Name of the Procedure:

Anesthesia for procedures on male genitalia (including open urethral procedures); insertion of penile prosthesis (perineal approach)

Summary

Anesthesia for penile prosthesis insertion involves administering anesthesia to manage pain and discomfort during the surgical placement of a penile prosthesis through a perineal approach. The prosthesis is a device designed to help men with erectile dysfunction achieve and maintain an erection.

Purpose

This procedure addresses severe erectile dysfunction that does not respond to other treatments. The goal is to provide a permanent solution to impotence, allowing for satisfactory sexual intercourse.

Indications

• Severe erectile dysfunction unresponsive to medication or other treatments
• Peyronie's disease with associated erectile dysfunction
• Psychological or physiological conditions causing impotence
• Patients seeking a permanent solution to erectile dysfunction

Preparation

• Fasting for at least 6-8 hours before the procedure.
• Discontinuation of certain medications as advised, such as blood thinners.
• Pre-procedure diagnostic tests including blood tests, EKG, and possibly imaging studies.
• Thorough consultation with the surgical team and anesthesiologist.

Procedure Description

1. The patient will be placed under general or regional anesthesia.
2. Surgical site is sterilized, and an incision is made in the perineal area (the space between the scrotum and the anus).
3. The penile prosthesis, typically an inflatable device, is inserted into the penis.
4. The prosthesis reservoir is placed in the abdomen and the pump in the scrotum.
5. The incision is closed with sutures.
6. Anesthesia is monitored throughout to ensure patient comfort and safety.

Duration

The procedure typically takes 1 to 2 hours.

Setting

This procedure is generally performed in a hospital operating room or a specialized surgical center.

Personnel

• Urologist or specialized surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses
• Operating room technician

Risks and Complications

• Infection
• Bleeding or hematoma formation
• Mechanical failure of the prosthesis
• Injury to surrounding tissues or organs
• Anesthesia-related complications
• Difficulty in urination post-surgery

Benefits

• Restoration of erectile function
• Improved sexual satisfaction and quality of life
• Long-term solution for erectile dysfunction
• Relief from psychological distress and improved self-esteem

Recovery

• Patients may need to stay overnight in the hospital for monitoring.
• Prescribed pain medications and antibiotics to prevent infection.
• Instructions for wound care and activity restrictions.
• Follow-up appointments to monitor healing.
• Most can resume sexual activity 4-6 weeks post-surgery.

Alternatives

• Oral medications (e.g., phosphodiesterase inhibitors)
• Vacuum erection devices
• Intraurethral suppositories or penile injections
• Vascular surgery for erectile dysfunction
• Each alternative has varying success rates and suitability depending on patient condition.

Patient Experience

• Minimal pain expected due to anesthesia during the procedure.
• Post-operative discomfort managed with pain medications.
• Mild swelling and bruising of the area are common.
• Follow a specific activity restriction and care routine to ensure proper healing.