What is a Malleable Penile Prosthesis?
A Malleable Penile Prosthesis, sometimes referred to as a semi-rigid penile prosthesis, is a permanent implant used to restore erectile function in men who cannot get erections on their own. Unlike other types of penile prostheses, a malleable prosthesis does not change in size. Instead, it can be bent into an erect position or downward for comfort and convenience.
Why might I need a Malleable Penile Prosthesis?
Men with severe erectile dysfunction or erectile dysfunction that does not respond well to other therapies can consider a malleable penile prosthesis placement. While many men prefer the more natural cycle of the inflatable penile prosthesis, malleable penile prostheses have essentially no risk of mechanical failure, a lower infection risk, and require very little manual dexterity or hand strength to use effectively.
Men who experience infection with inflatable penile prostheses may have a malleable penile prosthesis implanted as a temporary or permanent option to reduce risk of recurrent infection.
Preparing for your Malleable Penile Prosthesis:
In general, preparation for a malleable penile prosthesis will involve the following steps:
- You will have bloodwork and other testing done at the hospital
- The hospital will call you to confirm arrival time and instructions
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You should refrain from taking anti-inflammatories or blood-thinning medications a week prior to the procedure. Any blood thinning medications will be discussed with you and your doctors
- It is also important to inform your doctor if you are pregnant or might be pregnant, diabetic, asthmatic, or have any other medical conditions.
- You may be asked to refrain from eating 8 hours prior to your scheduled arrival time and drinking 2 hours prior to your arrival time.
- You should remove all metal objects and accessories such as eyeglasses, jewelry, watch, etc. as they can interfere with the imaging technique used.
- You should arrange for someone to drive you home after the procedure.
What happens during placement of a Malleable Penile Prosthesis?
When you arrive at the hospital an anesthesiologist will discuss how they will make you sleep and keep you comfortable during the surgery.
In the operating room, after you go to sleep, a regional nerve block will be placed to cause numbness for around 12 hours. This will help you recover immediately after the surgery.
After your genitals are shaved and cleaned, the surgeon will make an incision in the middle of your scrotum. The prostheses (every patient gets one per side) will be inserted after careful measurement are taken. The skin is then closed and a dressing is placed. The surgery usually takes under an hour.
You will wake up in the recovery room.
Post-Operative Instructions
Medications:
You will be given pain medication to help control any discomfort you feel after your surgery. Usually this will include regular doses of Tylenol, with the addition of opiate-based analgesics as needed. Your surgeon will review your medical history and instruct you what you will be prescribed.
You will be prescribed laxatives to reduce your risk of constipation. If you find these are making your stool too loose, you should stop them.
You will be given a course of antibiotics. It is very important to complete this course of antibiotics.
Bathing:
Do not bathe for 3 days after your procedure. You can use wet clothes to wash your body, but don’t allow your incision or dressing to get wet.
Wound Care:
You can remove the dressing on your genitals 48 hours after your procedure. Sometimes the dressing will fall off earlier than this.
Activity:
You cannot use your prosthesis until instructed by your surgeon. You can walk, carry up to 10lbs, and eat normally after your surgery. You should not engage in strenuous activity, heavy lifting, sex, or masturbation until you are told it is safe.
Follow up:
Most patients will see their surgeon 4-6 weeks after their surgery. Your surgeon will discuss how to safely use the prosthesis. Most patients are able to resume sexual activity around six weeks after their surgery.
What can I expect after my Malleable Penile Prosthesis?
Immediately following your surgery it is normal to have significant bruising and swelling of your genitals. This can be alarming, but is normal. It is not normal to have progressively increasing swelling, leakage of blood from your incisions, or to have your scrotum significantly increased in size. If you have any concerns, call your surgeon’s office.
Expect it will take around 6 weeks to heal before you can use the penile prosthesis.
What are the risks of a Malleable Penile Prosthesis?
The most significant risks of penile prosthesis placement are infection of the prosthesis and erosion of the prosthesis through surrounding tissue. With a malleable prosthesis the infection risk is very low, but there is a 1-2% risk of erosion. The prosthesis is a foreign object and if it becomes infected, usually needs to be replaced. Thankfully this is a rare complication.
Bleeding, causing a hematoma (localized blood clot) is also a risk of this procedure.
Other risks include injury of local structures such as nerves, blood vessels, and the urethra. Other risks are exceedingly are and your surgeon can discuss them with you.