What are the risks of a penile prosthesis?

As with any surgical procedure, there are complications associated with the placement of a penile prosthesis. These risks may be subdivided into intraoperative complications (those occurring during surgery) and postoperative complications (those occurring after surgery).

Intraoperative Complications

Perforation

During dilation of the corpora cavernosa, the dilating instrument can perforate the urethra. If this occurs, the procedure must be terminated, the catheter must be left in place, and the urethra must be allowed to heal. If one cylinder has already been placed on the other side, it may be left in place and connected to the pump and reservoir before the surgery is completed. If the patient desires, the surgeon can go back in a few months and try to replace the cylinder. Some men find that they are able to achieve adequate rigidity with only one cylinder in place and do not wish to undergo another surgical procedure.

Similarly, during dilation of the corpora, a hole may be made from one corpus cavernosum into the other. The surgery can continue in this case, but the cylinders must be properly placed in each corpus cavernosum. If a hole is made, a cylinder may cross over, meaning that it starts in one corpus cavernosum but passes through the hole and ends in the other corpus cavernosum. If this situation goes unrecognized, it may cause asymmetry and pain with use of the prosthesis.

Existing Scarring

In individuals with significant penile fibrosis, such severe scarring may be present that narrower cylinders will be required. Rarely, it will be difficult to close the corpora over the cylinders. A patch of synthetic material or tissue must be removed from another area of your body in this case and used to cover the corporal defect.

Excessive Bleeding and Anesthesia Complications

As with all surgical procedures, there are bleeding and anesthetic risks with the implantation of a penile prosthesis.

Postoperative Complications

Decreased Penile Length

Decreased penile length is actually not a complication of penile implantation, but rather is intrinsic to the surgery. The cylinders are of a fixed length. To obtain penile rigidity, the cylinders increase in width (girth). Very observant patients will note a 1- to 2-cm decrease in penile length after the procedure.

Infection

One of the most devastating complications of penile prosthesis surgery is infection. Infection rates range from 2-16% in first-time procedures but increase to 8-18% in reoperations. Patients with diabetes and spinal cord injury, in particular, are at increased risk for infection.

Signs of infection include persistent pain, erosion of a part of the prosthesis, purulent drainage, fever, swelling and redness of the scrotum, and fixation of the tubing to the scrotal skin. In most cases, but particularly when infection occurs early after implantation, the entire prosthesis must be removed emergently. The area must then be irrigated with antibiotics, and intravenous antibiotics followed by oral antibiotics must be given. Implantation of a second prosthesis can be attempted 6 months later, after the area has completely healed.

When an infection occurs later and is caused by less aggressive bacteria, the surgeon may try to salvage the prosthesis. In such a case, the patient is taken to the operating room, the infected prosthesis is removed, the area is irrigated copiously with antibiotic solutions, and a new prosthesis is placed. The risk of infection associated with the new prosthesis in this situation is about 15%.

In an attempt to help decrease the risk of infection, some of the penile prostheses come impregnated with antibiotics and others have a coating which allows an antibiotic to be adhered to it.