Inflatable Penile Prosthesis Surgery Recovery

Essential Post-operative physiotherapy

Dr Rados P. Djinovic Urogenital Reconstructive Surgeon

Questions about physiotherapy following surgical implantation of an inflatable penile prosthesis (IPP), answered by Dr. Rados P. Djinovic MD, Chairman of the Genitourinary Reconstructive Surgeons Section (ESGURS) of the European Association of Urology (EAU), with additional details by Dr. Nikola I. Stanojević MD.

1) How many days after surgery should a total phalloplasty stage three patient leave the inflatable penile prosthesis erect at the percentage of inflation set by the surgeon?

About 3-4 weeks.

Dr Nikola I. Stanojevic Urogenital Reconstructive Surgeon

It varies from case to case but about 3-4 weeks.

2) Must the penis be kept constantly in an upright position from the day of surgery until the first deflation?

As much as possible.

Yes!

3) How many days after surgery should a total phalloplasty stage three patient experience swelling and pain in the scrotum?

A few weeks.

As little as one week if all is OK, 2-3 weeks if hematoma or edema occurs.

4) How many days after surgery should a total phalloplasty stage three patient expect to have difficulty urinating?

A few weeks.

Until full deflation of prosthesis (4-5 weeks, sometimes more, sometimes less).

5) What can a patient do to assist with complete voiding of urine?

Nothing much. He should only empty urethra well after voiding by milking it.

Right, not much you can do unless you use a catheter.

6) Do total phalloplasty stage three patients return home still with a catheter in place? if so, when should it be removed?

Usually after 5-7 days.

Yes they do for 1-2 weeks after surgery.

7) How many days after surgery should the total phalloplasty stage three patient deflate the inflatable penile prosthesis for the first time?

3-4 weeks.

About three weeks after surgery, depending on the patient. Advice is specific for every patient.

8) After deflating the penile prosthesis for the first time, what is the next post-op physiotherapy step?

To keep it inflated as often as they can during the day and in the proper, upright position.

Go through the inflate/deflate cycle, 2-3 times a day — gently at the start, fully after 5-6 weeks post-op). If needed because the penis is bent due to excessive scarring, massage with skin creams.” (see

  • “Skin Elasticity vs. Softness, Smoothness, Tenderness”

    9) Do total phalloplasty stage three patients need to do cycling of their inflatable penile prosthesis?

    Yes.

    10) If so, how many days after surgery should the patient start cycling?

    3-4 weeks.

    It is patient specific. See my answer to question about: ‘After deflating the penile prosthesis for the first time’.

    Dr Stanojevic presentation to European Association of Urology Congress in Madrid, March 2015

    11) How many hours per day should the inflatable penile prosthesis be kept fully erect after the first time it has been deflated after surgery?

    As much as they can during the first 5-6 months, but a minimum of two hours each day.

    At the start, 15-30 minutes fully erect at one time then deflate, repeated several times a day.

    12) How many days after surgery can a total phalloplasty stage three patient being having sexual intercourse?

    After 2 months — at the earliest.

    This is also patient specific but usually not sooner than about eight weeks post-op.

    13) How many times must a total phalloplasty stage three patient pump a penile prosthesis to achieve 100% inflation of the implant?

    About 5-10 times, depending on prothesis size.

    • for a 15cm (5.9 inch) penile prosthesis, pump 5-6 times;
    • for an 18cm (7 inch) 2-piece or 3-piece inflatable penile pump implant, pump 6-8 times; and
    • for a 21 cm (8.3 inch) penis implant, pump 8-10 times, approximately.

    14) How long must a patient press the release valve of a inflatable penile prosthesis to deflate the device?

    Briefly — one second or less.

    Press and release. If needed, press again (and release.)

    15) Does the release valve give any indication it has been activated, such as click?

    No.

    No, but circulating prosthesis fluid can be felt as a indication of the valve opening.

    16) Must the liquid also be manually squeezed out of the prosthesis or will it drain completely unassisted?

    Yes. It goes out of the cylinders spontaneously until the pressure in them is higher then the pressure in reservoir.

    Yes. It will not empty completely by itself.

    17) When should a a total phalloplasty stage three patient send batches of photos of showing healing progress after surgery? Weekly? Monthly?

    After 1 week, 2 weeks and monthly thereafter.

    I like to see photos weekly for 6-8 weeks, then monthly.

    18) If a patient sends photos of healing progress and the doctor detects no problems, will the patient receive a comment back?

    Yes, but usually the person needs to wait until I have time. I answer immediately if i see some problem!!!!

    For me: no problems = no comments.

    19) Does no comment or acknowledgement from the surgeon mean there are no problems?

    Yes.

    See previous answer.

    20) How long must a patient place his penis in an upward position under clothing while hard? When can it be moved and tucked down the side?

    After 3-4 weeks.

    About six weeks, if possible, sometimes perhaps less.

    21) How many days must a a Total Phalloplasty Stage Three patient recover after surgery before returning to work?

    It depends on the work, but usually 2-3 weeks.

    About 2-3 weeks if no problems such as scrotal hematoma/edema.

    22) How many days must a Total Phalloplasty Stage Three patient recover after surgery before returning to work that requires daily heavy lifting?

    4-5 weeks.

    Again, this is patient specific and varies.

    23) What external medicine is recommended by the doctor to prevent infection of wounds after surgery? How long should it be used?

    Just good hygiene.

    You can use an antibiotic ointment up to 10 days. After that no external cream will stop an infection. Choose an ointment without corticosteroids.

    High quality scar reduction cream

    24) Does the surgeon recommend any creams for scar diminishment? If so, how long should it be used?

    Any anti-scarring cream.

    Yes, for 3-6 months. But which one depends on your country and the locally available pharmaceuticals.

    25) Does Dr. Djinovic and Dr. Stanojevic have any other advice, suggestions, warnings, cautions for patients recovering from Total Phalloplasty Stage Three inflatable penile prosthesis implantation?

    Patients should NOT keep the penis bandaged during the healing period, because the capsule that is forming around penile implant could be deformed. Also, if they notice that the penile implant tip is close to the skin — they should contact me and send me photos.

    They key points are:

    1. Handle with care.
    2. Keep your penis clean — wash regularly with soap and water.
    3. Avoid sweating until everything heals up.
    4. Don't leave the IPP deflated for long periods of time.
    5. Cycle regularly.