15 most common questions that you SHOULD ask your surgeon

Do you have an upcoming consultation for a penile implant? Be prepared with the 15 most common questions that you SHOULD ask your surgeon.

1.     How many implants have you performed?

2.     What is your personal infection rate?

3.     Do you perform penoscrotal or infrapubic placement of the implant?

4.     How big of an incision is needed for the surgery?

5.     What are the advantages and disadvantages of AMS vs Coloplast for me specifically?

6.     Do you place a surgical drain?

7.     Do you place a foley catheter?

8.     What sort of anesthesia will I receive?

9.     What kind of pain should I expect after the procedure and what protocol will be used for pain control?

10.  Do you have patients spend one night in the hospital after surgery?

11.  How long should I take off from work?

12.  Do you instruct patients to cycle the device in the post-procedure period?

13.  How long before I can resume exercise?

14.  How long before I can resume sexual activity?

15.  Will my insurance cover the surgery?

How many implants have you performed?

            This is an important question to ask your surgeon – generally high volume surgeons tend to have better outcomes and lower complication rates. I typically perform 12-20 implant surgeries a month and have performed over 1100 cases in my career.   

What is your personal infection rate?

            This is the most devasting complication after penile implant surgery. Surprisingly many surgeons will quote infection rates from research studies. I proud to say that I have a very low infection rate. My infection rates is 1% for primary surgeries and 3% for revision surgeries, using a modified minimally invasive, no-touch technique.  

Do you perform penoscrotal or infrapubic placement of the implant?

            Some surgeons exclusively perform one technique, however I do feel that certain men based on their anatomy may find a specific technique advantageous. See this previous blog post. I am very comfortable with the penoscrotal, infrapubic, and subcoronal approaches, however I most commonly use a penoscrotal approach.  

How big of an incision is needed for the surgery?

            Larger incision typically means a longer recovery and healing time. I’m proud to offer a minimally invasive technique that allows us to precisely place the different components of the penile implant through a small 1 inch vertical incision.

What are the advantages and disadvantages of AMS vs Coloplast for me specifically?

            Many surgeons exclusively offer one manufacturer for various reasons. I think its important to understand the subtle differences of each and whether one manufacturer might be a better option for you. See this previous blog post.

Do you place a surgical drain?

            I tend to place a drain on a case by case basis, but for most primary surgeries I do not leave a surgical drain. If a drain is placed usually it remains for <24 hours. The drain is very small closed drain that is relatively simple to manage and remove.

Do you place a foley catheter?

            Many men find a foley or urethral catheter uncomfortable after the surgery. However, about 25% of men after penile implant surgery will develop some degree of urinary retention or difficulty or inability to urinate. For this reason, I typically leave a urinary catheter for <24 hours to allow the bladder to fully wake up after anesthesia. The catheter is placed under anesthesia.

What sort of anesthesia will I receive?

            Most patients will receive general anesthesia during the surgery which is administered by an experienced anesthesia provider. We will not begin any aspect of the procedure until you are completely asleep under general anesthesia. In some men with restrictions with general anesthesia, I will also perform the procedure under spinal anesthesia and even twilight sedation.

What kind of pain should I expect after the procedure and what protocol will be used for pain control?

            Surprisingly, most men will endorse soreness rather than pain with our current protocol. You will receive several different medications for pain management immediately before, during, and after surgery. Additionally, I provide a series of numbing blocks during the surgery that can last 24-48 hours after the surgery.  

Do you have patients spend one night in the hospital after surgery?

            The majority of patients will discharge home or to local accommodations the day of the surgery. In certain situations, you may need to be admitted overnight (23 hour observation) after your surgery.

How long should I take off from work?

            For those men without a labor intensive job (prolonged standing, heavy lifting, etc) you could return to work even the following day after surgery. However, most men will take off 1-2 weeks after the procedure if they are able. We can assist with necessary paperwork.

Do you instruct patients to cycle the device in the post-procedure period?

            Yes, most patients will be seen 2 weeks after the procedure, when you will begin cycling (inflating and deflating the implant daily). I personally like to see back my patients and provide detailed instructions on cycling. Many high volume surgeons rely on other providers to instruct on cycling or provide no guidance at all, but I feel this is the most frustrating aspect of post-operative recovery for most men and where they need the most support. I find it rewarding to guide you through the whole process.  

How long before I can resume exercise?

            A conservative estimate will be around 4 weeks, although some men may be cleared for certain types of exercise within 2 weeks of the procedure. Everyone heals differently after the procedure so resuming exercise must be personalized.

How long before I can resume sexual activity?

            Most patients can resume sexual activity within 4-6 weeks of the procedure depending on healing and recovery.

Will my insurance cover the surgery?

            Many men are surprised to learn that the penile implant surgery is covered by insurance including Medicare. Many commercial insurances may require a statement of “medical necessity.” Thankfully, given the volume of surgeries we perform, our team is very well equipped to work with you and your insurance to ensure coverage for your procedure if applicable.

Ready to learn more or take the next step. Seek out a true expert - contact me for a consultation.

-Dr. Patel