Penile Implant Surgery steps

The urology team follows the below steps for performing penile implant surgery:

Before Penile Implant surgery

• Urologists usually perform penile implant surgery in hospitals or surgical centers. Most penile implant patients undergo an assessment by the surgeon to understand the reason for their erectile dysfunction and to estimate the risk associated with surgery.
• After patients have decided that a penile implant may be an appropriate choice, the doctor helps them understand the process, the risks and possible complications, and the best type of implant.
• Patients need to follow the surgeon's advice for taking medications both before and after the surgical procedure. Urologists frequently advise patients not to take any medicines that may change the function of platelets in the blood or raise the risk of bleeding during the two weeks before and after penile implant surgery.If a patient takes any medications that increase the risk of the surgery, the surgeon checks with the medications and provides alternatives.
• To lower the risk of infection, the surgeon may advise taking an antibiotic-infused soap bath three nights before the surgical procedure. Patients need to avoid shaving the surgical site by themselves.
  

• Usually, an anesthesiologist administers either spinal or general anesthetic during penile implant surgery.
• Antibiotics may be given to the patient a few hours before surgery to lower the chance of infection. 
• Urine is drained from the bladder by inserting a catheter, a tube through the urethra. Urinary catheters are usually removed within the first 24 hours following surgery.
• The surgeon will make an incision in the lower abdomen, at the base of the penis, or beneath the head of the penis.
• Next, the surgeon stretches the spongy tissues of the penis that would usually fill with blood during an erection. The two hollow chambers known as the corpora cavernosa contain this tissue.
• The surgeon will select the appropriate implant size and insert the cylinders inside the penis after flushing the area with an antibiotic solution to prevent infection.
• If the surgeon decides to implant a two-piece inflatable device, the pump and valve mechanism are inserted inside the scrotum. For a three-piece device, the surgeon will create an internal incision to implant a fluid reservoir beneath the abdominal wall.
• After the device is positioned, the surgeon will sew the incisions closed.
  

After Penile implant surgery

• After 48 hours of surgery, the majority of men go home.
• To avoid infection, patients need to take antibiotics as prescribed by the surgeon.
• Patients need to wear loose-fitting clothes and underwear after the procedure. It is essential for men who use an inflatable device to ensure that the scrotal pump remains in place as they heal.
• After surgery, most men can return to intense physical activity in about a month. Depending on their type of implant and the surgeon's advice, people can resume sexual activity four to six weeks after surgery.
  

There may be certain complications with the penile implant. They are rare. However, they tend to happen sometimes. Below are some of the complications of penile implant:

• Infection: Of 100 patients receiving an implant for the first time, 1 to 3 have an infection. If the surgery is repeated, infection is more likely. If it becomes infected, the implant will need to be removed. Though they can happen up to a year after surgery, infections typically happen within the first eight weeks after the surgery.
• Scrotal hematoma: Scrotal, lower abdominal, and inner thigh edema and bruises are seen. Blood accumulation can result in significant swelling. To help avoid this, the surgeon will place a scrotal support after surgery, which resembles a jockstrap.
• Penile implant failure: The device fails early. About two out of every 100 people who receive implants have this. Early after surgery, the pump or cylinders may stop functioning. The device will need to be replaced if this occurs.
• Second surgery: Within the first ten years following implant placement, 15 to 20 out of every 100 patients will require another surgery. This is a result of the device breakdown.
• Autoinflation: The device may inflate on its own. Usually, some effort is required for this to occur. To avoid this during surgery, doctors take considerable precautions. Even with the best measures, it might nevertheless happen in certain situations. Those individuals who have undergone surgery for prostate cancer or who are overweight are more likely to experience this.
• Erosion: The implant eventually penetrates the skin. It is more likely to occur if patients have had an infection. It may be necessary to remove the implant. 
• Migration: It refers to the dislocation of the implant. This may require additional surgery.
• Reduced penile length: Penile shortening may occur as a result of the penile implant surgery or may have been caused by trauma, scarring, post-priapism corporal fibrosis, radiation, or surgery in the past.
• Postoperative urinary retention: The inability to urinate while having a full bladder following surgery is known as postoperative urine retention. It is a common complication affecting patients after penile implant surgery.
  

• When can I go home?
• What kind of pain can I expect?
• When can I go back to work?
• When can I start exercising again?
• What can I eat and drink after penile implant surgery?
• Could this procedure have any long-term effects?
• How long will it take for my wound to heal?
• When am I allowed to drive again?
• Do I need any further treatment?
• How long after the surgery can I resume sexual activities? 
• Do I need to replace the penile implant after some years?
• When do I need to see my doctor again? 
  

History of Penile implant Surgery

• The “os penis” was created by Bogoras in 1936 and Frumkin in 1943 by implanting resected ribs into the dorsal part of the penis. These were the first reported attempts to reconstruct the penis to provide rigidity for intercourse.
• In 1948, Bergman and associates published a report on the use of a rib graft for rigidity in the plastic reconstruction of an amputated penis. Despite having intercourse, the grafted rib was completely absorbed in a few years.
• Scardino in 1950 and Goodwin and Scott in 1952 both reported the placement of acrylic penile splints.
• In 1960, Beheri incised the tunica albuginea to place paired polyethylene rods into the corpus cavernosum and used dilators to create tunnels within. Later, he announced that his prosthesis had been successful in treating 700 patients of erectile dysfunction in various categories.
• At the same time, Sayegh and Loeffler started using perforated acrylic implants between the corpora cavernosa.
• Lash and associates later used a similar prosthesis in the surgical treatment of Peyronie's disease.