Penile Implant After Prostate Surgery

Satisfaction After Penile Prosthesis Implantation

Satisfaction with erectile function and treatment is significantly higher after penile prosthesis implantation than after treatment with sildenafil citrate or after intracavernous prostaglandin E1 injection.18,19 Studies including partners have also shown high satisfaction rates when men undergo penile prosthesis implantation.2022

How Soon After Prostate Surgery Can Penile Implant Be Performed

A penile prosthesis can be implanted soon after radical prostatectomy once the patient recovers from prostate surgery. Usually for men who had good erections before surgery, waiting 6-12 months is optimal to see if the natural erections return.

Men with severe ED prior to surgery or severe ED 3 months after prostatectomy may choose to have penile prosthesis surgery earlier as a recovery of adequate erections without the use of oral or injectable medications is unlikely. Penile rehabilitation therapy is advisable as soon as the patient recovers from prostate surgery.

Pain After Penile Implant

At New York Urology Specialists we aim to minimize the pain and discomfort after penile implant surgery. Patients receive adequate pain medications before, during and after the procedure to minimize pain and discomfort after penile implant surgery. Many patients may not require narcotic medications after the procedure. Patients who undergo penile implant for treatment of severe Peyronies diseaseor after priapism may experience more pain. Usually, the pain subsides within 1 to 2 weeks after the procedure.

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Unable To Watch Bobs Video Read His Story Below

This video reflects one persons experience with Titan. Coloplast invited Bob to share his story and provided compensation for his participation in the video. Each persons situation is unique your experience may not be the same. Talk with your doctor about whether this product is right for you.

What circumstances lead you to get a penile prosthesis?

My name is Bob Harvey and Im a prostate cancer survivor. Im 72 years of age. I was very fortunate in that up until the age of 65 I had never had any problems with ED. My wife and I actually were high school sweethearts, so we started going out when we were 16. We had a very long and wonderful sex life until I was 65 when I was diagnosed with prostate cancer.

I was diagnosed in January of 2004. I had a radical prostatectomy in February of 2004 and after which, even though it was a nerve sparing prostatectomy, I was unable to achieve an erection after the prostatectomy. I researched the Coloplast penile implant very well. My backgrounds in the sciences, I probably over researched lets say, but I attended seminars and I felt very good about it, but I wasnt ready to move ahead until, in November of 2007, I had the opportunity to speak with two men who had it done.

How was your recovery?

My recovery was, again, I never sugar-coat it for the guys. Youre gonna have some soreness and youre going to have some pain but nothing severe. My recovery, it went very well.

How long was it until you were moving around normally?

What Happens During The Procedure

The surgery may be performed using spinal anesthesia or general anesthesia.

Prior to surgery, the area is shaved. A catheter is placed to collect urine, and an intravenous line for antibiotics or other medications.

If youve chosen a two-piece inflatable device, the saline reservoir, valve, and pump are placed inside your scrotum. With a three-piece device, the pump goes in your scrotum, and the reservoir is inserted under the abdominal wall.

Finally, your surgeon closes the incisions. Its usually done on an outpatient basis and the procedure generally takes 45 to 90 minutes but those times can vary.

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Treating Erectile Dysfunction With Penile Implants

Penile implants, an option patients with erectile dysfunction probably hear little about, might offer a lasting and satisfying cure. Abraham Morgentaler, M.D., director of Mens Health Boston, explains how.

All three medications have helped a significant number of men achieve an erection firm enough for intercourse. A 2001 study of Viagras long-term effectiveness reported an overall success rate of 69%. The success rates for Cialis and Levitra were similar 59% and 69%, respectively. However, the response can depend on what caused the ED in the first place. Men who have vascular problems as a result of diabetes or heart disease find that the drugs work only about half of the time. Response rates are lower just 30% for men whove had a radical prostatectomy.

Men who cannot take the ED medications or find them ineffective do have other options. For example, injections, penile bands, and vacuum erection devices can help men with ED achieve and sustain an erection. Yet many men and their partners find that using these aids requires planning and eliminates spontaneity, or that they produce less-than-satisfactory results.

For these men, a penile implant, also called a penile prosthesis, may be the best option. Men with an implant can have an erection at any time and maintain it for as long as they want without the use of medication or other devices, allowing for greater spontaneity. Broadly speaking, there are two types of implants:

Penile Prosthesis In The Management Of Erectile Dysfunction Following Cancer Therapy

Pranav Dadhich, Mark Hockenberry, E. Will Kirby, Larry Lipshultz

Department of Urology, , USA

Contributions: Conception and design: M Hockenberry, L Lipshultz Administrative support: P Dadhich Provision of study materials or patients: P Dadhich, M Hockenberry Collection and assembly of data: P Dadhich, M Hockenberry Data analysis and interpretation: All authors Manuscript writing: All authors Final approval of manuscript: All authors.

Correspondence to:

Abstract: Erectile dysfunction is a common problem in older men and occurs with even greater frequency following the treatment of pelvic malignancies. Inflatable penile prosthesis implantation is a safe and effective form of definitive ED treatment for those men who fail more conservative measures, and it can be used with similar outcomes in men following cancer therapy. Although many of these men remain dissatisfied with other therapeutic options for ED, IPPs are underutilized in this population. This review will discuss the current practice patterns, outcomes and nuances to surgical technique regarding the use of IPPs in patients with ED following cancer therapy.

Keywords: Penile prosthesis erectile dysfunction cancer therapy

Submitted Mar 30, 2017. Accepted for publication Jun 21, 2017.

doi: 10.21037/tau.2017.07.05

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The Last Stop For Erectile Dysfunction Treatment

28 May 2021

At this juncture in ones prostate cancer journey, spirits may be down, frustration levels high and all hope for a more fulfilling sex life might seem lost. As per last weeks blog various erectile dysfunction medications, mechanical devices and self-injections may have been attempted and either deemed ineffective or failed.

The prosthetic device can be placed within the 2 chambers of the corpora cavernosa.

There are two types of devices available:

• Semi-rigid prostheses

• The balloon stays permanently inflated and doesnt require inflation with a pump.
• This treatment is well suited for someone who has poor manual dexterity.
• Inflatable penile prostheses

Made by two different companies. Each company has various models and differences in composition of the implant, antimicrobial properties, and design of the pump and reservoir. Patient satisfaction with devices from both companies is very high, regardless of the company or specific device properties.

There are two types: 2 or 3 pieces

The difference between the two types is the 2 piece has an integrated storage reservoir rather than a separate storage reservoir.

Erection is achieved by repeatedly squeezing a pump each compression transfers fluid from the reservoir to the intracorporeal cylinders until adequate rigidity is achieved. Pressing a valve mechanism in the scrotal pump causes fluid to flow from the cylinders back to the reservoir.

A 3-piece device is thought to give slightly more rigid erections.

Penile Prosthesis Implantation When Erectile Deformity Is Present

Erectile deformity in men who have had a radical prostatectomy may occur for at least 2 reasons. First, some of these men chose penile injection therapy, which is associated with fibrosis complications that may result in erectile curvature.10 Second, men who have had radical prostatectomy may have erections with reduced rigidity, making these erections more susceptible to buckling injuries during coitus. These injuries are thought to be underlying factors in the development of Peyronie disease.11

The majority of men who choose penile prosthesis implantation in our practice choose a 3-piece inflatable prosthesis. Whenever possible, we use the AMS 700 Ultrex device because this implant allows both girth and length expansion. However, we have shown that in men with penile curvature due to Peyronie disease, using the girth onlyexpanding cylinders of the AMS 700 CX device allows better correction of the curvature.12 We therefore use the AMS 700 CX or CXR device when treating ED in men who also have erectile deformity .

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Management Of Erectile Dysfunction

About 75% of men who undergo nerve-sparing prostatectomy or more precise forms of radiation therapy have reported successfully achieving erections after using these drugs. However, they are not for everyone, including men who take medications for angina or other heart problems and men who take alpha-blockers.

How Each Part Applies To Penile Implant Surgery

Medicare will cover penile implant surgery if your doctor has decided that its medically necessary for ED in your case.

Penile implant surgery is considered an outpatient procedure, meaning that Medicare Part B typically covers it. Part B covers any doctors or specialists visits before, during, and after the procedure, as well as any medications administered directly by your doctor.

Pain medications and antibiotics will be covered under your Medicare Part D plan. If you dont have prescription drug coverage with your Medicare plan, youll pay 100 percent of the medication costs out of pocket.

If you require an inpatient hospital stay after the procedure to treat an infection or other complication, Medicare Part A will cover it. However, most postsurgery complications can be handled by your primary care physician.

If you have a Medicare Part C plan, specific coverage for penile implant surgery will depend on your plan.

For example, some Medicare Advantage HMO and PPO plans have coverage networks that determine how much you pay out of pocket for your services. In addition, your prescription drug coverage may vary depending on your plan.

Before you move forward with scheduling this procedure, make sure your doctor or surgeon accepts Medicare assignment. If youre not sure whether they do, Medicares provider search tool can help you find local physicians who participate in Medicare.

Heres how you can do that:

Out-of-pocket costs for Medicare may include:

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Doctors Experience In Penile Surgery Will Make The Difference

The most important step in the process when considering penile implant surgery, is finding the most experienced surgeon, one that you know you can trust. Dr. Eid has a high success rate and satisfaction rate and will help you maintain realistic expectations, ensure that you are prepared for life after a penile implant, and is backed by the experience to use the best techniques for your implantation to bring you the best results you can imagine.

Is Penile Implant Surgery Painful

After penile implant surgery, you can expect mild to moderate soreness for several days, but the symptoms should go away after a week or two.

“Since we’re operating in a sensitive area, there is some soreness after the procedure,” Dr. Starke explains. “We do several things to minimize your pain, though, such as draining any fluid that’s built up, prescribing pain medication and using compressive surgical dressings.”

The length of recovery can vary based on a variety of factors, and your doctor will let you know once you’ve recovered enough to resume sexual activity.

“In our practice, we typically activate the penile implant three weeks after the procedure, at which point it’s ready for unrestricted use.” says Dr. Starke.

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Penile Prosthesis Implantation After Androgen Deprivation Therapy

A subset of men who have had radical prostatectomy may also be receiving androgen deprivation therapy. In our practice, we have not experienced any difficulty in implanting penile prostheses in terms of dilating the corpora or implanting cylinders. The scrotal skin in these men, however, is thin and easily injured. Care should be taken in developing the sub-dartos pouch for the pump, as the usual amount of force may produce scrotal injury.

Penile Rehabilitation After Prostate Cancer Surgery

Think rehab, and you may conjure up the image of an athlete working his way back from a torn ligament or an older guy getting back on his feet after a total hip replacement. Penile rehabilitation is harder to picture. Indeed, it may sound more like a creative pick-up line than serious therapy, but it’s a real, if unproven, program advanced by many urologists.

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What Side Effects Do Penile Injections Have Are Penile Injections Painful

Like any medicine, penile injections can have side effects, but they are usually temporary.

You might experience:

• Pain, bruising or bleeding. While the small needle and correctly following your doctorâs instructions will definitely help, you could still experience some pain at the time. There may also be some bruising or bleeding at the place of injection, for a short time after injection or when you experience the erection.

Rarely, you may experience:

Certain conditions can make penile injections risky to use. Make sure to tell your doctor if you have any of the following:

• Sickle cell anemia or trait

What Current Options Exist To Treat Erectile Dysfunction After Radical Prostatectomy

Options include pharmacologic and nonpharmacologic interventions. Pharmacotherapies include the oral PDE-5 inhibitors , intraurethral suppositories , and intracavernous injections . Non-pharmacologic therapies, which do not rely on the biochemical reactivity of the erectile tissue, include vacuum constriction devices and penile implants .

Men who have undergone nerve-sparing technique should be offered therapies that are not expected to interfere with the potential recovery of spontaneous, natural erectile function. In this light, penile prosthesis surgery would not be considered an option in this select group, at least in the initial 2 year post-operative period, until it becomes evident in some individuals that such recovery is unlikely.

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Why Choose New York Urology Specialists For Treatment Of Erectile Dysfunction

• All treatment is performed by a board-certified urologist experienced in treating men with symptoms of ED, and other sexual problems using medical therapy, minimally invasive therapies, lasers, and surgery.
• We are one of the few practices in the region to offer a full range of options for the treatment of sexual, and erection problems in men.
• We offer diagnostic testing in our office which avoids hospital costs.
• Extensive Experience: Thousands of men have treated successfully using medical therapy, shockwave therapy for ED, penile injections with Trimix, and penile implant surgery.
• Confidential and Understanding Care. We understand that most of our patients desire privacy. We see patients with a variety of urological problems. Your reason for visiting us is entirely confidential.
• We are one of the few practices in the region to offer a full range of options for the treatment of sexual and erection problems in men.
• We are conveniently located within 30-60 minute commute to men who are seeking ED treatment in Manhattan, Brooklyn, Queens, Staten Island, Westchester, Long Island, Bronx, and New Jersey.

Can You Have Sex After Prostate Removal

The good news is that sex after prostate removal is very possible and enjoyable for most men. This is due to the newest robotic technologies that are nerve-sparing and preserve the sexual function.

Dr. Samadis robotic prostate surgery, SMART Surgery, was explicitly designed to spare the tiny nerve bundles surrounding the prostate in order to preserve sexual potency.

Men who undergo Dr. Samadis robotic prostate surgery have a reasonable chance of regaining complete erectile function for sex after prostate surgery.

So, prostate surgery does affect you sexually, but not in the ways you are thinking of.

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Learning How To Inflate And Deflate Penile Implant

It is very important that patients learn how to inflate and deflate the penile implant correctly. Failure to inflate and use a penile implant can lead to suboptimal penile length and girth. Failure to deflate penile implant after routine use can decrease the durability of a penile implant and can cause complications such as penile implant erosion and pain.

How To Prepare For Surgery

Your doctor will perform a thorough physical examination and review your medical history. This will help them determine whether a penile implant is right for you.

The physical exam will include a complete urologic exam. This can include examining your genitals and prostrate, and getting a urine sample.

Your doctor will probably advise against penile implant surgery if you have:

• an infection, such as a pulmonary infection or urinary tract infection
• diabetes that isnt well managed
• cardiovascular disease

Tell your doctor about your expectations and concerns. Youll have to choose the type of implant, so ask about the pros and cons of each type.

Your doctor will also inform you about the risks of penile implant surgery as well as follow-up care steps.

Your doctor will probably advise you to avoid eating or drinking after a certain time before your surgery. Youll also need to arrange a ride home after the surgery.

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Benefits Of The Erectile And Continence Recovery Program

If erectile dysfunction is an issue after going through the recovery program, your provider can discusspenile implants to help restore your virility and quality of life. Improvement in bladder control and a shortened time to dry. If urinary leakage remains a problem after the one-year mark, your recovery coach can discuss surgical options for the treatment of your incontinence.