A discussion about types of penile implants, risks and benefits, preoperative steps and postoperative expectations. Both malleable and inflatable penile prostheses are discussed.

1. Penile Prosthesis
Counseling and Preoperative Preparation
Ranjith Ramasamy, MD
ramasamy@miami.edu

2. Erectile Dysfunction
• The persistent inability to
attain and maintain an
erection sufficient to permit
satisfactory sexual
performance
• Causes:
– CV Disease, Diabetes, High
Cholesterol, Smoking
– Radical Prostatectomy
– Radiotherapy
– Brachytherapy
– Trauma

3. Step-Care Approach to
ED Management
First-Line TherapyFirst-Line Therapy
• Lifestyle / drug therapy modificationLifestyle / drug therapy modification
• Psychosocial counselingPsychosocial counseling
• Androgen replacement therapyAndrogen replacement therapy

4. Medication Sildenafil (Viagra) Vardenafil (Levitra) Tadalafil (Cialis) Avanafil (Stendra)
Dose 25-100mg 5-20mg 5-20mg 50-200mg
Peak Time 1 hour 45-55minutes 2hours 15-30mintues
Gone From body
8-12 hours 8-12 hours 36hours 8-12 hours
FDA Approval 3/29/1998 8/20/2003 2/2/2004 4/1/2012
Effects of eating
or drinking
No food or drink 1-
2hours before
Not affected by food or
alcohol
Not affected by
food or alcohol
Not affected by
food or alcohol
Side Effects Headache, flushing,
nasal congestion,
abnormal vision
(PDE6), heartburn,
bloodshot eyes
May prolong QT.
Headache, flushing,
nasal congestion,
abnormal vision
(PDE6), heartburn,
bloodshot eyes
Headache,
flushing, nasal
congestion,
backache, leg
cramps, heartburn,
bloodshot eyes
Headache,
flushing, nasal
congestion,
backache, leg
cramps, heartburn,
bloodshot eyes
Other
Greater selectivity and
fewer side effects than
Viagra. Slower to take
effect with fatty meal.
Slower to take
effect with fatty
meal (not clinically
sig apparently)

5. Second Line Therapy
http://www.muserx.com/
http://patients.uroweb.org/
Vacuum erectionVacuum erection
devicedevice
UrethralUrethral
SuppositorySuppository
Penile InjectionPenile Injection

6. Third Line Therapy: Penile prosthesis
Two types of penile prosthesis:
•Inflatable Penile Prosthesis (IPP)
•Malleable Penile Prosthesis

7. Inflatable Penile Prosthesis
www.coloplast.com

8. Malleable Penile Implant
• Indications
– Prior hernia, abdominal or urologic
surgeries that prohibit placement of
IPP
– Patients with increased risk of infection
or prior history of pelvic infections
• Advantages
– Ease of use; no pump necessary
– Simpler surgery
• Disadvantages
– Penis always feels at least partially
rigid

9. Risks of penile implants
• Infection is the number one risk; however, this
occurs in less than 5% of cases
– Signs: Excessive pain and redness around pump, fever
– Return to hospital if there is:
• 1. Swelling of scrotum to twice normal size
• 2. Fever
• 3. Extrusion of implant outside of penis
• Bleeding due to heavy lifting (greater than 10-
15lbs) within one month of surgery.
• No driving for several days due to narcotic
medications post-operatively

10. Overview of Process

11. Preoperative DON’T’s
• Do NOT shave prior to procedure
• No aspirin or products containing
aspirin or NSAIDs (eg ibuprofen,
naproxen, advil, motrin, etc) within
one week of the procedure
• No eating or drinking after midnight
prior to day of surgery

12. Postoperative Care
• Overnight in hospital with Foley catheter and
bed rest for 24 hours
• 2 days bed rest following discharge
• Wash scrotum with soap and water 48 hours
after discharge; wash 2 to 3 times per day
• Narcotic pain medication for pain management
when discharged

13. Sexual Activity
• Follow up visit 4-6 weeks post operation
• Able to perform sexual activities approximately
6 weeks after operation (Activate pump at this
time)