Some patients complain that their penis size has reduced after Penile Prosthesis Surgery. This is not entirely untrue because if the cause of ED is Peyronie's Disease, neglected ischemic priapism, loss of cavernosal smooth muscle or previous radical prostatectomy this may have resulted in tunical scarring or fibrosis that severely limits the elasticity of the tunica albuginea. While not apparent in a flaccid penis, it becomes obvious after a Penile Prosthesis Implant (PPI) has been inserted and inflated.
Secondly, many patients who underwent PPI insertion may have a history of ED lasting many months or years. This could affect the accuracy of their recollection of what their penile sizes were prior to the onset of their condition.
Thirdly, an inflated PPI fills up only the corporal bodies of the penis and has no impact on glanular engorgement, which is a physiological phenomenon in normal erections. This lack of glanular swelling may contribute to the perception of decreased penile size.
Fourthly, men who require PPI are usually in the older age group. As a man ages or puts on weight, the fat in the prepubic region has a tendency to increase and engulf the penile shaft. This phenomenon of a partially “buried penis” may affect the patient’s perception of penile length after PPI.
There is No Shortening If these Precautions are Taken
Patients suffering from ED due to some underlying condition like Peyronie's Disease, neglected ischemic priapism, loss of cavernosal smooth muscle or previous radical prostatectomy will not experience shortening of penile length after PPI if Vaccuum Erection Device is used daily and regularly after Radical Prostatectomy. If VED pumps are used for 2-3 months before the PPI surgery then longer implants can be placed inside the corpus cavernosa.
Another important factor is the choice of the surgeon. Those surgeons who do more than 25-30 surgeries every year are less likely to use smaller implants than those surgeons who do this surgery rarely. Dr Raman Tanwar at GNH Hospital has done more than 600 such surgeries and there is hardly any case of Penile Shortening.
In patients with refractory ischemic priapism and corporal smooth muscle necrosis, where subsequent erectile dysfunction, corporal smooth muscle fibrosis and penile shortening are almost certain. In such cases the Penile Prosthesis should be done immediatly in order to avoid Penile shortening. However the infection rate goes higher when we do immediate Penile Implant surgery in such patients.
Patient’s perception of decreased penile size after PPI can negatively influence overall satisfaction and sexual quality of life measures. Strategies to preserve and potentially increase penile size are of great importance to all implanters.
This 64 Year old British Patient came for Penile Implant Surgery. On the day of discharge he had this to say