Penile prosthetic surgery

The penile prosthesis is a medical device implanted through a surgical procedure in patients with severe organic erectile dysfunction of various origins, not susceptible to pharmacological therapy. In highly selected cases, it can also be performed on psychological patients with an indication validated by a psychiatrist or psychosexologist. The prostheses can also be used to correct congenital or acquired penile anomalies, such as curvature or Peyronie’s disease, and as support in female-to-male gender reassignment surgery. The implant does not alter the turgidity of the glans, penile sensitivity, and orgasm, which therefore remain unchanged by the surgical procedure.

Devices can be divided, based on construction and operating criteria, into two main categories: non-hydraulic and hydraulic. Non-hydraulic prostheses, also called semirigid, include soft prostheses, malleable ones, and mechanical ones (now rarely used). Hydraulic prostheses are divided based on the design and implementation of the inflation mechanism into single-component models (no longer used), two-component, and three-component models. The two-component ones consist of two inflatable cylinders that are inserted inside the two corpora cavernosa and a pump–reservoir placed in the scrotum. The three-component ones have, in addition, a larger reservoir that is inserted into the abdomen, in the pre-vesical space. The latter are preferred because they offer the best result both aesthetically and functionally, offering perfect concealment both when the penis is erect and flaccid, also due to the fact that the implant is carried out through a small scrotal or suprapubic incision perfectly camouflaged. In hydraulic prostheses, whether bi- or tri-component, mechanical erection occurs by activating the pump, placed in the scrotum, which conveys the fluid (saline solution) from the reservoir into the cylinders placed in the two corpora cavernosa, which then become rigid and remain so until detumescence is activated by pressing a micro valve located on the pump itself.

The surgical procedure, technically not demanding, is conducted under spinal or general anesthesia and is performed by me on a Day Hospital basis with admission in the morning and discharge in the early afternoon. The following morning, the urinary catheter will be removed and dressing will be performed. For this reason, patients coming from distant cities are invited to stay in Florence the first night. After three to four days of rest, it will be possible to resume daily activities, avoiding any kind of effort for at least three weeks. Post-operative pain is minimal and further reduced with the help of anti-inflammatory and analgesic drugs. The complication that requires the most attention is infection, which in my case series stands at 2%. For this reason, upon discharge, an oral and intramuscular antibiotic coverage is prescribed for 10 days. The activation of the prosthesis occurs after 4 weeks.

In June 2013, I performed the world’s first simultaneous placement of a penile prosthesis and laparoscopic-robotic prostatectomy.

I am part of the Board of the Italian Society of Andrology, which manages the Italian Prosthesis Registry—http://androprotesi.it/portfolio-items/nicola-mondaini/

Where I perform surgery

• • Villa Donatello (Firenze)

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