West Coast Urology  –  Geelong   |   Hamilton    |   Colac   |   Winchelsea

A. PROF RICHARD GRILLS

DR KATHRYN MCLEOD

MR PATRICK PREECE

Urological Surgeons

Inflatable Penile Prosthesis

To download a PDF document about ‘inflatable penile prosthesis’ please click:

  • A surgical solution for severe erectile dysfunction when other treatments have failed (such as tablets and injections).

  • Common reasons include:
    • Vascular disease
    • Diabetes
    • Prostate cancer treatment (surgery or radiotherapy)
    • Other pelvic surgery
    • Peyronie’s disease (a scarring condition of the penis)

 

What is an inflatable penile prosthesis?

  • It is a device that consists of two inflatable cylinders surgically inserted into the shaft of the penis. The cylinders are connected to a ‘inflate/deflate’ pump that sits under the skin in the scrotum and a fluid filled reservoir hidden in the pelvis.
  • When the cylinders are empty, the penis hangs in a flaccid state. By pressing the scrotal pump, fluid is pushed from the reservoir to fill the cylinders and cause an erection. A deflate button allows the erection to go down, returning fluid to the reservoir.
  • The inflatable prosthesis allows for a reliable ‘on demand’ erection where other treatments have proven unsuccessful. Satisfaction rates are approximately 90%.

There are several manufacturers of inflatable penile prostheses in Australia. All use a similar hydraulic mechanism with minor design differences. The choice of prosthesis is tailored to the individual.


Alternative erectile dysfunction  treatments

Your surgeon will discuss other possible options which include:

  • Tablets (sildenafil/ Viagra, tadalafil/ Cialis etc)
  • Injection therapy
  • Vacuum erection device
  • Malleable penile prosthesis



TO FIND OUT MORE

  • The procedure takes approximately 2 hours and is performed under a general anaesthetic.
  • It is completed through a small incision either on the upper scrotum or above the base of the penis. Sometimes a second lower abdominal incision is necessary.
  • The penis is measured on stretch during the surgery to ensure the largest possible prosthesis is implanted.
  • A two-night stay in hospital is standard.
  • Bleeding- Some bruising between the legs, of the scrotum or lower abdomen may occur. It usually settles quickly. Major bleeding is rare.
  • Infection- Minor wound infections can be treated with antibiotics. Severe infections involving the implant are thankfully uncommon (<5%), but may require removal of the prosthesis.
  • Erosion- Rarely the prosthesis can erode through the skin. In such cases the prosthesis needs to be removed.
  • ‘Floppy glans’- the cylinders reach to the glans rather than the very tip of the penis, meaning the glans doesn’t engorge like the rest of the penis with prosthesis inflation.
  • Injury to the urethra, bladder or bowel
  • Altered cosmesis with scarring and palpable components of the prosthesis.
  • Device malfunction- The hydraulic system can wear out over time. The average ‘life expectancy’ is 10 years. A faulty implant can be replaced with revision surgery.

Pre-operative tests:

  • 7-10 days prior to surgery you will have routine blood tests and provide a urine specimen to check for any infection. You will be notified if you require antibiotics in the lead up to surgery.


Before the surgery:

  • DO NOT shave around the penis and scrotum in the weeks leading up to surgery – you will be freshly shaved at the time of surgery to minimise the risk of infection.
  • Please ensure good genital and groin hygiene. It is important you notify your surgeon if you develop any rashes or infections (e.g. jock itch) prior to surgery.

 

Medications to stop:

  • Notify your surgeon if you take any blood thinners, medications for diabetes or medications that weaken your immune system as these may need to be withheld in the lead up to surgery.


Antibiotics

  • To minimise the risk of infection, antibiotics are used during and after the surgery.
  • Please notify your surgeon if you have any known allergies (e.g. penicillins).

  • One of the antibiotics sometimes used during the surgery is called gentamicin. It is a very effective antibiotic but has some potential (although fortunately rare) complications:
    • Tinnitus (a ‘ringing in the ear’, which in some cases may be irreversible)
    • Kidney damage (typically with only high doses and prolonged use)
  • Please notify your surgeon if you have pre-existing hearing difficulties or kidney troubles.

Wound care

  • All the stitches are dissolvable.
  • Keep the wounds clean and dry for 48 hours after surgery. You can then shower as normal, but ensure the wound is dry afterwards (pat dry with a towel or use a hair dryer)
    • Avoid baths or long showers which may macerate or ‘soften’ the skin around the wound
  • The waterproof wound dressings will be removed at a review appointment with the nurse in the week following surgery. If the dressings become wet or fall off beforehand, leave the wound exposed, and keep it clean and dry.


Recovery

  • Swelling, bruising, pain and discomfort can last for several weeks.
  • It will take up to 6 weeks before complete healing occurs.
  • Constipation is common following surgery and is often exacerbated by the use of strong pain medication. It is important to avoid straining on the toilet which can increase the risk of bleeding etc following surgery.
  • To prevent/ treat constipation, maintain good fluid intake, high fibre foods and use laxatives as required.


Exercise and activity

  • Avoid strenuous activity and physical work for 4 weeks.


Driving

  • It is safe to resume driving only when you are off all pain medications, are moving around freely.


Medications

  • When you leave hospital you will be given:
    • Tablet antibiotics for 5 days
    • Pain relief medication
    • Laxatives to prevent constipation


Follow up appointment

  • You will reviewed in the rooms:
    • One week after surgery to review the wound and encourage you to start feeling for the scrotal pump
    • 4 weeks after surgery to begin cycling the prosthesis

 

  • If you did not receive an appointment when leaving hospital, please contact reception staff at West Coast Urology to make one.

 

Using the prosthesis

  • The prosthesis can start to be cycled once the post operative discomfort and swelling has settled. For most men this is about 4 weeks after surgery.
  • 2-3 weeks of daily cycling should be performed, with resumption of sex from around the 6 week mark. 

Cause for concern

  • Contact your surgeon if you notice any of the following during the recovery period:
    • Fever
    • Worsening pain, increased swelling, redness or wound discharge
    • The wound opening up
    • Any component of the prosthesis being directly visible (i.e. eroded through the skin)
    • Difficulties with urination