Intervention

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Processes and techniques used in the implantation of the device

Although it may seem a very complicated operation, penile prosthesis implantation is a relatively quick surgery with minimal implications for the patient, thanks to novel surgical techniques that allow easier access to the anatomical compartments where the elements of the device will be placed.

In our medical center, this surgery may take less than an hour and is performed under local or spinal anesthesia, depending on each specific case. In this way, the patient can fall asleep while the surgery is performed and not unconscious under general anesthesia (as happens in many surgeries).

Prior to penile prosthesis implantation: preoperative assessment

Depending on the patient and his or her personal history, he or she may require further evaluations. For example, if the patient is hypertensive or diabetic, he/she should be evaluated by a cardiologist and an endocrinologist, respectively, who will determine if he/she is suitable for surgery.

See this article to learn about the implications of diabetes on erections.

Prior to surgery, the patient must undergo pre-surgical tests to know the patient’s health status and take the necessary precautions. In addition to the surgeon, the patient must be evaluated by the anesthesiologist and any other specialist if necessary. These tests include:

A complete physical examination
Medical background check
Preanesthetic assessment
Blood tests
Urine cultures (to rule out urinary tract infections)

Safety protocols: minimum risk of complications

Taking into account the (minimal) risk of post-surgical infections, our Clinic redoubles all efforts to prevent the occurrence of any infectious complication and to this end, several actions are followed to ensure surgical safety. Among these actions are:

Skin examination of the genital area for skin lesions suggestive of infectious processes.
Shaving of pubic hair with an electric razor (inside the operating room) and washing of the area with antiseptic solutions.
Preoperative and postoperative administration of antibiotics to prevent infections
Use of double surgical gloves by all operating room personnel (surgeons, anesthesiologist, instrumentalist, nurses, etc.).
Exclusive use of prostheses treated with antibacterial (InhibiZone® type) or hydrophilic coatings.

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+34 615 55 11 55

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Anesthesia for penile implant: local, the minimum necessary.

At all our Andromedi locations in Madrid, Seville, Tenerife and Malaga, we employ a safety anesthetic approach. That is, a local anesthesia is administered accompanied by a sedation that provides the patient with a pleasant sleep (which is not the same situation as a general anesthesia).

This local method, known as epidural anesthesia, puts the body to sleep from the waist down. Once the anesthetics are applied and the patient is asleep, a localized vasoactive drug is administered to emulate the erection and to be able to measure the implant that best fits the patient’s anatomy.

Penile prosthesis without obvious scar

To introduce the silicone rods into the corpora cavernosa and the other elements (pumps and reservoir, in the case of a three body implant), the penescrotal approach is usually used, in which a small cut is made at the base of the penis.

The incision (about 3 cm) to insert the penile implant is usually made in the scrotum, taking advantage of the natural “scar” that men have in the middle raphe of the scrotum. When the entire prosthesis system is in the right place, the surgeon closes the surgical incision with fine sutures.

Step-by-step procedure of penile prosthesis implantation

Depending on the type of prosthesis to be implanted, the procedure will change. Obviously, this is due to the fact that in the case of malleable prostheses only the cylinders must be inserted, while in the case of inflatable prostheses there are more components. The following table describes the steps of each procedure.

Complications of surgery: minimal risk

Thanks to the advancement of new surgical technologies and the updating of increasingly cutting-edge designs, complication rates have been reduced to less than 2% over the implant’s lifetime, a spectacular figure when compared to other types of surgery.

According to an article in the prestigious journal Sexual Medicine Reviews, published by the International Society for Sexual Medicine (ISSM), less invasive approaches, such as those employed by all Andromedi specialists, reduce the rate of complications. The research yielded the following results:

“The single/multiple small incision technique was observed to be free of complications in 97% of patients.”

Procedure: Malleable vs Hydraulic Prostheses

Malleable penile prosthesis	Hydraulic penile prosthesis
Local anesthesia with sedation. The patient falls asleep and feels no discomfort. Once asleep, penile nerve block is placed to make waking up less uncomfortable. Injection of the drug to create a pharmacological erection. Marking of the scrotal area to make the incision. Introduction of the silicone cylinders through the scrotum. Closure of the scrotal incision.	Local anesthesia with sedation. The patient falls asleep and feels no discomfort. Once asleep, penile nerve block is placed to make waking up less uncomfortable. Injection of the drug to create a pharmacological erection. Marking of the scrotal area to make the incision. Introduction of the inflatable cylinders through the scrotum. Dissection of the inguinal area to accommodate the reservoir. Introduction of the activation pump inside the scrotum. Connection of all elements to each other. Verification of the implant's functioning. Closure of the scrotal incision.

Malleable penile prosthesis

Hydraulic penile prosthesis

Local anesthesia with sedation.
The patient falls asleep and feels no discomfort.
Once asleep, penile nerve block is placed to make waking up less uncomfortable.
Injection of the drug to create a pharmacological erection.
Marking of the scrotal area to make the incision.
Introduction of the silicone cylinders through the scrotum.
Closure of the scrotal incision.

Local anesthesia with sedation.
The patient falls asleep and feels no discomfort.
Once asleep, penile nerve block is placed to make waking up less uncomfortable.
Injection of the drug to create a pharmacological erection.
Marking of the scrotal area to make the incision.
Introduction of the inflatable cylinders through the scrotum.
Dissection of the inguinal area to accommodate the reservoir.
Introduction of the activation pump inside the scrotum.
Connection of all elements to each other.
Verification of the implant's functioning.
Closure of the scrotal incision.

💡 Useful information: This table describes the step-by-step procedure of each type of penile prosthesis implantation. Swipe horizontally to view all content on small screens.

Postoperative

The postoperative period after penile prosthesis surgery does not require special care beyond relative rest and surgical wound dressings. The patient can leave the clinic in less than 24 hours after the intervention, except in cases with some specific risk factor which are advised between 24 and 48 hours of stay.

After four to five weeks of adaptation and after a medical visit to check the proper functioning of the penile prosthesis activation and deactivation, you can restart your sexual life.

Below is a video containing images of a penile prosthesis implantation, in a case that also includes a parallel urinary sphincter operation.

Information

The images shown may be disturbing to some viewers.