Penile Prosthesis or Implants
There are basically two different types of penile prosthesis or implants. The first type is an inflatable device. The inflatable device consists of a reservoir and cylinders, combined with a pump. Penile implant technology has advanced quite dramatically over the last few years and certainly the momentary squeeze pump manufactured by AMS is very popular with patients and favoured by Mr Minhas. There are other types of implant also manufactured by companies such as Coloplast. The inflatable device is coated with a special coating of antibiotic solution, which appears to lower the risk of infection of the prosthesis. The risk of infection following implant surgery should be less than 5%. When choosing an implant, our patients are extensively counselled before such surgery. The other type of implant is the malleable device where malleable rods are placed into the corpora cavernosa of the penis, as opposed to the cylinders with inflatable device. In the case of the inflatable implant, the penis becomes erect by squeezing the pump, which results in fluid from the reservoir entering the cylinders. In the case of malleable implant, the actual rigidity of the implant keeps the penis erect, and following intercourse the patients can bend the penis downwards.
Once a decision has been made that a patient wishes to have a penile implant (this is usually after all medical treatments have failed, including injections, tablets, vacuum device and MUSE®), the patient is usually brought in the day before surgery. Patients have an antiseptic cream placed in the nose, and also are advised to have a shower with antiseptic solution. On the day of surgery patients will receive a shave and rigourous scrub in theatre. Mr Minhas’ preference is to use a penile-scrotal incision on the scrotum, to put the implant in place. In the case of inflatable implant, the reservoir which contains the fluid to fill the cylinders is either placed through the incision in the scrotum or alternatively if you have had previous surgery a separate incision is made on the abdomen. In some instances a separate incision is made due to other medical reasons. The muscle tubes or corpora cavernosa of the penis are dilated with special dilators and the penile implant placed.
With the malleable device the same type of incision is used, but a reservoir or pump is not necessary in these cases.
A catheter is also inserted at the time of surgery so that the urethra (‘water-pipe’) is identified and not damaged during the procedure. After surgery a drain is left in the scrotum and the catheter and drain are usually removed the following day. If an inflatable device is inserted, patients are taught to inflate and deflate the device after two weeks.
After surgery patients are warned they may experience some bruising and swelling to the scrotal area. They are also told to look out for signs of infection of the implant. It is Mr Minhas’ policy to give antibiotics following the surgery for at least one week. The risk of penile infection with implants is very low, but does depend upon the number of implants the surgeon is putting in. Mr Minhas has extensive experience of inserting penile prosthesis and is a recognised specialist in this field.