The penis is composed of one channel for urine and semen and three compartments with tough, fibrous walls containing "erectile tissue." With appropriate stimulation, the blood vessels that lead out of these compartments constrict, trapping blood. Blood pressure fills and hardens the compartments producing an erection of sufficient firmness to perform sexual intercourse. Additional stimulation leads to ejaculation, where semen is pumped out of the urethra. When this system fails, impotence (failure to create and maintain an erection) occurs.
Impotence can be caused by a number of conditions, including diabetes, spinal cord injury, prolonged drug abuse, and removal of a prostate gland. If the medical condition is irreversible, a penile prosthesis may be considered. Patients whose impotence is caused by psychological problems are not recommended for implant surgery.
Penile implant surgery is conducted on patients who have exhausted all other areas of treatment. The semi-rigid device consists of two rods that are easier and less
expensive to implant than the inflatable cylinders. Once implanted, the semirigid device needs no follow-up adjustments, however it produces a penis which constantly remains semi-erect. The inflatable cylinders produce a more natural effect. The patient is able to simulate an erection by using a pump located in the scrotum.
With the patient asleep under general anesthesia, the device is inserted into the erectile tissue of the penis through an incision in the fibrous wall. In order to implant the pump for the inflatable implant, incisions are made in the abdomen and the perineum (area between the anus and the genitals). A fluid reservoir is inserted into the groin and the pump is placed in the scrotum. The cylinders, reservoir, and pump are connected by tubes and tested before the incisions are closed.
Surgery always requires an adequately informed patient, both as to risks and benefits. In this case, the sexual partner should also be involved in the discussion. Prior to surgery, antibacterial cleansing occurs and the surrounding areas are shaved.
To minimize swelling, ice packs are applied to the penis for the first 24 hours following surgery. The incision sites are cleansed daily to prevent infection. Pain relievers may be taken.
With any implant, there is a slightly greater risk of infection. The implant may irritate the penis and cause continuous pain. The inflatable prosthesis may need follow-up surgery to repair leaks in the reservoir or to reconnect the tubing.
Jordan, Gerald H., et al. "Surgery of the Penis and Urethra." In Campbell's Urology, ed. Patrick C. Walsh, et al. Philadelphia: W. B. Saunders Co., 1998.
Lewis, Ronald. "Surgery for Erectile Dysfunction." In Campbell's Urology, ed. Patrick C. Walsh, et al. Philadelphia:W. B. Saunders Co., 1998.
J. Ricker Polsdorfer, MD
General anesthesia—Deep sleep induced by a combination of medicines that allows surgery to be performed.
Perineum—Area between the anus and genitals.
Scrotum—The external pouch containing the male reproductive glands (testes) and part of the spermatic cord.