54416 Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis at the same operative session

Name of the Procedure:

Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis

Summary

This procedure involves the removal of a damaged or malfunctioning penile prosthesis and the insertion of a new one. Penile prostheses are devices implanted within the penis to allow men with erectile dysfunction to achieve an erection.

Purpose

The procedure addresses severe erectile dysfunction that has not responded to other treatments. The goal is to restore the patient's ability to achieve and maintain an erection sufficient for sexual intercourse.

Indications

• Severe erectile dysfunction unresponsive to medications or other treatments.
• Mechanical failure or infection of an existing penile prosthesis.
• Patient desire for prosthesis replacement to improve functionality or satisfaction.

Preparation

• Patients are usually required to fast (no food or drink) for 8 hours before the procedure.
• Adjustments to medications, such as blood thinners, may be necessary.
• Preoperative blood tests, urine tests, and possibly imaging studies to assess the prosthesis.

Procedure Description

1. Anesthesia is administered, typically general or spinal anesthesia.
2. An incision is made to access the existing prosthesis.
3. The malfunctioning or infected prosthesis is carefully removed.
4. The new prosthesis, either semi-rigid or inflatable, is then implanted.
   • Semi-rigid prosthesis: flexible rods are inserted into the penile tissue.
   • Inflatable prosthesis: inflatable cylinders are placed in the penis, connected to a pump in the scrotum.
5. The incision is closed with sutures.
6. The procedure is completed, and the patient is monitored as the anesthesia wears off.

Duration

The procedure typically takes about 1-2 hours.

Setting

The procedure is usually performed in a hospital operating room or a surgical center.

Personnel

• Urologist or specialized surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding or hematoma
• Mechanical failure of the new prosthesis
• Pain or discomfort
• Scarring
• Anesthesia-related risks

Benefits

• Restoration of erectile function
• Improved quality of life and sexual satisfaction
• Benefits can be realized immediately after recovery, usually within a few weeks.

Recovery

• Post-procedure care includes pain management, antibiotics to prevent infection, and instructions on wound care.
• Patients may need to refrain from sexual activity and strenuous activities for several weeks.
• Follow-up appointments to monitor healing and prosthesis function.

Alternatives

• Oral medications (PDE5 inhibitors) like sildenafil.
• Vacuum erection devices.
• Intracavernosal injections or urethral suppositories.
• Lifestyle modifications and psychotherapy.
  • Pros of alternatives: Non-surgical, less invasive.
  • Cons of alternatives: May be less effective for severe erectile dysfunction, temporary solution.

Patient Experience

Patients may experience mild to moderate pain and swelling immediately after the procedure, which can be managed with prescribed pain medication. Adjustments to the new implant and instructions on its operation will be provided. Most patients can return to normal physical activities within 4-6 weeks.

This markdown layout provides a comprehensive and patient-friendly overview of the procedure for removal and replacement of a penile prosthesis.