Penile Prosthesis implantation.
Implantation of a penile prosthesis remains the last tool available to the specialist for the treatment of erectile dysfunction. It generally requires 24–48 hours of hospitalization (unless complications occur) but can be performed under local anesthesia on an outpatient basis if a malleable prosthesis is used (a technique pioneered in Italy). The procedure consists in emptying of the corpora cavernosa and replacement with prosthetic cylinders that can be hydraulic, with manual activation and deactivation by means of a pump located in the scrotum and connected to a reservoir, or malleable that is “movable” but always rigid. Not all patients can be submitted to hydraulic prosthesis implantation. Each surgical procedure has its indications and contraindications, and the hydraulic prosthesis is not necessarily the best option for every patient. Visually, the patient will notice a single scar of approximately 5 cm at the scrotal level for the hydraulic prosthesis, or two small sub-coronal scars of about 2 cm in the case of the malleable prosthesis.
Why use a malleable prosthesis?
The malleable penile prosthesis is a well-known solution for erectile dysfunction and represents a “novelty” in that it permits surgery on an outpatient basis and under local anesthesia. Only very few specialists are performing this surgical technique worldwide.
There are various justifications for use of such an implant, including aspects of the surgical approach, general considerations, and the advantages of local over general anesthesia. In particular:
(1) The surgical incision (as can be seen in the video) is minimal, being about 2 cm on each side of the penis, and the rate of complications due to the surgical approach is correspondingly low in comparison with other techniques.
(2) The cost of this outpatient intervention is lower than that associated with inpatient surgery, some articles citing a reduction of about 41% in certain countries.
(3) The patient’s privacy is more respected by an outpatient procedure as he will not have to give many explanations to family or friends and the reduced hospital stay decreases the risk of being recognized during hospitalization.
(4) There is a reduced risk of urinary tract infections simply because there is no need to catheterize the patient during surgery because of the form of anesthesia.
(5) The time on the waiting list is clearly shorter than with a classic intervention.
(6) The return to “normal” activity and life is achieved more quickly owing to the type of prosthesis (easier surgical implantation and less complicated handling compared with the hydraulic prosthesis) and the form of surgery (as an outpatient).
(7) The side effects and risks of local anesthesia are obviously much lower than when using general anesthesia.