DEFINITIONS

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• IPP: inflatable penile prosthesis aka the pump implant

• MPP: malleable penile prosthesis aka the rod or semi-rigid implant

• Fever: elevated body temperature; if greater than 101°F, notify your surgeon

• Rash: new red spots that develop on the skin

• Constipation: not having regular bowel movements (example: one large bowel movement per day is expected)

• Erosion: the implant is visible through the skin

• Infection: surgical site that has redness that spreads beyond the incision line combined with increased pain and tissue swelling and/or pus

 

GENERAL INSTRUCTIONS

 

• Activity: Avoid any activity or position that puts strain or tension on your incisions.

  • Examples: sitting on your scrotum especially with the IPP or with newly placed testis implants; putting your thighs close together, compressing your scrotum; plopping into a chair; sit ups, pull ups.

  • For the first 4 weeks, any new activity or position requires checking on your scrotum and repositioning them to make sure no undue pressure is being placed on the implants and incisions. 

    • This will eventually become second nature and you won't have to be as conscientious, although certain activities like riding bikes and sitting directly on your scrotum for prolonged periods of time can lead to a delayed erosion.​

  • Pain is the body’s way of telling you a certain movement or position may inhibit healing; listen to your body and limit those positions and movements.

  • Walking is encouraged (about 1 hour per day; example: six 10-minute walks); check the surgical sites to make sure pressure/tension isn't applied on the incisions while walking.

  • No jogging for 6 weeks; start slowly and gradually increase to your pre-surgery cardio routine.

  • Avoid sexual activity for 8 weeks.

• Return to work: for desk dominant jobs, many can return to work when their pain is well controlled (as early as1-2 days after surgery or 1-3 weeks more commonly). For jobs that are strenuous, 6 weeks off is more appropriate.

• Diet: eat normally whenever your appetite returns. Water is a good drink choice.

• Showering: may shower in 2 days; no baths/pools for 6 weeks.

• Underwear: when wearing underwear, it may be more comfortable to have gauze over the incision. Slightly loose boxer briefs tend to work well. You will typically have mesh underwear after surgery.

• Penis positioning: gently supporting the phallus is ideal and this can be achieved with slightly loose boxer briefs or a similar underwear. Then, using a wash cloth or gauze sponges, position the wash cloth or sponges in between the phallus and scrotum. The goal is to support the anchor site of the penile implant at your pubic bone. Don’t smash the phallus or scrotum and avoid prolonged dangling of the phallus as this may weaken the anchor site attachment.

• Implant phallus position: you may position your phallus in a way that's comfortable; it could be up and to the left or down and to the right and all other combinations. Avoid moving the implant too fast or forcefully as it could weaken the implant anchor site. The goal is to keep the cylinder component of the implant within the phallus as close to the middle of your phallus as possible and to make sure it stays in the center of your glans.

• Scrotum positioning: avoid sitting or smashing the scrotum. A wider walk stance may help and paying attention when sitting may help avoid smashing the scrotum when you do sit. There will be frequent conscious crotch adjustments until things become second nature.

• Driving: Do not drive while taking prescription pain meds; therefore, don’t drive yourself until you are completely off pain meds.

• Urination: Sometimes urinating can be difficult due to postoperative swelling. The stream may be weaker but should improve in 1-3 days as the swelling improves.

• Leakage: Urinary leakage is common after surgery since post urination compression of the urethra is done more gently to minimize moving the anchor site of the penile implant to the pubic bone. Post void compression is safe as long as it's done gently; after 6 weeks, returning to normal compression after urination is generally safe. One should avoid pulling on the implant within the phallus when "milking" the urethra. Squeezing and shaking is a better option.

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SURGICAL SITE CARE

 

• Incisions: closely observation and avoiding certain activities will help it heal. 

  • Avoid putting tension on the incision site.

  • There will be purple glue or a steri-strip on your incision that will slowly peel in about 7 days; they can be removed in the shower at that time.

  • Frequently, patients are provided mesh underwear with gauze; this can be removed and/or discarded a few hours later or the following day.

 

POSTOPERATIVE CONCERNS

 

• Infection: redness spreading beyond the incision combined with worsening swelling and pain, and sometimes fever (defined as higher than 101°F) are consistent with infection; notify your surgeon immediately. If you notice chest pain or lightheadedness with these symptoms, call 911.

• Pain: this is very common and should stay about the same for a few days and gradually improve thereafter. It is not normal if the pain progressively worsens without any activity (that is, pain not brought on by any particular activity).

• Constipation: very common after surgery especially when needing to take pain meds regularly; make sure to take miralax or other stool softener while you are on pain meds.​

• Implant pump position: if the pump component of the implant in the scrotum starts to move upward, it may be due to positioning of the scrotum in your underwear.

  • Try new underwear or position ​your genitals differently within your underwear so it's not pushing on your scrotum

  • Massage the pump component downward; do this only after you see your surgeon for in-person instructions at your postop visit. In general, use the fingers (without the nails) to pull on the pump downward without putting pressure or tension on the incision(s). 

• Erosion: rare; if the skin near the implant is subject to chronic tension and/or gets infected, there will be a higher chance of erosion.

  • Early sign: the tissue gets pink where part of the implant is regularly or constantly pushing on the skin.​

  • Later signs: tissue gets stuck over the implant and the tissue thins; further color changes may occur (i.e. pink to red); this is when risk of erosion is high.

  • Prevention: position the penis and scrotum in a way that minimizes skin tension on the penis and scrotum; to achieve this, point the penis a different way; also, avoid putting tension on the scrotum by walking carefully and checking the scrotum when you sit to avoid tugging or smashing the scrotum. If there are skin color changes overlying the implant, massaging the skin regularly may help avoid erosion. 

• Drainage: it is expected/normal if it is a small amount of slightly blood-tinged yellow fluid. It is not normal if it is bright red blood or cloudy and cream colored, or if there is a large continuous volume with no improvement.

• Bleeding: occasional spot bleeding from the skin edges is expected and should stop with time; sometimes holding pressure over the incision for 5 minutes (like holding pressure on a paper cut) is required. If there is any concern or the bleeding does not stop, contact your surgeon.

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IPP pump instructions:

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• After the 5-6 week period, we will “activate” the pump. This is done frequently in person or on video and you are taught how to inflate and deflate the device.​ Please review the instructions on inflation/deflation prior to the appointment.

  • There is a video online

  • From postop week 6-8 (total 2 weeks), inflate and deflate daily to build muscle memory

• After 8 weeks, you are generally cleared to have penetrative intercourse. Use copious amounts of lubrication, use positions that are most comfortable for you and your partner (pain is a good indicator to avoid a certain position), and take it easy in the beginning.

  • Penis swelling after intercourse is common and expected. If it persists and worsens beyond 48 hrs and if it involves the scrotum or is associated with fever, notify your surgeon as infection is possible.​ 

  • Inflate and deflate on average once per week to ensure good implant function.

 

POSTOPERATIVE MEDICATIONS

 

• Take over the counter Tylenol 1000 mg every 6-8 hrs for baseline pain control. This will likely be needed for 3-7 days.

• Tramadol 50mg tablet: pain medication; take 1-2 tablets every 6-8 hrs as needed for breakthrough pain.

  • Over the counter ibuprofen 200-400mg is acceptable for further pain control if needed.

  • Take it with meals. Ibuprofen may be taken at the same time as Tramadol and Tylenol since they are not in the same class.

  • Side effects*: itchiness, constipation, diarrhea, nausea, sweating, insomnia; liver problems (when acetaminophen is included)

• Miralax: stool softener to be taken while on pain medication; 17g by mouth daily (mix powder with liquid of your choice)

  • Side effects*: nausea, gas, drowsiness, stomach ache, loss of appetite

• Bactrim (trimethoprim/sulfamethoxazole): DS by mouth, twice per day, for 5 days (take night of surgery))

  • Side effects*: itching, rash, diarrhea, nausea, headache

  • If allergic to this or sulfa drugs, can substitute with  another antibiotic like Augmentin, Clindamycin, or Ciprofloxacin

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*This is not a complete list of all the side effects that may occur with these medications. Getting side effects are infrequent; the side effects named are the more common ones for those who do experience side effects. Please call the office if you have any questions about your medications. Definitely notify us if you notice a rash that started soon after starting a new medication. If you notice shortness of breath or difficulty breathing after taking a new medication, call 911 and/or go to the nearest emergency room. You may be having a serious allergic reaction to the medication.

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Call office or your surgeon for fevers, chills, redness and pus from the incision, or pain not controlled with pain medication. If after hours, call the office phone number and leave a message; urgent messages will be relayed to the surgeons. If you feel it is a medical emergency and need immediate help, call 911 and/or go to the closest Emergency Room.