What happens if I get an infection?
Should an infection occur after the prosthesis is inserted, the patient will need to be hospitalized and the device removed entirely. A salvage procedure may or may not be possible with simultaneous re-insertion of another device immediately at the same time that the infected device is removed. This is performed in order to prevent shrinkage and scarring of the penis, which occurs after penile prosthesis infection. If the type of bacteria causing the infection is not identified, the patient will require 2-3 weeks of intra-venous antibiotics. If a device is not immediately re-inserted another implant may be placed in the future however in addition of resulting in a much shorter penis the surgery is much more difficult and at a higher risk of urethral perforation and patient dissatisfaction. Given the fact that infections are rare, surgery and a scarred penis very difficult, re-implantation after an infection should only be performed by very experienced physicians and not generalists with little to no experience.
What are the possible risks, side effects and complications of penile implants?
Possible surgical, medical and device related risks and complications includes infection, erosion of the implant through the skin, urethra and small bowel intestine, colon, or injury to artery or vein of lower extremity, temporary severe pain in the surgical area and mechanical failure of the implant.
Loss of remaining spontaneous erectile ability will also occur after an implant and patients who have spontaneous functional erections should be aware of this occurrence.
Other risks of a general nature inherent in any type of surgical procedure such as bad reaction to anesthesia, contracting pneumonia if the procedure is performed under general anesthesia, phlebitis, or other dangers arising from existing heart problems are also potential complications.
Possible need for further surgery if a complication or dissatisfaction occurs following the initial implant.
What is the No-Touch Technique and why did Dr. Eid invented it?
Click here to read more about the No-Touch Technique.
What is Peyronie’s disease?
Peyronies disease is a term utilized to describe the presence of scar tissue in the penis. The scar tissue is formed as a result of damage to erectile tissue. Lack of blood flow, injury to the erectile nerves and direct trauma to the penis ate the most common causes of penile tissue damage. This condition is quite common in men who suffer from diabetes since obstruction of small blood vessels occurs as a result of the diabetes. Scarring in this scenario is always permanent and irreversible as opposed to scarring which is caused by a penile fracture or penile trauma (these patients have normal penile blood flow). Therefore no medical treatment has been proven effective in removing scar tissue from the penis of men suffering from diabetes.
Penile scarring alters the compliance (elasticity) and the anatomy of the penis. Trapping of blood during erection depends on tissue compliance and intact penile anatomy. Any alteration of penile tissue will result in venous leak during erection.
Is the size of the erection with the implant and the penile injection the same?
The size of the erection with the implant is identical to an erection post injection. The difference is in the flaccid penis. A penis with an implant will never be as small/short or soft as a penis w/o an implant. Patient satisfaction with the erection is much higher with implants than with injections. This is easily documented since all patients who receive an implant try the injections first.
After radical prostatectomy for cancer, can a man with an internal penile pump have an ejaculation?
After radical prostatectomy, a man will be able to have an orgasm without an ejaculation. The fluid that normally comes out of the penis during orgasm is made in the prostate and seminal vesicles, organs that are completely removed during the radical prostatectomy. Furthermore, a vasectomy is performed during the radical prostatectomy so that sperm dose not leak inside the body. The patient will feel near normal sensation during intercourse with the penile pump, provided it is performed correctly.
Is there a minimum amount of time (s) per day, per week, per month that the prosthesis should be used to achieve maximum efficiency or to ensure its effectiveness?
No. The device can be used whenever desired and is not constricted by maximum or minimum attempts.
Is there some sort of a preventive maintenance program to care for the prostheses?
Are training classes provided on how to use the prosthesis?
The patient returns 4 to 8 weeks following the procedure to learn how to activate the device for the first time with Dr. Eid. You will be initially trained on how to deflate the device. Once this is achieved, you will then be trained on how to inflate the device. The longer one waits after the surgery, the easier it is to learn how to use it. It is not unusual for patients to need several visits before learning how to use it. After you have learned how to deflate it, you will be required to cycle the device at home everyday until you are comfortable with its use. You may at this point only begin to use it.
Does the use of prescription drugs and insulin affect: a) the healing process and/or b) the longevity of the prostheses or c) it's effectiveness in terms of routine use, say once or twice per week.
No it does not.
Does the prostheses always work? If not, is the prostheses removed or is there a corrective procedure that can be tested before removal is considered?
Mechanical malfunction has occurred in two patients out of our first 1089 prosthesis within the first 5 years. Most will last 8 to 12 years. The more often it is used the more likely it will fail. When the prosthesis malfunctions it is easily replaced. Replacement is much easier and causes much less discomfort. Expect a minimum of 8 years enjoyment from a penile prosthesis without malfunction. Most will get 10 to 15 years and some are now over 18 years into their device.
Diabetics are prone to infection and/or long healing process. Is this condition troubling in the prosthesis procedure?
In our hands diabetic men have fewer infections than non-diabetics. The reason for this observation is unknown. One explanation is perhaps that diabetics have decreased blood flow to the penis and therefore bleed less during surgery. Collection or accumulation of blood (hematoma) in the cavity of the scrotum increases the risk of infection and this is less likely to occur in patients with poor circulation.
Can the Artificial Urinary Sphincter and the Internal Penile Pump procedure be done simultaneously or one after the other?
Many of our patients have received the sphincter and the penile prosthesis at the same time but experience with these simultaneous procedures has taught us that it is preferable to do the penile prosthesis first, followed by the sphincter. (see previous section on this topic)
After having the implant, will I have a normal ejaculation of sperm during sex? How is that affected if at all?
Erection, orgasm and ejaculation are three independent functions. Men who are impotent from vascular causes continue to have an orgasm and ejaculation with a soft penis. Therefore, restoring erections with prosthesis in that individual will result in a patient that continues to have an orgasm and ejaculation. Patients have fathered children with an implant.
A patient suffering from ED following radical prostatectomy or radiation therapy loses the ability to have erections and ejaculation. Therefore an implant in that scenario will result in a patient that has an erection and orgasm but no ejaculation.
Will the insertion of the pump hinder my physical activity in any way?
Generally you will be able to participate in all physical activities without any limitations whatsoever. Obviously some caution is advised as would be with any other procedure. If cycling is involved, the positioning of the pump is crucial. You will need to change your bicycle seat to a wider one with a gap in the middle. Swimming is not an issue either.
I have heard of semi-rigid implants as an option. How does this treatment option compare to the IPP?
Rigid implants were most popular in the 70’s prior to the introduction of inflatable devices. They remain the preferred implant of Urologists who perform very few implants per year. There are several drawbacks associated with semi-rigid implants that are not present with inflatable implants. Semi-rigid implants can result in less than optimum erections and the penis tends to swivel. These implants also result in a rather poor flaccid penis, making it difficult to conceal. As the device is not as flexible as an inflatable pump, a larger cut on the penis is required to insert it and the possibility of bleeding, hematoma, infection, and numbness is increased. The pain and discomfort that result after the procedure are significantly more pronounced with a rigid device than an inflatable one. The pain lasts much longer, 4 to 6 weeks after the procedure. Finally, rigid prostheses are more likely to extrude through the skin several years later since they are always hard and provide constant pressure on the head of the penis. Eventually, the flesh of the head of the penis over the tip of the device becomes thinner and loses sensitivity. Dr. Eid prefers to use of this device only for patients who cannot manipulate the pump, whether due to severe arthritis or neurological disorder. A rigid prosthesis may also be used for revision surgery after infection has occurred, where it serves as a temporary stent to maintain penile length and girth. Finally, penises with an inflatable penile implant look and feel normal, whereas a penis with a rigid penile implant looks and feels abnormal. Currently, fewer than 20% of implants performed in the United States are of the rigid type.
I had a vasectomy over 20 years ago. Does that in any way cause a problem with this procedure?
No it does not.
Is circumcision necessary for the IPP procedure?
Circumcision is not necessary to have a pump placed. We therefore do not recommend circumcision and as a matter of fact we discourage it. Our philosophy is only to do what is absolutely necessary and indicated. Less is better when it comes to penile procedures.
I have a heart condition and rely on the use of a defibrillator. How will this affect the procedure?
In the medical clearance note obtained from your cardiologist, the model and type of your defibrillator will be identified. This information is forwarded to our Cardiac Physiology/Telemetry unit and a reservation is made for a technician/nurse to come to the OR to deactivate your defibrillator prior to the procedure. It is reactivated prior to returning to the recovery room. The defibrillator needs to be deactivated so that we may use the electric knife during the procedure (routinely performed in order to stop bleeding).
Since a foreign object is being placed within the body, is there a problem with adverse reactions where it would have to be removed or has it ever been rejected?
The body will not reject the device unless it is infected. In Dr. Eid’s hands in over 3,000 cases, the risk of infection is 1%. If it is infected the entire device will need to be removed, the patient will need strong antibiotics and it is replaced it with another temporary rigid implant. Please see information on the No-Touch Technique invented by Dr. Eid and utilized routinely for every case.
Is the procedure accomplished under general or local anesthetic?
Dr. Eid’s preference is spinal anesthesia as it dilates the penis prior to the procedure and provides for prolonged pain relief after the procedure is finished. It is also very safe and easily performed by the anesthesiologist. However, this procedure may also be performed with general or epidural anesthesia. Dr. Eid will generally let the anesthesiologist and patient decide.
How long will it take me to reach the New York-Presbyterian Hospital or the Center for Specialty Care from an airport, and how much will it cost for car service?
The Hospital and the Center for Specialty care are both about 45 minutes by cab from LaGuardia Airport, and will cost about $30.00. It is about 60-90 minutes from both JFK and Newark airports. A cab from JFK will cost $35.00 plus tax, and a cab from Newark can cost up to $60.00.
Is it a hospital only procedure or is it done in an outpatient setting?
Both patients with Medicare and other major insurances are required to do the procedure as outpatient, unless overnight observation is medically necessary. For patients with insurances that the surgery center participates with, it will be performed as outpatient. You are discharged to your hotel that afternoon.
Under what circumstances will this procedure be covered by medical insurance?
Coverage of this procedure by medical insurance depends more on your insurance policy. Medicare covers it completely except for the co-pay. Others will cover if it is in their contract and depending on cause of ED: Vascular (Diabetes, Hypertension, Hypercholesterolemia, Tobacco, Coronary artery disease) or related to cancer surgery/treatment (prostate, colon, bladder, etc...).
Will I have normal feeling after the procedure?
Sensation is preserved after the insertion of the Internal Penile Pump. You will have the same feeling you had before the procedure, which means that you will have a normal orgasm as well.
What is the lifespan of the Internal Penile Pump (inflatable penile prosthesis)?
The pump typically lasts for 8-15 years, on average, and has been known to last for up to 18 years. The pump also comes with a lifetime warranty for replacement.
How many appointments will I need after the procedure?
Three sutures need to be removed 10 to 14 days after the procedure at which time you will be instructed on what to do next. You therefore need to return one more time to NY for this, or, if you have a friendly Urologist in your area, this may be done locally. As soon as you are able to cycle the device without discomfort you may start sexual activity (3 to 4 weeks).
How long does the IPP procedure take to complete?
The procedure usually takes 45 to 90 minutes.
I use Medicare as my primary insurance. Where would the procedure be performed?
The procedure is performed as outpatient at the Manhattan Eye and Ear Ambulatory Hospital, the Center for Specialty Care or at the Lenox Hill Hospital. You need to arrive in New York the day prior the procedure and meet with me so that a physical examination and pre-operative testing are performed. You will be receiving a list of hotels that are next to our facilities or Hospitals and it is recommended but not absolutely necessary that you remain in NYC for a least three nights. You will be staying at the Hospital on the night of the procedure only if you suffer from severe sleep apnea or cardiac insufficiency and discharged on in the morning and you may return home two days later.
How far in advance do I need to plan for the Internal Penile Pump procedure?
In order to have the procedure performed, you need to make a reservation four to six weeks prior to your preferred date.