From the Guidelines
Patients considering a multi-component inflatable penile prosthesis should have a thorough consultation with a urologist to discuss expectations, risks, and benefits before proceeding, with a focus on minimizing infection risk, as recent evidence suggests that vancomycin and gentamicin prophylaxis may be associated with a higher infection risk than nonstandard regimens 1. The procedure is typically recommended for men with erectile dysfunction who have failed or cannot tolerate other treatments like PDE5 inhibitors (sildenafil, tadalafil), vacuum erection devices, or intracavernosal injections.
- Candidates should understand that the surgery is generally irreversible and involves implanting a fluid-filled system with cylinders in the penis, a pump in the scrotum, and a reservoir in the abdomen.
- Preoperative preparation includes stopping blood thinners 7-10 days before surgery, taking prophylactic antibiotics (considering alternative regimens due to the potential increased risk of infection with vancomycin and gentamicin), and thorough genital cleansing.
- Recovery involves 4-6 weeks of sexual abstinence, pain management with medications like acetaminophen or NSAIDs, and proper wound care.
- Patients should be aware of potential complications including infection (1-3% risk), mechanical failure, erosion, and changes in penile sensation or length.
- Regular follow-up appointments are essential to monitor healing and provide instruction on device operation. The procedure has high satisfaction rates (over 90%) and can significantly improve quality of life for appropriate candidates by providing reliable, on-demand erections without affecting urination or orgasm, as supported by studies on penile prosthesis implantation outcomes 1.
From the Research
Recommendations for Patients Considering a Multi-Component Inflatable Penile Prosthesis
- Patients should undergo a thorough preoperative evaluation to determine appropriateness for a penile implant, including assessment of sexual history, relationship functioning, and patient expectations for and knowledge of the procedure 2.
- The implantation of an inflatable penile prosthesis can produce excellent functional results and return of normal sexual activity in properly selected patients, with careful surgical technique by a skilled and experienced surgeon 3.
- Patients should be aware of the potential complications of penile prosthesis implantation, including infection, mechanical malfunction, and erosion of the reservoir 4, 5.
- In patients with a history of inflatable penile prosthesis presenting with new lower urinary tract symptoms (LUTS), reservoir erosion should be considered in the differential diagnosis and investigation with cystoscopy and computed tomography included early in the investigatory armament of the urologist 4.
- The use of antibiotic-coated penile prostheses and perioperative antibiotics can reduce the risk of prosthesis infection 5, 6.
- Patients should be informed that penile prosthesis implantation is a recommended treatment option for a subset of patients who present with erectile dysfunction, particularly those who have failed other treatment interventions 2, 6.
Considerations for Penile Prosthesis Implantation
- The most common indications for prosthesis implantation include diabetes mellitus, vascular disease, and radical pelvic surgery 3.
- The most troublesome complication of penile prosthesis implantation is prosthesis infection, which can result in further surgery, loss of penile tissue, and even the inability to replace the penile prosthesis 5.
- Design improvements have resulted in devices that have freedom from mechanical failure ranging from 92% to 94% 6.
- Patients should be aware that a defunctionalized reservoir can cause trouble in the future and that its removal is recommended 4.