Erectile
Dysfunction

How To Prepare?

It is important to follow your doctor’s instructions carefully in order to prepare for surgery. This includes not eating, drinking, or smoking for a specified period of time before the procedure and discussing any current medications with your doctor. It is also important to follow any other instructions given by your doctor, such as showering with a special soap, avoiding certain activities, or arranging for transportation to and from the hospital. By preparing carefully, you can help ensure that your surgery goes smoothly and that you have the best possible outcome.

Penile Prosthesis Surgery Procedure

For penile implant surgery, you will receive either general or spinal anesthesia. You will also get a urinary catheter, which can be removed the day after surgery. Once you are under anesthesia, the doctor will make a small incision either above the penis or between the penis and the scrotum. The incision exposes the erectile chambers, and the surgeon measures them to place a penile implant of the correct length. Once the cylinders are in place, the reservoir is placed behind the abdominal wall, and the pump is placed in the scrotum between the testicles to conceal the pump.

Finally, all elements of the implant are connected, and the incision is sutured. The wounds are cleaned, and a compressive bandage is applied. Most surgeons choose to leave the penile implant inflated for one day. Some surgeons prefer to leave a drain, which is then usually removed one day after the procedure.

After the Penile Prosthesis Surgery

In the first 2-3 days after surgery, there may be a small amount of discharge from the incision. There is no need to treat this since it usually stops on its own.

For 4-6 weeks after the surgery:

• Do not lift anything heavier than 5 kilograms.
• Do not do any heavy exercise and avoid bike riding.
• Do not take thermal baths or go to the sauna.
• Discuss any prescribed medication with your doctor.
• Your doctor will schedule an appointment to inflate the implant for the first time. This is done once the swelling and soreness have gone, about 4-6 weeks after the procedure.
• After the appointment, you may start having sexual activity.

You should notify your urologist if:

• The swelling is severe or not improving.
• You have a discharge of a large amount of fluid each day.
• The pain gets worse or does not improve.
• You notice increased redness or tenderness around the incision site.
• You have a fever.

Benefits of Penile Prosthesis:

• Low rate of mechanical failure.
• It is possible to inflate the device discreetly.
• Inflatable implants are easy to conceal.
• No risk of priapism.
• Highest level of satisfactory outcome out of all possible treatments.
• Highest level of patient satisfaction of all ED therapies if the patients and their partners are informed correctly about what to expect from the implant.

Types of Penile Prosthesis:

a) Three-piece inflatable penile prosthesis:

Three-piece inflatable penile prosthesis consists of a pair of cylinders implanted in the penis, a pump implanted in the scrotum, and a reservoir implanted in the lower abdomen. Three-piece inflatable is a self-contained fluid-filled (usually saline) system made from silicone. When the fluid within the reservoir is pumped manually into the cylinders by rapidly pressing and releasing the pump, the inflation creates an erection that provides rigidity.

Inflatable Penile Prosthesis

Features of the inflatable penile prosthesis:

• Entirely concealed within the body.
• No adverse pharmacologic or hormonal effects one might experience with oral medications for ED.
• Provides a natural-like erection.
• The device is inflated to provide rigidity and deflated for concealment.

b) Malleable penile prosthesis:

Malleable prosthesis is the most effortless type of penile prosthesis. The prosthesis consists of a pair of malleable rods that are surgically inserted into the penis. The prosthesis is manually positioned up for sexual intercourse or down for concealment during daily activities.

Malleable Penile Prosthesis

Features of the malleable penile prosthesis:

• Easier to use.
• Requires less manual dexterity.
• The simpler surgical implantation procedure.
• Lower risk of mechanical failure.
• Entirely concealed within the body.
• No adverse pharmacologic or hormonal effects one might experience with oral medications for ED treatment (when compared to the inflatable penile prosthesis).

• Member of the Executive Committee of the European Society of Sexual Medicine (ESSM)
• Member of the European Society of Genito-Urinary Reconstructive Surgery (ESGURS)
• Professor at Hasselt University, Faculty of Medicine, and consultant urologist at the University Hospitals in Leuven
• Member of the Belgian Association of Urology (BVU)
• Member of the European Association of Urology (EAU)
• Fellow of the European Board of Urology (FEBU)
• Full member of the EORTC and of the Recognition Committee for Urology