The patient is a 59-year-old male who had undergone radical prostatectomy for the treatment of prostate cancer 1 year ago. This patient had severe erectile dysfunction following his radical prostatectomy; he had tried, and failed, oral medications and penile injections to improve his erections.
In this patient’s surgery, we have chosen to use the Titan inflatable penile prosthesis. There are two medical device companies that produce inflatable penile implants in the United States: Coloplast Corp and Boston Scientific Corp. The Coloplast product is the Titan; the Boston Scientific product is the AMS 700. The patient requested the Titan device since the Titan has the greatest diameter cylinders available giving the possibility of the greatest diameter/widest erection possible for his penis.
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 #2: Placement of a Boston Scientific AMS700 Inflatable Penile Prosthesis
Dr. Brian Christine, Director of Prosthetic Urology and Men's Sexual Health, Fellowship Director, Urology Centers of Alabama
Dr. Christine has practiced urology for over 20 years in a large urology group, and has focused exclusively on urologic prosthetics, men's sexual health, and male urinary incontinence for the last decade. As an active member of the International Society of Sexual Medicine, the Sexual Medicine Society of North America, the European Society of Sexual Medicine, the American Urologic Association, the International Continence Society, and the Southeastern Section of the American Urologic Association, he maintains an active interest in surgical education. Dr. Christine has organized, conducted, and moderated multiple surgical education events for urology Residents and Fellows, Nurse Practitioners and Physician Assistants, and practicing urologists in the USA, Asia, Europe, Australia, and South America. With a firm belief that surgical education events are conducted for the benefit of the attendee/viewer, Dr. Christine will use this live broadcast to introduce, demonstrate, and explain the Why and How of penile implant surgery.