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Our penile implant surgery patients who suffer from erectile dysfunction are given intravenous antibiotics before surgery (this is continued after surgery. It is our preference to perform penile implant surgery under general anesthesia. There are 2 common approaches. One approach is called infrapubic, where the incision is made at the base of the top of the penis. The other approach is peno-scrotal, where the incision is made at the base of the undersurface of the penis just below where the skin of the penis and scrotum join. Our preference is the peno-scrotal approach because we prefer to enter the corpora of the penis along the ventral aspect (the area just lateral or to the side of the urethra). The dorsal or top portion of the penis is the location of the neurovascular bundle, which are nerves and blood vessels that provide blood and sensation to the head of the penis, and we believe that an infrapubic approach can be associated with an increased risk of damage to these structures. Most penile implants are accomplished with a single small transverse incision along the base of the penis that is barely noticeable when healed.
At the time of penile implant surgery, potential complications include perforation of the proximal tip of the crura (the tip of the penis inside the body where it joins the pelvis) and cross over, a situation where the implant is on the left side at one end and then crosses over to the right side on the other end. Both of these complications, which occur with increased frequency by inexperienced implanters, can be easily corrected at the time of surgery without consequence. A more troublesome complication is urethral perforation. This generally is best managed with aborting the implant to prevent subsequent penile implant infection. One patient referred to our center with urethral stricture disease after an aborted attempt at a penile implant due to a urethral injury was found to have an 8 cm total obliteration of his urethra. We have never had this particular complication.
Our patients are usually admitted to the hospital for a "23 hour stay." They given additional antibiotics and are discharged the morning following surgery. Antibiotics are given at the time of discharge. A very devastating potential complication of penile implant surgery is wound and penile implant infection. When this happens, antibiotics alone are generally ineffective and the required treatment is implant removal or in some cases, a salvage replacement surgery. Therefore, we make every effort to take every precaution to prevent infection and this includes special care when shaving and prepping the penis and scrotum at the time of surgery, certain technical details during surgery to maintain sterility such as the use of a clear adhesive drape to cover the skin, and the liberal use of antibiotics. Patients are instructed to remain sedentary during the first week after surgery. A follow-up appointment is scheduled the week following surgery. Penile implant surgery patients return 6 weeks after penile implant surgery to be counseled in the use of the device and can then resume sexual relations.
There are three different types of implants a patient may receive during penile implant surgery. A Malleable Penile Implant, AMS Penile Prosthesis, Ambicor and an inflatable penile prosthesis 3-piece. Each of the penile implants our discussed in further detail on our penile implant types page