Operative note 34 Advanced
Penile prosthesis
What it does: implants to restore erections.
malleable rods
- Approach: above pubis, peno-scrotal, or under the glans. Lateral cut in the tunica, 2.5-4 cm.
- Dilate each corpus with Hegars.
- DANGER 1, far end: dilator tips onto the sitting bone. Commonest perforation site.
- DANGER 2, near end: advance SIDEWAYS. Straight-on = crooked rod (SST look).
- Hard to dilate? Wrong plane, cross-over, or perforation. Stop and think.
- Measure. Between sizes: take the SHORTER.
- Antibiotic wash. Rods in, rear tips on.
- Tunica closed 4/0.
inflatable, 3 pieces
- Same access. Cylinders via a glans needle tool.
- Pump in a scrotal pocket, dominant hand side.
- Balloon behind the rectus, via the groin floor: through the external ring, cord kept lateral, then transversalis. Bladder empty first. Space big enough: no more than 5 mL drains back, or it self-inflates.
- Cycle on the table. Leave empty.
- First activation 4-6 weeks.
Perforation rules
- Near-end perforation, 1st side: stop. Redo in 6 weeks.
- 2nd side: repair. Rod on the good side. Or abandon, wash out.
- 2026 update: Coated implants + no-touch: fewer infections.
- 2026 update: Classic numbers still quoted: infection up to 10% in diabetics. Satisfaction 79-92% inflatable.
From the UroRef Operative Quick Guide.