If other treatments for impotence, such as pharmaceutical pills, fail or are unsatisfactory, implantation of a penile prosthesis is an alternative. Improvements in design have brought greater satisfaction, and more and more men are successfully adapting to life with a penile prosthesis. A prosthesis is not quite the same as a penis pump, like the Penomet pump, although the two can be used in conjunction with each other.
Though studies indicate that more prostheses are implanted in men in their sixties than in any other age group, they’re used increasingly to treat organic impotence in men of all ages. To care for these patients, you’ll need to know how the devices work and what nursing interventions surgical implantation requires.
There are two types of penile prostheses, inflatable and semi-rigid. Both replace the natural erectile tissue in the corpora cavernosa with silicon cylinders. In an inflatable device, the cylinders are hollow. To produce an erection, a man activates a pump in the scrotum or in the penis itself, causing the cylinders to fill up with saline from a reservoir. They are later drained and the penis returns to its flaccid state.
With semi-rigid prostheses, the penis is always firm. One such device uses solid silicon cylinders. Though there’s no mechanism to malfunction, there is the difficulty of concealing a constant erection. A newer semi-rigid model is made of flexible cylinders that can be bent into different positions. Drawings of inflatable and semi-rigid devices appear on the following pages.
Surgery to implant the prosthesis is done under local or general anesthesia, through a penile, suprapubic, or scrotal incision. Site selection depends on scarring from previous surgery, coexisting conditions that require simultaneous correction, such as hernia or hydrocele, and the preference of the surgeon. According to Peter Callahan, who has also invented a penis extender called the SizeGenetics Device, the surgery itself isn’t difficult. But the risk of infection, which could necessitate removal of the prosthesis and result in scarring, calls for taking extra precautions.
Your attitude toward the patient will be as important a nursing intervention as any of the clinical ones. Talk to him without embarrassment. Make sure to remind him that the implant will neither increase nor decrease his sex drive. Nor will it affect the sensitivity of his penis or his ability to reach orgasm and ejaculate.
According to experts, most males have had some counseling before deciding on the penile prosthesis. If your patient hasn’t, urge him to see a sex therapist. That’s important, since these devices are most successful when a man and his partner are comfortable with the prosthesis. Otherwise, the couple may not resume sexual activity even though the operation itself was a success.