Health

Penile Prosthesis: What Should We Do about Complications

Erectile dysfunction (ED) has become a less of dead-end problem over the past years, with effective and safe oral medications. But implanting a penile prosthesis seem to have become the definitive solution for the treatment of organic ED. 

The three main types of prosthesis most commonly used include three-piece inflatable device, two-piece inflatable device, and the soft, malleable penile prosthesis. The three-piece inflatable device has become the most commonly used or preferred option for most patient. The main advantage is that it improves the erection as well as the flaccid appearance of the penis. It also yields a more acceptable, aesthetic and functional results. However, it has its own disadvantages too, such as the relative complexity of the three-piece device and chances of mechanical failures and difficulties in handing the device. In the past years, continuous improvement in medical sciences and the mechanical function of the devices as well as the composition of the materials used has reduced the likelihood of device-related complications.

Penile implant surgery is offered by many hospitals across India and has an excellent success record. The patients not only benefit from the affordable penile prosthesis surgery cost in India but also the quality of services at such low prices. The surgery is performed by skilled urology surgeons who are highly experienced in penile surgery. 

 

There are many post-operative complications can be prevented by proper assessment and care. The surgeon must discuss and understand the patient’s real needs and expectations along with his partner in order to help them choose the right kind of prosthesis. During the consultation, the doctor also explains the procedure and how the device functions. They are also informed about the obvious changes that will arise in the sexual life of the couple. It is mandatory to have informed consent before the procedure. Therefore, discussing the options of a penile implant suitable for the patient, possible risks and complications, and the irreversibility of the procedure should be discussed beforehand.

 

Complications of penile prosthesis 

Infection – One of the most feared complications of a surgery, has been reported to have an incidence of 8 to 20% in case of implants. Infections may occur a few days or even months after the surgery. The typical sign include a persistent, unchanging, or even increasing pain in the operated area. The pain can be managed by activating the device. Some other symptoms of infection are fever, penile or scrotal erythema, drainage from the wound, and skin erosion. Patients who have diabetes are more prone to developing an infection after the surgery. Other medical conditions that can possibly increase the risk of infection include the use of immunosuppressive drugs and steroids, and the spinal cord injury. The standard approach to treatment of an infected device is the immediate removal of all its components followed by the placement of a new implant after some delay for healing. The method offers the advantage that the new implant is placed only when the infection has been completely cleared. However, it has the disadvantage that the scarring may occur inside the penis, leading to penile retraction which causes more difficult surgery later.

 

Pump infections require the same management as described above for cylinders. Prevention of hematoma and swelling with closed-suction drains has been shown not to increase the infection rate and to promote an earlier recovery time. In a large series of 425 consecutive primary three-piece penile prosthesis implantations, there were a total of 14 (3.3%) infections and three hematomas (0.7%) during a mean follow-up of 18 months [14].

 

Wrong size – If an oversized cylinder is used, it can lead to complications such as an S-shaped deformity and buckling. An oversized cylinder can also lead to constant pain and make the patient vulnerable to the risk of erosion. This is usually managed by replacing the prosthetic device. Another problem that can happen is undersizing, which may cause the effect of “concorde deformity” with excess mobility of the glans. In such cases, removal of the cylinder is not necessary as it is possible to mobilize the glans with making a subcoronal incision. 

 

Mechanical failure – The mechanical failure of the cylinders could lead to loss of fluid caused by breakage, bulging, or aneurysmatic dilatation. The treatment to manage this kind of cases involves the removal of the broken prosthetic device and replace it with a new penile implant. The introduction of new covering materials have significantly reduced the risk of cylinders bulging.

 

Reservoir complications – This does not happen frequently but may cause positioning of the reservoir over the fascia. It is rare for patients to have migration and it usually occurs when a too big space is created through the fascia. The doctor can make a suprapubic incision to replace the reservoir in the correct paravesical space.

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