Penile Prosthesis: What is it?
A penile prosthesis is two artificial cylinders that fill with fluid to allow the penis to become hard for an erection. It is placed under the skin and within the erection parts of the penis. These products have been utilized since 1973.
What does it treat?
A penile prosthesis is used to treat men with erectile dysfunction (inability to get an erection). Most of these men have tried oral medication prior to placement of a penile prosthesis. In addition, penile prosthesis can be a part of the treatment of Peyronie’s disease. These products do not add length to the penis. Most patients are very happy with the penis prosthesis after learning how to use it.
How does it work?
There are currently two basic types of penile prosthesis. Both are very effective and should not change the feeling in the penis.
Malleable penile prosthesis:
These devices are a semi-solid tube with a central series of segments allowing the product to be shaped into position. When interested in sexual activity, this prosthesis allows straightening in the upward direction. When dressing, the prosthesis can be aimed downward. The malleable prosthesis has extremely low failure rates and is easy to use.
Inflatable penile prosthesis:
An inflatable penile prosthesis allows fluid to be taken from a storage site and to fill cylinders within the penis. A pump is placed in the scrotum next to the testicle so that the patient can inflate this when desired. This prosthesis most closely mimics the normal erection.
Who should get one?
Any patient with erectile dysfunction is a possible candidate for a penile prosthesis. It does require surgery for placement. In general and based on American Urologic Association guidelines, patients should have a reason not to use oral treatment prior to consideration for prosthesis placement.
Does my insurance over a penile prosthesis?
Most insurance companies including Medicare do cover surgery for a penile prosthesis.
Is it painful?
Most patients experience some pain after the surgery due to swelling and inflammation. This is generally short lasting. Once the pain resolves, the patient can often begin to use the prosthesis.
Recovery Guideline After Prothesis
Most patients recover fairly quickly after the procedure but the swelling associated with the surgery may take weeks to resolve. Pain should improve during the first week after surgery.
We highly recommend the following guidelines to help healing:
Ice packs may be put on the scrotum and penis to limit swelling after surgery in the first 48 hours. Be sure not to leave the ice in direct contact with the skin for much time.
As mentioned, it is normal to have a moderate amount of scrotal swelling after surgery. Contact your surgeon if the swelling is severe (larger than a moderate orange) or if you are draining a large amount of fluid (soaking several pads per day). Scrotal support in the form of a jock strap or tight underwear will help limit swelling.
You may begin to shower between 48 and 72 hours after surgery. Allow the water to wash over the incision but do not scrub the area. Tub baths are not recommended in the first 10 days after surgery. Swimming should be avoided until about 2 weeks after surgery. Sitz baths are useful to decrease swelling and discomfort beginning about 10 days after surgery.
A small amount of blood may stain the dressings for 72 hours after surgery. This problem will usually stop on its own. For the first few days, by adding two or three gauze pads to the surgery site, you will aid the healing process and help keep your clothes clean.
Stitches will dissolve and do not need to be removed.
In general you will be sent home with a few days of pain medication. Use this only as needed. After 48 hours, most patients can take extra strength Tylenol or ibuprofen for pain.
Most patients can get around the house for light activities the same day as their surgery. You are advised to wear a scrotal support (jock strap) for a week and decrease heavy activity for two weeks after surgery. You may return to work in a day or so, but you should limit heavy lifting (greater than 20 pounds) or any extended walking or running.
The penile prosthesis will typically be activated (inflated) for the first time at an office visit once the swelling has decreased. This usually occurs between 4 and 6 weeks. You may begin to have sexual intercourse at this time.
When to Notify the Physician
Contact your surgeon if the swelling is severe or if you are draining a large amount of fluid (soaking several pads per day). Other reasons to contact your surgeon after penile prosthesis placement include worsening pain after 48 hours, increased redness or tenderness around the incision site or a fever of greater than 101.