exam.

 
LAB WORK/EKG PRIOR TO SURGERY

This is generally done 1-2 weeks prior to surgery and can often be done in the same visit as your pre-op surgeon’s visit. You do not need to fast for this lab work. If you have any other medical problems (heart, lung, blood disorders) you may need to evaluated further for surgical clearance – we will notify you if this is needed.

 
PRIOR TO YOUR SURGERY

 

Some medications may increase your risk of surgical bleeding.  Hold all HERBALS AND SUPPLEMENTS for two (2) weeks prior to surgery. Hold all ASPIRIN, OR ASPIRIN – LIKE, PRODUCTS for one (1) week prior to surgery. TYLENOL IS OKAY TO USE. See included Blood Thinning List.   If you are taking or have recently been taking any of these types of medications be sure to inform your Urologist. Due to the need for an anesthetic, it is required that a patient not eat or drink anything (except a tiny sip of water for medications approved by your physicians) after midnight the night before surgery .      

 

 THE PROCEDURE

 

Penile implant surgery usually takes between one and two hours and is done while you're under general or spinal anesthesia.

To insert the penile implant, your doctor will stretch these tissue-filled chambers inside your penis (corpora cavernosa). With an inflatable implant, your doctor may place a pump inside your scrotum or a fluid-filled reservoir in your lower abdomen.

Immediately before surgery

  • Within a couple of hours before the surgery, you may be given antibiotics to reduce your risk of infection.

  • You'll get an anesthetic to make you unconscious (general anesthesia) or a spinal anesthetic to block the pain.

  • A tube called a catheter may be placed into the bladder through your urethra to drain urine while you are under anesthesia. In most cases, the urinary catheter is removed in the first 24 hours after surgery.

During surgery

  • Your surgeon will make an incision below the head of the penis, at the base of the penis, or in the lower abdomen.

  • Next, your surgeon stretches the spongy tissues in the penis that would normally fill with blood during an erection. This tissue is inside each of the two hollow chambers called the corpora cavernosa.

  • After flushing the area with antibiotic fluid to prevent infection, your surgeon will choose the correct size implant and place the cylinders or semi rigid rods inside the penis.

  • If your doctor is implanting a two-piece inflatable device, a pump and valve are placed inside the scrotum. For a three-piece device, your surgeon will also implant a fluid reservoir under the abdominal wall through an internal incision.

  • Once the device is in place, your surgeon will sew the incisions closed.

Recovery

  • Most men go home within 24 hours of surgery.

  • You'll need to take antibiotics as directed by your surgeon to prevent infection.

  • After surgery, wear loose fitting underwear and clothing. Men with an inflatable device will need to make sure the scrotal pump stays in place during healing.

Most men can resume strenuous physical activity about a month after surgery. You can resume sexual activity four to six weeks after surgery, depending on the type of implant you have and the instructions of your surgeon.

 
WHAT TO EXPECT AFTER THE PROCEDURE

 

1. WOUND AND PENILE PUMP CARE

First of all, dress for comfort. Continue to wear the athletic supporter until you are examined at your post-operative appointment. Keep your incision clean and dry. The dressing should be removed 48 hours after the procedure. 

In the first week after the procedure, scar tissue will form around the entire components of the internal penile pump. It is imperative that the penis be maintained in a straight position during this time. This will involve keeping the penis pointing towards the umbilicus (belly button) using the athletic supporter which is provided to you at the end of the procedure.  A certain amount of fluid remains in the cylinders at all times. This is to prevent formation of scarring on a completely deflated cylinder. It is therefore normal for patients to feel that a partial erection is present. As swelling subsides, stretching of the penis will occur and the penis will eventually return to a more flaccid (soft) state.  Scar tissue will also form around the scrotal pump. Therefore, if the pump is pushed up into the scrotal sac (by sitting on the scrotum) during the first 7 days, the pump will permanently stay there. The pump will be more difficult to find, and the activation / deactivation of the device will be more challenging. 

It is normal to have bruises and discoloration of the scrotum and penis in the first 10 to 14 days of the surgery. Swelling of the penis and foreskin is also commonly observed. With warm baths, swelling will slowly disappear over a 10 to 14 day period. As healing occurs, pain will gradually subside. It is normal to have pain and discomfort when standing. In the supine position, pain should gradually subside. It is not normal for the pain to increase after 5 to 7 days. Please call at anytime if you feel that the pain is increasing in the post operative period.

2. BATHING

On the third day after the procedure, please start 2 to 3 warm baths a day (not showers). These should last approximately 20 minutes and will help reduce swelling and tenderness. Wash the incision with soap and water and pat it dry. Do not apply cream or ointment to the scrotum. Warm bath soaks are required for comfort, pain relief and tissue healing.

3. ACTIVITY

For the first 48 hours, please remain in bed in order to minimize swelling. You should walk for approximately 15 minutes 3 times a day. On the third day after surgery, please begin light to moderate activities and gradually increase movement as you feel better. You may return to work at your discretion, usually after 1 to 2 weeks.

4. MEDICATIONS

You will be sent home with several prescriptions. Be sure to get these filled. You may not experience any discomfort at the time of discharge, but it is not unusual for patients to have an increase in pain 3- 5 days after surgery as your activity increases. Pain medication should be taken as needed for comfort. If a laxative is necessary, use a mild one such as Milk of Magnesia, Senekot, Metamucil or Fleet Enema. If you are on medications at home, you should resume them unless otherwise instructed by your doctor.

5. DIET

There are no diet restrictions. However, we recommend balanced meals including foods that promote tissue healing, such as lean meats, green and yellow vegetables, citrus fruits, dairy products, and whole wheat breads and grains. If you are diabetic, return to your pre-operative recommended ADA diet. Constipation is usually experienced after a surgical procedure and is often due to pain medication. For that reason, we recommend that you start taking Colace twice daily, three days before the procedure.

6. GENERAL INFORMATION

You should make an appointment 10-14 days after surgery in order to remove the stitches. At the end of the visit, you will be given an appointment in 4-6 weeks for instruction on use of the pump. You should be sexually functional within 4- 8 weeks after the procedure.

 

OPERATING INSTRUCTIONS

You will be given instructions on operating your implant based on what type you have implanted.  Instructions will be reviewed by your surgeon during one of your follow-up visits.

 

 

 

Please schedule a follow up appointment per your surgeon. 

If you have any questions or concerns prior to your visit please call us at

303-825-8822

 

 

 

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