Penile Implant Surgery
Penile implants (or prostheses) are devices that can completely restore erections in many men with erection dysfunction (ED). Penile implants require a surgical procedure and it is the most common surgery performed for treating ED.
Anatomy: The penis contains two chambers called the corpora cavernosa, which run the length of the penis. A spongy tissue fills these chambers. The corpora cavernosa is surrounded by a thick covering layer, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa and is also surrounded by spongy tissue, called the corpus spongiosum.
How Does An Erection Occur? Erection begins with sensory or mental stimulation, or both. Impulses from the brain and local nerves cause arteries to open up and the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining erection. When the arteries close down again, and the muscles in the penis contract to stop the inflow of blood and open outflow channels, erection is reversed.
When there are problems with the nerve messages, the arteries and veins, or the structure of the penis itself, erections may not happen, and a penile implant is the best way of restoring erections.
Types of Penile implants
There are two main types of implants:
Malleable implants: Malleable implants usually consist of paired rods that are inserted surgically into the corpora cavernosa to make the penis firm. The patient can manually adjust the position of the penis by bending it, containing the rods, up, down or to the side.
Adjustment does not affect the width or length of the penis, and it cannot be made flaccid
Inflatable implants: Inflatable implants consist of paired cylinders (like inner tubes are in a car tyre), which are surgically inserted inside the penis and can be filled or emptied to cause an erection or a flaccid penis using fluid. Tubes connect the cylinders to a fluid reservoir and a pump, which are also surgically implanted.
The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum, and the inflatable implants fill with fluid, expanding the length and width of the penis somewhat. Pressing a valve causes the implant to deflate leaving the penis in a more natural state
Penile Implant surgery is performed under sterile conditions in the operating room with the patient under general or spinal anaesthesia. The operation usually takes less than 1 hour with a single overnight stay after surgery in the hospital.
The surgery involves the following steps:
An 3cm incision is made across pubic area, above the penis
Special instruments are inserted through the incision to stretch the spongy tissues inside the hollow chambers of the penis (corpora cavernosa).
Dr. Love then flushes the chambers with antibiotic fluid to reduce the risk of infection post operatively.
The implant rods or cylinders are then inserted into position inside the penis. If an inflatable prosthesis is used, a pump and valve is inserted into the scrotum and a fluid reservoir is implanted under the abdominal wall through the same incision.
When the prosthesis is in place and functioning, then incision is closed with internal stitches and skin glue.
Patients are advised to apply an ice pack to the groin area to minimise pain and swelling, and also oral antibiotics are given to decrease the risk of post-operative infection.
Dr. Love and his nurse assistant will instruct you on how to use your new implant once the pain and swelling has subsided. Most patients can resume sexual activity between 4 – 6 weeks after surgery.
Risks & Complications
As with any surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages significantly outweigh the potential disadvantages.
It is important that you are informed of these risks before the surgery takes place. Complications can be medical (general) or specific to Penile Implant surgery.
Medical complications include those related to the anaesthesia and your general well being. Most patients do not have complications after Penile Implant surgery; however, complications can occur and depend on which type of surgery your doctor performs as well as the patient’s health status. (Obese, diabetic, smoker, etc.)
Specific complications for Penile Implant surgery include:
Infection: Infection can occur with any operation. Infection rates vary but with Dr. Love’s surgical technique are very low for healthy men. (0.4% chance). Infection can occur weeks or longer after penile implant surgery and may present as pain, swelling of the scrotum, fever, or drainage. If infection occurs, it can usually be treated with antibiotics but may require further surgery to remove the implant until the infection has resolved. In rare cases, the prosthesis can erode through the skin requiring surgical intervention.
Mechanical Breakdown: Although rare, mechanical breakdown can occur and requires surgery to repair or replace the broken prosthesis. Mechanical problems with implants have diminished in recent years due to technological advances., with 95% of implants still functioning well 10 years after implantation.
Injury to the other structures: Damage to other structures in the area is rare but can occur during surgery and requires repair.