Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir
CPT4 code
Name of the Procedure:
Insertion of Multi-Component Inflatable Penile Prosthesis (IPP), including the placement of a pump, cylinders, and a reservoir.
Summary
This surgical procedure involves implanting a device inside the penis to help men with erectile dysfunction achieve an erection. The device consists of inflatable cylinders placed in the penis, a pump located in the scrotum, and a reservoir implanted in the abdomen. When the pump is activated, fluid from the reservoir inflates the cylinders, creating an erection.
Purpose
The procedure addresses erectile dysfunction (ED) that has not responded to other treatments such as medication or therapy. The primary goal is to enable men to achieve and maintain an erection sufficient for sexual intercourse, thus improving quality of life and sexual satisfaction.
Indications
- Severe erectile dysfunction not responsive to oral medications or other treatments.
- Patients seeking a permanent solution for ED.
- Men with Peyronie's disease complicated by ED.
- Psychogenic ED that has not responded to counseling or therapy.
- Specific conditions like spinal cord injuries affecting erectile function.
Preparation
- Complete cessation of food and drink typically 8 hours before surgery.
- Potential adjustment or discontinuation of some medications (e.g., blood thinners).
- Pre-operative assessments such as blood tests, ECG, and a physical examination.
- Discussion with the physician about medical history and any past surgical complications.
Procedure Description
- Anesthesia: General or regional anesthesia is administered.
- Incision: A small incision is made, usually in the lower abdomen or near the base of the penis.
- Cylinder Placement: Inflatable cylinders are inserted into the corpora cavernosa of the penis.
- Pump Placement: The pump is positioned inside the scrotum.
- Reservoir Insertion: The fluid reservoir is placed in the lower abdomen.
- Connection: All components are connected via tubing.
- Closing Incisions: Incisions are sutured closed and dressed.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
The procedure is performed in a hospital surgical suite or a specialized outpatient surgical center.
Personnel
- Urologist or specialized surgeon.
- Surgical nurses.
- Anesthesiologists.
- Surgical technologists.
Risks and Complications
- Infection: Potential for postoperative infection at the surgical site.
- Device malfunction: Possibility of mechanical failure or displacement.
- Pain and swelling: Common initial post-op symptoms managed with medication.
- Scarring: As with any surgical procedure, there may be some scarring.
- Erosion: Rare event where the device can wear through penile tissue.
Benefits
- Reliable and consistent ability to achieve an erection.
- Improved sexual satisfaction and quality of life.
- Long-term solution for men unresponsive to other ED treatments.
- The device is inconspicuous and controlled discretely by the patient.
Recovery
- Initial recovery involves a few days of rest and limited activity.
- Pain and inflammation managed with prescribed painkillers.
- Avoid sexual activity for about 4 to 6 weeks.
- Follow-up appointments to monitor recovery and device function.
- Gradual return to normal activities over several weeks.
Alternatives
- Oral medications such as phosphodiesterase inhibitors (e.g., sildenafil, tadalafil).
- Injection therapy or urethral suppositories.
- Vacuum erection devices (VEDs).
- Lifestyle modifications and counseling.
- Each alternative varies in invasiveness, effectiveness, and patient suitability.
Patient Experience
- During: The procedure is performed under anesthesia, so the patient will be unconscious or sedated.
- After: The patient can expect some pain, swelling, and bruising around the incision sites. Pain management strategies will be utilized.
- Long-term: Most patients report a high satisfaction rate and improved sexual performance. Comfort measures and follow-up care contribute to positive outcomes.
Please consult with a healthcare provider to understand the specifics related to the individual case and receive personalized medical advice.