Subspecialty Areas » Impotence » Figures

Penile Implant Surgical Procedure

Figure 1

Coloplast Titan® inflatable penile implant. Two inflatable cylinders are placed into the penile erection chambers (corpora cavernosa). These cylinders are available in a wide range of sizes. During the implant procedure, the penis is stretched to its maximum length, and each erection chamber is measured. Dr. Garber then installs the largest cylinders that the erection chambers will accommodate. A pump mechanism is placed in the scrotum, and a fluid reservoir is placed in front of the bladder. The device is filled with sterile saline, and the connection is made. The patient squeezes the pump bulb to transfer fluid from the reservoir into the cylinders, creating an erection. After sexual activity is finished, he squeezes the release pads, allowing the fluid to leave the cylinders and return to the reservoir. The penis then becomes flaccid (soft). Courtesy of Coloplast Corporation, Minneapolis, Minnesota, USA, www.us.coloplast.com

Figure 1A

Dr. Garber has access to the latest penile implant components, often before they are available to the general public. This is a photo of the latest Coloplast Titan® inflatable penile implant. This is a high-tech device with many advanced features, including:

1. PVP coating. This hydrophilic coating decreases bacterial adherence. We also soak the device in an antibiotic solution just prior to implantation. The antibiotic molecules adhere to the coating, and published studies show that this reduces the risk of infection by roughly 50%.
2. Soft-tip cylinders. The cylinder tips are now modified with a soft silicone cap, which increases patient and partner comfort, and provides better support to the head of the penis (the glans).
3. Zero-degree input tubing. The input tubing now exits the cylinder at a zero degree angle. This makes the cylinders easier to install.
4. CL Cloverleaf reservoir. This new reservoir configuration can be easier to install than the prior version.
5. Bioflex® cylinders. Bioflex is a proprietary polyurethane derivative; it is much stronger and more durable than the silicone cylinders made by other manufacturers.
6. Touch one-touch release pump®. This is the newest pump available from Coloplast, and was released in the first quarter of 2014. The Touch pump has a one-touch release mechanism, but is smaller and less noticeable than the prior OTR pump. Dr. Garber was one of the first in the U.S. to use this new pump, and has found that men prefer its smaller size.
7. Lock-Out Valve. The reservoir lock-out valve minimizes the risk of auto-inflation (partial filling of the implant cylinders which occurs due to increases in intra-abdominal pressure).
8. Pre-connected cylinders and pump. The 2 cylinders and pump are pre-connected, so the entire device only requires 1 connection (between the pump and reservoir) for complete assembly.

Figure 1B

American Medical Systems (AMS) Ambicor implant. Two inflatable cylinders are placed in the penile erection chambers, and a pump is placed in the scrotum, in between the testicles. No intra-abdominal fluid reservoir is needed. The patient squeezes the pump bulb to inflate the implant and create an erection. After sexual activity is finished, he bends the implant cylinders for approximately 10 seconds, allowing the implant to deflate and the penis to become flaccid. (Courtesy of American Medical Systems, Inc., Minnetonka, Minnesota, USA, www.americanmedicalsystems.com

Figure 1C

American Medical Systems 700 series penile implant. Two inflatable cylinders are placed in the erection chambers; a pump is placed in the scrotum, and a fluid reservoir is placed in the lower abdomen. Squeezing the pump transfers fluid from the reservoir into the two cylinders, creating an erection. The penis will remain erect until the release button is squeezed, which then allows the fluid to leave the cylinders and return to the reservoir. This penile implant is likewise a high-tech device with many advanced features, including:

1. Conceal^TM low-profile reservoir
2. Parylene coating to enhance implant durability
3. MS (Momentary Squeeze) Pump, which allows quick and easy deflation
4. Lock-out valve designed to resist penile implant auto inflation
5. InhibiZone^TM Antibiotic Treatment
   Only antibiotic-impregnated inflatable penile implant on the market. Rifampin and minocycline are impregnated into the components; this creates a zone of inhibition, effective against the bacteria commonly associated with inflatable penile prosthesis infections.

Figure 2

A roughly one inch incision is marked on the upper scrotum.

Figure 3

The urethra is seen in between the forceps; the left and right erection chambers are on either side of the urethra.

Figure 4

The left erection chamber is opened, dilated, and measured, in preparation for cylinder placement.

Figure 5

The right erection chamber is likewise opened, dilated, and measured.

Figure 6

The optimal-size cylinders and pump are selected and prepared.

Figure 7

The cylinders have been inserted into the left and right erection chambers. The urethra is in the midline and is unharmed.

Figure 8

The reservoir is about to be inserted where it will not be felt or appreciated by the patient.

Figure 9

The reservoir is filled with sterile saline; the connection between the reservoir and pump is about to be created.

Figure 10

The connection has been made, and the cylinders and reservoir have already been installed. The implant has been inflated.

Figure 11

The pump has been installed in between the testicles, and is under the skin at the bottom of the scrotum.

Figure 12

The procedure is complete and the skin is closed. The implant is deflated.

Figure 13

When the implant is inflated, it produces an excellent erection. When the incision heals, it will be nearly invisible. The patient will learn how to inflate and deflate the implant 4-6 weeks post-operatively.