Doctors performing penile implant surgery have a number of options for the implant procedure. Placement of an inflatable penile prosthesis can be performed through an incision made underneath the penis; this is called the peno-scrotal approach. Or, surgeons can make an incision in the lower abdomen in the pelvic area above the penis. This method is called infrapubic. Most recently, the peno-scrotal approach has been popularized. But, in fact, the original approach was infrapubic. There are now several expert urologists specializing in penile implants in the U.S. who prefer the infrapubic approach and have reverted to this approach for many reasons. In my opinion, the reasons for this shift include ease of procedure for the surgeon and easier recovery for the patient — including a typically earlier use of the penile implant device.
The penile implant is placed in patients as an outpatient surgery or with an overnight stay. I prescribe, and patients take, preoperative antibiotics before the procedure. For the implant procedure I make an incision about 3-4 cm long roughly 1 cm above the penis. (There will be a small, straight scar at the incision site afterwards which typically is hidden by growth of hair.) I am an experienced implanting urologist and the procedure typically takes approximately 30 minutes to perform. Every physician and patient are unique, however.
I am an experienced implanting urologist and the procedure typically takes approximately 30 minutes to perform.
After the Procedure
At the end of the procedure, the doctor will take steps to help ensure proper healing and recovery. For example, I will leave a Jackson-Pratt bulb suction drain in place as well as do a large wrap of gauze around the penis as a compressive “mummy” dressing. These are left in place for approximately 24 hours and in my experience have been shown to significantly improve recovery as they can reduce the amount of swelling — and thus pain — after the penile implant procedure. I’ve learned that the average output of the drain overnight will be 200-400 cc.
Once the drain and wrap have been removed, I allow the patient to shower; soap and water is all the patient needs to use once daily. The inflatable penile implant, which had been left at 75% erect at the end of surgery, is also taken down to about 50% erect on postoperative day 1. I prescribe medications after the penile implant procedure. Specifically, the patient receives oral antibiotics to take for one week after the procedure along with adequate pain medication and stool softeners.
Penile Implant Procedure Follow-up
I advise the patient to expect to be sore and somewhat swollen for 10-14 days. After two weeks, I see the patient for a postoperative visit and instruct him on the location and the use of the pump. Typically, the majority of pain and swelling has been resolved by this two-week appointment.
I schedule the next visit at five to six weeks post-procedure. This visit is to ensure the patient has mastered the pump and has had complete resolution of any swelling or discomfort. It is important to instruct the patient on complete deflation. Full and complete deflation enables the device to look completely natural. When deflated, the penile implant is undetectable to anyone who may see the patient disrobed.
I then ask the patient to maximally inflate the device and leave it inflated for 20-30 minutes daily whether or not they use it for sex.
I clear the patient on free use of the device once they have accomplished goals around full and complete inflation and proper deflation. I then ask the patient to maximally inflate the device and leave it inflated for 20-30 minutes daily whether or not they use it for sex. I tell them to do this for six months as it helps to assist in stretching of the penis and for better cosmetic outcomes. Lastly, I see the patient for a six-month follow-up visit and then only as needed thereafter.
This physician is a Boston Scientific consultant but was not compensated for the creation of this article. The post-operative treatment scenario described is that of Dr. Kansas and may or may not parallel the practice of other physicians.