Penile Implant

1. The treatment approach is dependent upon your health condition and the opinion of your treating surgeon.
2. The surgical procedure of penile implant involves the following steps:
3. Once you are under general or spinal anaesthesia, the doctor will make a small incision immediately above the penis or between the penis and the scrotum.
4. The incision exposes the erectile chambers, and the surgeon measures them to place the appropriate penile implant.
5. Once the cylinders are placed, the reservoir is kept behind the abdominal wall, and the pump is installed in the scrotum between the testicles to conceal the pump.
6. At last, all elements of the implant are connected, and the incision is sutured. 
7. A compressive bandage is applied to the wounds after they have been cleaned. 
8. Typically, surgeons leave the penile implant inflated for one day. After the procedure, some surgeons prefer to leave a drain (to prevent fluid or infectious matter from accumulating at the site of the surgery), which is usually removed one day later.

The following questions should be asked of your surgeon:

1. Do penile implants work?
2. Are penile implants safe? 
3. Is a penile implant noticeable?
4. Which type of penile implant is best suitable for me?
5. What are the benefits of a penile implant?
6. What is my expected recovery time?

Additionally, tell your doctors about the following:

1. If you are taking any prescribed medicines. The medicines may need to be stopped a few days before surgery. 
2. If you have an active infection anywhere in the body, such as an infection of the urinary tract or genital infection.
3. If you suffer from unresolved problems of urination.

What to Expect Before Surgery?

You can expect the following:

1. You will either receive general or spinal anaesthesia for penile implant surgery. You will also get a urinary catheter attached on the day of the surgery to drain urine from the bladder.
2. Your doctor may ask you to avoid eating, drinking and smoking six hours before the procedure to prepare you for the anaesthesia.
3. In addition, inform your doctor if you are taking any prescription medications. You may need to stop taking them several days before surgery.
4. The majority of patients stay in the hospital overnight following penile implant placement.
5. If a medical cause of ED is established, these operations are usually covered by insurance.
6. Before the surgery, the surgeon will collect your previous medical history which includes any previous surgeries, and physically assess your abdomen to see if you have any previous surgical incisions that may affect the surgery.
7. The surgeon will carefully examine the genitalia. The surgeon will evaluate the stretched length and girth of your penis.

Types of penile implant:

Implants come in a variety of types. Your surgeon will help you choose the most appropriate implant.

You can expect the following:

1. The healthcare team will provide you with preoperative parenteral (injecting directly into the body) antibiotics before the surgery.
2. The healthcare staff will cut the hair at the surgical site, i.e., shave down lower abdominal hair and pubic hair surrounding the penis and scrotum.
3. Be sure to check-in at your scheduled surgery time. 

What to Expect During Surgery?

You can expect the following:

1. You will be placed in a supine, into a modified ‘frog-legged’ position.
2. Foam padding will be placed under your feet, with additional foam rolled under the knees.
3. Safety straps will be applied to your legs below the knee.
4. Once you have been prepared for surgery, general anaesthesia will be administered. 
5. You will be prepped from the belly button to the mid-thigh, and sterile draping (the process of creating and maintaining a sterile field during surgery by covering the patient and surrounding areas with a sterile cloth) will be applied. Next, the bladder will be drained with a foley catheter (It is a flexible tube that a doctor passes through the urethra and into the bladder to drain urine) placed on the sterile field.
6. The surgical area will be prepped with an iodine-based solution.
7. An incision will be made, and the reservoir will be placed. Next, the cylinder measurements will be performed. After that, the scrotal pump will be placed by the surgeon. Once all parts are connected, and in position, the skin will be sealed in two layers.

Recovery process in Hospital:

1. You might have to remain in the hospital overnight.
2. The catheter attached on the day of surgery will be removed the day after surgery.
3. A short course of narcotic pain medication may be warranted. Additionally, prophylactic (intended to prevent infection) antibiotics will be prescribed on discharge for infection.
4. The day after surgery, after the compressive bandage has been removed and your doctor has deflated the implant, you can leave the hospital.

Recovery process/expectation after hospital discharge:

Diet:  You can resume your normal diet 24 hours after the procedure.

Wound care (dressing):

1. Don’t shower for two days after your operation.
2. Do clean yourself with a washcloth. 
3. 48 hours after the procedure, change your dressing once a day for five days. You can also take a shower but try to keep your incisions dry.
4. When the sterile dressing is removed, tight mesh underwear or scrotal support may be used.
5. Your incision site will have sutures that are dissolvable and are made to stay in for a long time. They will likely dissolve over four to eight weeks

Work, Activity, Restrictions:

1. After surgery, you may experience pain, soreness, and swelling of the penis and scrotum for a few days or weeks. Cold packs and analgesics (painkillers) can be used to relieve this pain.
2. A small amount of discharge may appear from the incision in the first two to three days after surgery. After that, the discharge usually stops on its own without treatment.
3. It will be recommended that you avoid heavy lifting until your follow-up appointment in seven to 14 days.
4. In a few days, you may be able to return to work, but it may take several weeks for you to fully recover.

For four to six weeks after the surgery:

1. Avoid heavy exercise and bike riding.
2. Discuss any prescribed medication with your doctor.
3. Avoid taking thermal baths or going to the sauna.
4. Do not lift anything heavier than five kilograms.

Medicine: You might have bruising and swelling at the incision site. The healthcare team will provide you with post-operative pain medication, and you may use an ice pack to help with swelling.[3]

First Follow up Appointment

You should remember the following:

1. Your doctor will schedule the follow-up appointment four to six weeks after the surgery. This appointment is scheduled once the swelling and soreness have gone.
2. At this appointment, your doctor will inflate the implant for the first time. You may begin to have sexual activity after the appointment.

Risks/complications - warning signs/possible signs of infection for which a patient should consult a doctor:

1. The swelling is severe or doesn't seem to be improving. 
2. Discharge of large amounts of fluid from the incision site. 
3. There is a worsening or no improvement in the pain. 
4. You notice redness or tenderness around the site of the incision.
5. You have a fever.

Sequelae of infection/complication if not treated in time:

1. A major complication of penile implant surgery is infection.
2. Moreover, patients may suffer from acutely ill conditions such as fever, constitutional symptoms (the symptoms that affect the sense of well-being, e.g., weight loss, pain, headache, etc.), and drainage at the incision site.
3. In either case, treatment typically involves using broad-spectrum antibiotics and the removal of all prosthetic components. If an appropriate washout has been performed, a new implant can be placed immediately after removal.