Name of the Procedure:

Prosthesis, penile, inflatable (HCPCS Code: C1813)
Common Names: Inflatable penile prosthesis (IPP) implantation, Penile implant surgery

Summary

An inflatable penile prosthesis is a surgical procedure in which a device is inserted into the penis to allow men with erectile dysfunction to achieve an erection. This device is inflated manually by the patient to create an erection strong enough for sexual intercourse.

Purpose

Medical Conditions:

• Erectile dysfunction (ED), especially when unresponsive to medications like Viagra or Cialis.

Goals:

• Enable men to achieve and maintain an erection sufficient for sexual activity.
• Improve sexual satisfaction and overall quality of life.

Indications

Specific Symptoms or Conditions:

• Severe erectile dysfunction resistant to other treatments.
• Peyronie's disease with ED.
• Post-prostatectomy erectile issues.

Patient Criteria:

• Men who have not responded to more conservative treatments (medications, vacuum devices).
• Motivated and informed patients willing and fit for surgery.

Preparation

Pre-procedure Instructions:

• Fasting for 8 hours before surgery.
• Cease certain medications like blood thinners under a doctor's guidance.
• Get preoperative clearance from a cardiologist if necessary.

Diagnostic Tests:

• Complete medical evaluation including blood tests.
• Consultation with a urologist.
• Possibly penile doppler ultrasound to evaluate penile blood flow.

Procedure Description

Step-by-Step:

1. Anesthesia: Administered general or spinal anesthesia.
2. Incision: A small incision is made in the lower abdomen, base of the penis, or scrotum.
3. Implant Insertion: Cylindrical prostheses are inserted into the penile shaft, a pump into the scrotum, and a fluid reservoir in the lower abdomen.
4. Closure: The incisions are closed with sutures.

Tools and Equipment:

• Inflatable penile prosthesis device (cylinders, pump, reservoir).
• Surgical instruments for incision and implantation.

Anesthesia:

• General or regional anesthesia.

Duration

• The surgery typically takes about 1 to 2 hours.

Setting

• Usually performed in a hospital or outpatient surgical center.

Personnel

• Urologist or specialized surgeon.
• Anesthesiologist.
• Surgical nurses and assistants.

Risks and Complications

Common Risks:

• Infection
• Device malfunction

Rare Risks:

• Bleeding
• Persistent pain
• Mechanical failure of the device
• Erosion of the prosthesis through the skin

Management:

• Most complications can be managed with additional surgery or antibiotics.

Benefits

• Restoration of erectile function.
• High satisfaction rates for both patients and partners.
• Long-term solution for erectile dysfunction.

Recovery

Post-procedure Care:

• Antibiotics and pain management medications.
• Instructions on how to use the inflatable device after a recovery period.
• Wear a support garment for comfort and to reduce swelling.

Recovery Time:

• Initial recovery in 1-2 weeks.
• Full recovery with resumption of sexual activity in about 4-6 weeks.
• Follow-up appointments for evaluation and training on device use.

Alternatives

Other Treatment Options:

• Oral medications (e.g., PDE5 inhibitors like Viagra).
• Intracavernosal injections.
• Vacuum erection devices.
• Other types of penile implants (e.g., malleable rods).

Pros and Cons:

• Medications and vacuum devices are nonsurgical but may not work for severe cases.
• Malleable rods are less complex but don't offer the natural feel of inflation.

Patient Experience

During Procedure:

• Under anesthesia, patient will not feel pain during the surgery.

After Procedure:

• Some pain and swelling for about 1-2 weeks.
• Pain managed with prescribed medications.
• Gradual return to normal activities including sexual function within 4-6 weeks.

Comfort Measures:

• Pain medications.
• Supportive garments.
• Detailed post-operative care instructions to manage discomfort effectively.