Things to keep in mind for penile implant surgery
In theory, hydraulic penile implants sound very simple: incision, insertion, positioning, stitching, finished.
In practise, however, penile implant surgery is a highly complex operation if it is to result in a functional penis that is very satisfying to the patient.
This already begins with the incision:
Before the surgery can even be allowed to begin, an extensive and clearly defined disinfection protocol (on and around the site of the surgery) must be followed. This is extremely important and goes far beyond the disinfection involved in other surgeries. A penile implant and its attachment are inserted across the entire length of the penis. If an infection agent survives and penetrates into this area due to insufficient preliminary disinfection, this can have very uncomfortable repercussions.
There are also significant differences in the actual incision. Our technique merely involves a single minor incision directly below the penis that normally heals very well and is no longer visible late. Even the fluid reservoir is inserted through this incision. No further incision in the groin is required using this technique, thereby eliminating the risk of damaging important structures.
This continues with the insertion:
For visually successful and long-term results, maximum preparation is absolutely necessary on the part of all of the staff involved so that the surgery can be performed rapidly according to routine.
The penile implants must be removed from their packaging according to a defined procedure so that there is no possibility of them coming into contact with pointed or unclean instruments. The internal pieces must not be contaminated with blood components either. Special penile implant instruments are to be used exclusively.
It is extremely important and a basic pre-requisite for lasting success that the cavities into which the implants are inserted are prepared very quickly, precisely and without trauma. If the surgery is performed too slowly, too traumatically or in unsterile conditions then there is a risk that the incorrect penile implant length will be selected and the distal damage from this will cause the penile implants to later penetrate through the glans penis.
Our experience has shown that inexperienced or unqualified surgeons often use penile implants that are too short due to fear of distal tissue damage. This leads to an unnatural visual appearance and a bend in the glans penis during erection. This makes sexual intercourse significantly more difficult or even impossible.
The positioning is also a critical moment:
The individual pieces of the implant, particularly the connecting tubes, the reservoir and the cylinders, absolutely must not be allowed to be damaged through the use of too much force and/or incorrect instruments.
Attention must also be paid to correctly permanently positioning the tubes and the pump in particular. The pump must absolutely not be positioned above or between the testicles. This will make it externally visible as well as painful and barely operable.
The tubes must be optimally position in order to remain invisible and not put pressure on the testicles.
The stitching is the simpler part of the procedure in comparison:
Despite this, again and again we encounter patients with extremely nasty scars who underwent surgery somewhere else. Working with care and expertise is therefore important in this area as well so that the scarring is invisible in the end.
As nice and relieving as it is to have normal function returned again after the insertion of the prosthesis, there can be many uncomfortable consequences if the quality of the performed surgery is poor and/or the wrong materials and instruments are used.
Personal note from the author:
Currently over half of our work with penile implants involves removing and correcting implants that were incorrectly inserted and/or were the wrong size. The fact is that there are only a few surgeons who have really mastered penile implant surgery. These surgeries are extremely rare procedures in most urology departments that are unfortunately performed by those with little expertise all too often.
The subsequent correction is then frustrating work for us. Due to our many years of experience we are indeed usually capable of achieving a good result, yet due to the internal scarring from the initial surgery this result is almost never the same as the result that we could have achieved (in terms of the length of the penis) if we had performed the initial surgery from the beginning.
Not every penile implant surgery goes wrong in public hospitals, of course, but the number of our patients and our experience clearly show that it is not a rare occurrence.
Please don’t misunderstand. You can have the surgery performed anywhere you like, as we already have plenty of patients, but if you have already heard about us before your initial surgery then please think a little more about coming straight to us for the initial surgery instead of coming later for corrective surgery. This would save you another surgical procedure and make the work significantly easier for us. It is much more fulfilling for our surgeons to achieve a good result than to have to correct another’s mistakes.
I am aware that I may be ‘stepping on the toes’ of some medical colleagues with these comments, but I feel that it is justified. We are very open and inviting to all of our medical colleagues of any type, but please be sure to remember that medical practise involves helping patients and not protecting colleagues who constantly provide unsatisfactory work.
It is not about decrying the fact that surgeries sometimes go wrong but rather working on persuading surgeons who constantly deliver poor work to cease performing this procedure in the future. This can only succeed if patients simply stop going there.