Today we will be discussing home care following placement of a penile prosthesis through an infra-pubic approach. I suggest you write them down as we go along.

1) Keep the area clean and dry for 48 hours. Patients may shower with no direct water to the wound after 48 hours.

2) Any penile dressing should be removed after 24 hours.

3) Ice should be applied for the first five days, at least three times daily for 20 minutes each time.

4) If a bulb draining system is utilized for the first 23 hours, this will be removed in the hospital office or in your home.

5) A pressure bag will be placed on the pubic bone for the first two hours after surgery. After that, if the drainage is brisk (meaning more than 150cc per eight hours) then we will continue to maintain that pressure.

6) The penis should be maintained against the abdomen for the first 48 hours.

7) If a scrotal support is utilized, you can remove it after 48 hours.

`8) After 48 hours the patient should begin gently pulling down on his penis at least three times a day.

9) Non-diabetics begin hot shower soaks after five days (diabetics after seven days) at least three times daily for 20 minutes, followed by ice for 20 minutes.

10) If the patient has visible sutures or staples, they should be removed at 7-10 days.

11) Patients should begin deep tissue massage of the incision after 10 days.

12) Patients should be gently pulling down on the scrotal pump as soon as they can tolerate.

13) Patients should begin finding the deflate mechanism when pulling down on their pump as soon as this can be tolerated.

14) Patient should not cycle the implant until advised by the doctor.

15) Calls to the surgeon should include but not be limited to: bulb drainage that is excessive (meaning more than 150cc per eight hours); a temperature greater than 101.5 degrees; skin that appears red or hot; any drainage from the wound; swelling that goes up instead of down in any 24 hour period; any difficulty voiding; blood in the urine.

16) Narcotics cause constipation. Patients should utilize over the counter mechanisms to avoid this problem. The surgeon should be notified if these remedies prove ineffective.

17) If anti-inflammatories are advised, these may be utilized during the post-operative period as long as they are taken with food and plenty of water.

After more than 4,000 implants I have some pearls to offer you that I find helpful to all of my patients.

1) Expect the pump to be hard at the beginning. This will soften up over time. I advise patients to use two thumbs to inflate their implant in order to provide the physiologic erection they used to have.

2) Some patients develop more fluid around the pump in the immediate postoperative period. This will eventually dissipate with time and is expedited by deep tissue massage.

3) When the cylinders are completely deflated, you may feel the folds of the cylinders (sometimes called “dog ears”). Over time they will become less noticeable and you will learn how to make them discrete when partially inflating your implant.

4) Leaving the implant inflated will result in pain in the tip of the penis and oftentimes difficulty with ejaculation.

5) When given permission, cycling the implant daily is your best means for enjoying your implant.

6) Make sure that your testosterone levels are normal. This allows you to maximize your ability to enjoy your implant.

7) Your doctor should check your list of medications to ensure that you are not on any medication that inhibits ejaculation.

Remember, nothing is better than the penis that you used to have when it functioned properly. Treat your new penis like a sports-related injury and do everything you can to maximize the benefits of your repair.

Assuming your implant was placed appropriately, you should be rewarded with the ability to be intimate again when all else has failed in the past.
 
Thank you again.

At the SEASAUA meeting in March, 2012 on Amelia Island, world-renowned penile implant surgeon Dr. Paul Perito presented an abstract to attendees regarding the alternative reservoir placement option to under-fill the new Titan® Cloverleaf reservoir for ectopic placement. Also during the month of March, Dr. Paul E. Perito was recognized by Coloplast for his Minimally Invasive Penile Implant Surgery Technique and for his many contributions to the advancement of prosthetic urology. Coloplast honored Dr. Perito with a plaque that proclaimed him to be “The Single Largest Penile Implant Surgeon In the World.”

ABSTRACT: Alternative Reservoir Placement Option to Under-fill New Titan® Cloverleaf Reservoir for Ectopic Placement

Paul Perito, MD FACS (Miami, FL), Edward Gheiler, MD FACS, , Steven K Wilson, MD FACS FRCS

Introduction: Increasing data suggests desire for reservoir placement outside of traditional retroperitoneal space. Flexibility in reservoir placement is imperative for implanters due to variance in patient anatomy. We studied whether the new Coloplast Titan® geometric cloverleaf shaped reservoir (CL) allows ease of alternative placement in non-traditional reservoir location and underfilling capability, maintaining abdominal surface aesthetics in patients.  We compared to traditional reservoir placement.

Methods:  Two experienced implanters placed 30 CL during standard IPP procedures over a two-week period (3/11).  The infrapubic (67%) reservoirs were placed ectopically — anterior to transversalis fascia but posterior to abdominal wall muscles.  The penoscrotal (33%) CL were placed in traditional retroperitoneal space. Cylinder size was similar –18.6cm penoscrotal and 19.3cm infrapubic.  Both sites used nominal Rear Tip Extenders to maximize cylinder capacity.  Both groups of patients were assessed at 6 weeks for auto-inflation and palpable reservoir.

Results: 13 (43%) 75cc and 17 (57%) 125cc CL were placed. Average fill volumes of the two CL sizes was 69ccm (75cc) & 79cc (125cc).  To maximize erection, varying degrees of fluid were left in cylinders, depending on cylinder size and reservoir level. An average of 9.8cc and 14.9cc remained in cylinders for 75cc and 125cc reservoir procedures, respectively.   There were no auto-inflation or patient palpation problems in either group.

Conclusions: The Cloverleaf design of the new Titan reservoir seems to lend itself to flexibility in fill levels providing the option of ectopic placement without palpable abdominal evidence

For more information about the Minimally Invasive Penile Implant Technique visit Dr. Paul Perito online at www.peritourology.com

According to Dr. Paul E. Perito, men who have experienced the loss of one or more testicles can restore the cosmetic look of their genitalia with a simple surgical procedure.

Beginning in the testicles, testicular cancer germinates from the cells that produce sperm and can affect a man’s entire reproductive system, says Dr. Paul E. Perito. This form of cancer is prevalent in Caucasian men and is the most common form of cancer in males 15 to 35. According to Dr. Paul E. Perito there are two specific types of testicular cancer: seminomas and non-seminomas. Seminomas cancer grows slowly, and is sensitive to radiation therapy while non-seminomas is more aggressive and involves multiple types of cells, reports Dr. Paul E. Perito.

Dr. Paul E. Perito notes that there are a variety of treatment options available to treat testicular cancer including radiation, chemotherapy and orchiectomy (surgical removal of the testes.) The latter procedure halts the body’s production of testosterone. However, men who have their testicles removed face issues of self-consciousness and poor self-esteem, as it also leaves the genital area with an unnatural look, reports Dr. Paul E. Perito.

Fortunately, reports Dr. Paul E. Perito, advancements in medicine have allowed for a procedure that utilizes a silicone and saline implant to restore the aesthetic appearance of the testicles. The implants are safe, and although they do not restore a man’s sperm producing capabilities, often they will restore his self-confidence which will lead to more satisfying sex life postoperatively, says Dr. Paul E. Perito. According to Dr. Paul E. Perito, testicular prostheses have been around for over half a century and have changed dramatically over the years. The first testicular implant, in 1939, was made of vitallium – a metal alloy. In 1997, a panel of medical and scientific professionals proved that saline-filled prostheses were safe to implant into the scrotum, reports Dr. Paul E. Perito.

The procedure to place a testis prosthesis is performed under local anesthesia on an outpatient basis. Dr. Paul E. Perito notes that the procedure takes less than 15 minutes and involves a small incision in the scrotum for device placement. The prosthetic is cleaned with a bath of strong antibiotic solution and then filled with saline and placed into the scrotum. At the close of surgery, Dr. Paul E. Perito says that the surgeon will thoroughly rinse the area with a solution of antibiotics and carefully close the incision.

Postoperatively, patients are advised to rest for the first 24 hours and cover the area with ice. Dr. Paul E. Perito insists on no heavy lifting or strenuous activity, including sex, for the following week. Also to minimize risk of infection on the incision patients are advised to avoid soaking baths for at least ten days.

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Dr. Paul E. Perito graduated from the University Of Maryland School Of Medicine in 1988. His Coral Gables, Florida, urology center, Perito Urology, draws patients from around the globe for its innovative and updated Erectile Dysfunction treatments. Having successfully performed over 3,000 penile implants since 2005, Dr. Paul E. Perito is considered a leader in the field. His signature minimally invasive technique, The Perito Approach, has been taught to surgeons worldwide through travel and at Coral Gables Hospital, where he is Director of Urology. Dr. Paul E Perito has participated in countless medical studies in his quest to simplify the penile implant process and make the procedure safer for his patients.

The information contained above is provided by Dr. Paul E. Perito for educational purposes only. It is not intended to treat or diagnose any condition.

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