Penile Prosthesis

Penile prosthesis surgery involves the implantation of an erectile device within the penis and remains the most effective treatment for erectile dysfunction.

 

It provides men the ability to have an erect penis at anytime and over any duration of time. Penile prosthesis device has been around since early 1970s and continued scientific advances in designs and prosthesis materials have resulted in a very effective, safe and durable surgical device. Published literature supports the use of penile prosthesis implant in men with medically refractory erectile dysfunction and/or men who have suboptimal outcome with their current erectile medications. Penile prosthesis provides excellent patient and partner satisfaction.

There are two main types of penile prostheses, the Semi-Rigid implant or the Inflatable (2 or 3-piece) penile implant.

Semi-Rigid implants involve placing a semi-rigid rod into the penis. After having this operation, you will have a semi-permanent erection, although this will not be as firm as your previous erections, it is adequately suitable for sexual intercourse. It is also flexible enough to be pulled down and tucked away when you are clothed, thereby avoiding any unwanted attention or embarrassment.

 

 

Inflatable implants can be a 2-piece or 3-piece models. The 3-piece inflatable penile prosthesis closely simulates a natural penile erection and the majority of men prefer this 3-piece inflatable penile prosthesis implant. It involves the insertion of two cylinders into the penis, a fluid (filled with saline) reservoir inside the abdomen, and a control pump in the scrotum. By manipulating the pump, fluid moves in and out of the cylinders and reservoir, producing artificial penile erection and flaccid (soft) penis.

 

 
Professor Chung has published extensively on penile prosthesis implant surgery (see below) and is considered the leading surgeon expert in Australia and worldwide. He has mentored many surgeons over the years including invitation as surgeon expert at various hospitals and surgical workshops around the world. He is often asked to see complex and salvage penile prosthesis implant cases by other surgeons.

 

What preparation is required?

The penile prosthesis implantation is performed under general anaesthesia, and you should be fasted (nothing to eat or drink) for 6 hours prior to surgery. Regular medications can be taken with a sip of water with the exception of blood thinning agents (such as warfarin, clopidogrel) or non-steroidal anti-inflammatory drugs which need to be stopped for 7-10 days. A mid stream urine (MSU) test is required to ensure the urine is sterile before treatment is undertaken.

What happens in the operating room?

You will meet Professor Chung and your anaesthetist prior to surgery. Your procedure will be performed under general anaesthesia with appropriate anti-microbial cover. The genital area will be shaved in the theatre, and appropriate povidine surgical scrub will be performed to minimise microbial skin colonisation and infection risk.

What are the risks?

Since penile prosthesis implant involves the insertion of a foreign device, strict microbial prophylaxis and safe surgical techniques are paramount. When performed by an expert surgeon, penile prosthesis implant is a safe procedure with minimal complications.

Common complications involve:

  • Pain usually around the inguinal region
  • Bruising, bleeding or hematoma of scrotum
  • Dysuria from urinary catheterisation
  • Skin irritation or minor wound complications
  • Penile length and sensory change

Potential serious complications include

  • Prosthesis infection is the most dreaded complication and usually involves explantation of the penile prosthesis
  • Prosthesis malfunction- commonly due to wear and tear of device
  • Injury to the urethra or bladder during prosthesis implant

What to expect afterwards?

You are usually required to stay overnight to receive intravenous antibiotic for 24 hours postoperatively. Your urinary catheter and surgical dressing will be removed the next morning after your surgery. When you are comfortable and passing urine satisfactory, you will be discharged with 14 days of oral antibiotics. At home you should rest and avoid strenuous physical exertion for 4-6 weeks. During this time, your penile prosthesis remains deflated and any sexual activity is discouraged.

Follow-up care

You may be contacted or have an appointment the following week in order to check on your progress. The recycling of the penile prosthesis occurs at your second follow-up visit with Professor Chung at 4-6 weeks postoperatively. At that visit, you should take simple oral analgesia prior to the appointment as you might experience local pain when the penile prosthesis is activated for the first time.

Some of the key articles published by Professor Chung on artificial urinary sphincter

  • Chung E. Mulhall J. Practical considerations in inflatable penile implant surgery. J Sex Med. 2021;18(8):1320-1327
  • Chung E. Penile prosthesis implant in the special populations: diabetics, neurogenic conditions, fibrotic cases, concurrent urinary incontinence, and salvage implants. Asian J Androl. 2020;22(1):39-44
  • Chung E, Ng BHS, Wang J, Can malleable penile prosthesis implantation improve voiding dysfunction in men with concurrent erectile dysfunction and buried penis? Investig Clin Urol. 2021;62(3):305-309
  • Chung E, Wang R, Ralph D, Levine L, Brock G. A worldwide survey on Peyronie’s disease surgical practice patterns among surgeons. J Sex Med. 2018;15(4):568-75
  • Chung E. Editorial comment on “A comparative study between two different grafts used as patches after plaque incision and inflatable penile prosthesis implantation for end-stage Peyronie’s disease. J Sex Med. 2018;15(6):925-26
  • Chung E. Management of treatment-related sexual complications in cancer care: Evidence for erectile function recovery and penile rehabilitation after radical prostatectomy in prostate cancer survivorship. Expert Rev Qual of Life Cancer Care. 2017;2(6):279-86
  • Chung E. Translating penile erectile hydraulics to clinical application in inflatable penile prosthesis implant. Current Sexual Health Rep. 2017;9(2):84-89
  • Chung E. Penile prosthesis implant: Scientific advances and technological innovations over the last four decades. Transl Androl Urol. 2017;6(1):37-45
  • Chung E and Gillman M. Prostate cancer survivorship: A review of current literature in erectile dysfunction and the concept of penile rehabilitation following prostate cancer therapy. Med J Aust. 2014;200(10):582-5
  • Chung E, Solomon M, DeYoung L and Brock GB. Clinical outcomes and patient satisfaction rates among elderly male aged ≥ 75 years with inflatable penile prosthesis implant for medically refractory erectile dysfunction. World J Urol. 2014;32(1):173-37
  • Chung E, Solomon M, DeYoung L and Brock GB. Comparison between AMS 700 CX and Coloplast Titan penile prosthesis for Peyronie’s disease treatment and remodelling: Clinical outcomes and patient satisfaction. J Sex Med 2013;10(5):1259-67
  • Chung E, Van CT, Wilson I and Cartmill R. Penile prosthesis implantation for the treatment for male erectile dysfunction: clinical outcomes and lessons learnt after 955 procedures. World J Urol. 2013;31(3):591-5
  • Lee D, Chung E and Wang R. Chapter: Reoperation for penile prosthesis implantation. In: Biomaterials and Prostheses Implant in Urology
  • Chung E. Chapter: Novel therapies for erectile dysfunction: Beyond current PDE5 inhibitors, intracavernosal vasoactive agents and penile prosthesis. In: Erectile Dysfunction: Causes, Risk Factors and Management. Nova Science Publishers, Inc, NY
  • Chung E. Dual prostheses implantation for the treatment of male urinary incontinence and erectile dysfunction. In: Urinary Incontinence: Causes, Epidemiology and Treatment. Nova Science Publishers, Inc, NY