What is the procedure for implanting a penile prosthesis?

Penile Prosthesis Implantation Procedure

Penile prosthesis implantation is performed under general, spinal, or epidural anesthesia, with thorough preoperative preparation focused on infection prevention and requires broad-spectrum antibiotic coverage. 1

Preoperative Preparation

• Patient must be free of urinary tract infection, systemic infection, and cutaneous lesions in the operative area to reduce infection risk 1
• Broad-spectrum antibiotics providing both Gram-negative and Gram-positive coverage must be administered before incision (commonly aminoglycosides, vancomycin, cephalosporins, or fluoroquinolones) 1
• The operative area should be shaved immediately prior to surgery, not earlier, to prevent small skin cuts that could become infected 1
• Thorough skin preparation is performed after shaving 1

Surgical Approaches

• Three main surgical approaches are used for inflatable penile prosthesis implantation 2:

  • Penoscrotal approach (most commonly used globally)
  • Infrapubic approach
  • Subcoronal approach

• The penoscrotal approach offers several advantages 3:

  • Avoids potential injury to dorsal sensory nerves
  • Provides better corporeal exposure
  • Allows for proper pump placement in the scrotum

• The infrapubic approach may be faster but carries theoretical risk of penile sensory loss 4

Types of Prostheses

• Two general types of penile prostheses are available 5:

  • Semirigid (malleable and mechanical)
  • Inflatable (two-piece and three-piece)

• Three-component inflatable prostheses offer advantages 5, 6:

  • Softer when deflated with better cosmetic result
  • More natural erection
  • Higher patient satisfaction

• Inflatable penile prosthesis is recommended for patients with Peyronie's disease as it allows for modeling to maximize curvature correction 1

Special Considerations

• For patients with Peyronie's disease and erectile dysfunction, penile prosthesis implantation may be combined with adjunctive procedures such as modeling, plication, or incision/grafting 1
• Modern penile implants are MRI-compatible at 1.5 Tesla field strength, with no current manufacturers producing MRI-contraindicated devices 1
• Infection rates have been reduced with antibiotic-coated or hydrophilic-coated devices (rates of 1-2%) 1

Postoperative Expectations

• Patients should be thoroughly counseled regarding post-operative expectations 1
• Potential complications include penile edema, hematoma, corporeal injury, urethral injury, and acute urinary retention 1
• Infection is a serious complication typically occurring within the first three months after surgery 1
• Patient and partner satisfaction rates are generally high (>80%) with both surgical approaches 4

Important Caveats

• Patients must understand that prosthesis implantation will likely reduce the efficacy of subsequent therapies should they be needed 1
• Mechanical failure can occur despite improvements in device design 6
• Proper patient selection and counseling are essential for optimal outcomes and satisfaction 6