How do I use the penile prosthesis and how is it placed

Placement of a penile prosthesis is a surgical procedure that can be performed under general anesthesia or spinal anesthesia. You will stay in the hospital overnight and are usually able to go home the following morning.

To minimize the risk of infection, prior to the procedure your scrotal area is shaved, you are scrubbed with an antibacterial soap and you are given intravenous antibiotics to kill any residual bacteria that may be present on your skin. These intravenous antibiotics will be continued during your entire hospital stay, and you are discharged to home with a 10- to 14-day supply of oral antibiotics.

Three approaches to placement of the penile prosthesis are used, and the location of the incision varies with the type of prosthesis being placed and your surgeon's preference:

1. A subcoronal incision, a circumcision-type incision, is used for placement of semirigid prostheses.

2. A penoscrotal incision is used for placement of multipart prostheses, for reoperations, and in cases of penile fibrosis (scarring). This kind of incision is made in the midline of the upper part of the scrotum. If you look at your scrotum, you will see that a line runs up the middle of the scrotum; the incision is made in this line so that when it heals, it will be incorporated in the normal scrotal line.

3. Some surgeons use an infrapubic incision for placement of multipart prostheses. This kind of incision is made below the pubic bone near the base of the penis.

Usually, all components of a multipart prosthesis can be placed through a single incision. In some patients, prior abdominal and groin surgery—such as a hernia repair or a radical prostatectomy—may make placement of the reservoir of the three-piece prosthesis difficult. In this situation, your surgeon may make another incision on your abdomen to enable the reservoir to be implanted correctly. Each corpora cavernosa is opened and dilated to accommodate the cylinder. Each corpora is then measured. Your penis is actually much longer than you think—it extends back behind your pubic bone—and it is very important that the correct size of cylinder be placed. The pump is implanted either in the midline of your scrotum between the two testicles or on one side of the scrotum. You should discuss pump placement with your surgeon before surgery to ensure that its location will be easy for you to maneuver, particularly if you do not have good use of both hands. The reservoir in the three-piece unit is placed in the pelvis near the bladder. The tubing that connects the reservoir, pump, and cylinders runs deep under your skin so that it is not visible; if you feel closely, you may be able to identify the tubing, but the goal is to have it be unnoticeable. Before the procedure is completed, your surgeon will test the prosthesis to ensure that all components are working well, that when inflated it gives you a fully rigid erection, and that the tips of the prosthesis are in a good position in the tip of your penis.

Before the incision is closed, a small drain is placed to prevent a hematoma from forming, and the prosthesis is deflated. The surgeon may leave the prosthesis partially inflated and then deflate it the following morning because it can sometimes help prevent bleeding. When you wake up from surgery in the recovery room, you will have a catheter in place that drains your urine; a dressing around your penis, which will be taped up against your abdomen; and a drain in place.

In men with ED and prostate cancer who are undergoing a radical prostatectomy for treatment of their prostate cancer, the prosthesis can be placed at the time of surgery. There does not appear to be an increased risk of infection when this route is taken.

Bob's comment:

[I had my penile prosthesis] placed under general anesthesia. As a part of the initial discussion on the penile prothesis, Dr. Ellsworth discussed the mechanics of the prosthesis with me. As she was explaining the mechanics of the prosthesis, she must have noticed a puzzled look on my part. She said, "Do you want to see one?" "Sure," I responded. She returned carrying a rubbery device that has a manually operated pump at one end with two tentacles approximately

7 or 8 inches long protruding from either side. Frankly, it reminded me of one of those Day-Glo plastic Halloween skeletons that bobble all over the place. I said (to myself this time), "Is that thing going into my body?" It was. Incidentally, Dr. Ellsworth urged me to take the device home (in a brown paper bag) to show my wife and familiarize ourselves with the device.

After placement of the prosthesis and my hospital stay . . . I wanted nothing to do with activating the device for the first 3-4 weeks because ofsoreness in the vicinity of the incision. During this time, Dr. Ellsworth examined me periodically to ensure that there were no signs of a bacterial infection. Finally, when the tenderness had abated, the time came for Dr. Ellsworth to demonstrate how the penile prosthesis worked. The pump—the part that produces the erection— is inside the scrotum. It is somewhat rectangular in shape, about the size of a caramel candy, with a ball-type pump affixed on one side and the release valves along either end of the device. In principle, it works this way: Before intercourse, one locates the pump and presses it six or seven times to transfer fluid from the reservoir into the penile cylinders to create an erection. The penis will remain rigid as long as one desires. When one is finished with intercourse, one squeezes the release valves, and the fluid drains out of the cylinders and back into the reservoir. Gentle squeezing on the penis helps to get all of the fluid out of the cylinders. As with anything new, it is difficult to use initially, but with practice, it becomes much easier to use. It is not long before you adapt. It merely becomes part of you.

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