This patient is 64 years old. He is a prostate cancer survivor; however, he also suffers from diabetes. Both his prostate cancer treatment and his diabetes contribute to his severe erectile dysfunction; more conservative treatments (Viagra, Cialis, etc) have failed to provide adequate erections.
In this patient’s surgery we have chosen to use a Boston Scientific device. After preoperative counseling this patient requested the AMS700 device based on the anti-infection coating of the implant: note the orange color of this implant; the color is the result of impregnation of the device with a combination of the antibiotics rifampin + minocycline. This impregnation has dramatically lowered infection rates during penile implant surgery. The anti-infection mechanism of the Coloplast Titan is a hydrophilic coating that allows the implant to be dipped into a solution of antibiotics of the surgeon’s choice prior to implantation.
There are two primary incisions used in inflatable penile implant surgery: the infrapubic incision and the scrotal incision. Both incisions are effective. In this surgery (as in over 90% of my penile implant procedures) we used the infrapubic incision; I believe the infrapubic incision causes less patient discomfort and bleeding and allows the patient to begin to use the device for sexual intimacy sooner vs the scrotal incision. My patients can begin device use for sex 3 weeks after implant surgery.
The basic steps involved in inflatable penile prosthesis surgery, as demonstrated in this case:
- Artificial Erection - insulflation of the penis with a combination of saline solution and a local anesthetic; this causes engorgement and stretching of the penis and provides pain control postoperatively.
- Skin incision and exposure of the corporal bodies.
- Dilation and measurement of the corporal bodies (the cylinders of sponge-like tissue in the penis that fill with blood during a natural erection and into which the implant cylinders are placed; notice that no tissue is removed in penile implant surgery).
- Frequent irrigation of the surgical field with antibiotic solution to reduce risk of infection.
- Placing the reservoir.
- Placing the cylinders into the penis.
- Test inflation of the device to ensure correct sizing and fit of the cylinders.
- Placing the pump into the scrotum.
- Connection of the pump tubing to the reservoir tubing.
- Placing a drain to prevent hematoma formation in the scrotum.
- Closure of the wound.
This patient was discharged from the hospital on the day of surgery. He will return to my office in 3 weeks for instruction in the inflation/deflation of the device, and at that time he may begin sexual activities. With an inflatable penile prosthesis there is no restriction on sexual intimacy practices (penetrative vaginal or anal sex, oral sex, masturbation).
Click Here to View Case #1: Placement of a Coloplast Titan Inflatable Penile Prosthesis