Erectile
Dysfunction

How To Prepare?

It is important to follow your doctor’s instructions carefully in order to prepare for surgery. This includes not eating, drinking, or smoking for a specified period of time before the procedure and discussing any current medications with your doctor. It is also important to follow any other instructions given by your doctor, such as showering with a special soap, avoiding certain activities, or arranging for transportation to and from the hospital. By preparing carefully, you can help ensure that your surgery goes smoothly and that you have the best possible outcome.

Penile Prosthesis Surgery Procedure

For penile implant surgery, you will receive either general or spinal anesthesia. You will also get a urinary catheter, which can be removed the day after surgery. Once you are under anesthesia, the doctor will make a small incision either above the penis or between the penis and the scrotum. The incision exposes the erectile chambers, and the surgeon measures them to place a penile implant of the correct length. Once the cylinders are in place, the reservoir is placed behind the abdominal wall, and the pump is placed in the scrotum between the testicles to conceal the pump.

Finally, all elements of the implant are connected, and the incision is sutured. The wounds are cleaned, and a compressive bandage is applied. Most surgeons choose to leave the penile implant inflated for one day. Some surgeons prefer to leave a drain, which is then usually removed one day after the procedure.

After the Penile Prosthesis Surgery

In the first 2-3 days after surgery, there may be a small amount of discharge from the incision. There is no need to treat this since it usually stops on its own.

For 4-6 weeks after the surgery:

• Do not lift anything heavier than 5 kilograms.
• Do not do any heavy exercise and avoid bike riding.
• Do not take thermal baths or go to the sauna.
• Discuss any prescribed medication with your doctor.
• Your doctor will schedule an appointment to inflate the implant for the first time. This is done once the swelling and soreness have gone, about 4-6 weeks after the procedure.
• After the appointment, you may start having sexual activity.

You should notify your urologist if:

• The swelling is severe or not improving.
• You have a discharge of a large amount of fluid each day.
• The pain gets worse or does not improve.
• You notice increased redness or tenderness around the incision site.
• You have a fever.

Benefits of Penile Prosthesis:

• Low rate of mechanical failure.
• It is possible to inflate the device discreetly.
• Inflatable implants are easy to conceal.
• No risk of priapism.
• Highest level of satisfactory outcome out of all possible treatments.
• Highest level of patient satisfaction of all ED therapies if the patients and their partners are informed correctly about what to expect from the implant.

Types of Penile Prosthesis:

a) Three-piece inflatable penile prosthesis:

Three-piece inflatable penile prosthesis consists of a pair of cylinders implanted in the penis, a pump implanted in the scrotum, and a reservoir implanted in the lower abdomen. Three-piece inflatable is a self-contained fluid-filled (usually saline) system made from silicone. When the fluid within the reservoir is pumped manually into the cylinders by rapidly pressing and releasing the pump, the inflation creates an erection that provides rigidity.

Rigicon^® Infla10^® Inflatable Penile Prosthesis

Features of the inflatable penile prosthesis:

• Entirely concealed within the body.
• No adverse pharmacologic or hormonal effects one might experience with oral medications for ED.
• Provides a natural-like erection.
• The device is inflated to provide rigidity and deflated for concealment.

b) Malleable penile prosthesis:

Malleable prosthesis is the most effortless type of penile prosthesis. The prosthesis consists of a pair of malleable rods that are surgically inserted into the penis. The prosthesis is manually positioned up for sexual intercourse or down for concealment during daily activities.

Rigicon^® Rigi10™ Malleable Penile Prosthesis

Features of the malleable penile prosthesis:

• Easier to use.
• Requires less manual dexterity.
• The simpler surgical implantation procedure.
• Lower risk of mechanical failure.
• Entirely concealed within the body.
• No adverse pharmacologic or hormonal effects one might experience with oral medications for ED treatment (when compared to the inflatable penile prosthesis).

QUALIFICATIONS

• MBBS (University of Melbourne, 2000)
• FRACS (Urology, 2010)

AWARDS

• The Exhibition Prize for Functional Biochemistry (University of Melbourne, 1996)
• The Keith Kirkland Prize for best clinical research (Urological Society of Australia and New Zealand, 2007)
• Karl Storz Travelling Award Fellowship Prize (2007)
• Best clinical paper (North-Eastern section American Urological Association, 2011)
• Best clinical paper award (Asia Pacific Society of Sexual Medicine, 2011)
• Best clinical paper award (Asia Pacific Society of Sexual Medicine, 2019)
• The ISSM Emil Tanagho prize @ World Meeting on Sexual Medicine (2021)
• The International Society of Sexual Medicine (ISSM) Special Service Award (2021)
• • World Chinese Urological Society (WCUS) Lifetime Achievement Award (2022)

RESEARCH GRANTS

1. Boston Scientific educational research grant 2021: Artificial urinary sphincter surgery in Asia Pacific countries
2. PA Research Foundation 2020 Research Awards: Effects of exercise training on erectile and cardiovascular function in men with prostate cancer
3. The University of Queensland’s Faculty of Health and Behavioural Sciences 2019 Research Collaboration Seeding Grant: Erectile and cardiovascular dysfunctions in prostate cancer patients and survivors
4. Coloplast research grant 2017: An in-vivo analysis of drug elution and a double-blind, randomized controlled trial comparing local anesthesia elution in clinical outcome and patient satisfaction
5. Storz Medical AG Research Grant 2017: A prospective, randomized, double-blind, placebo-controlled clinical trial using low-intensity extracorporeal shock wave therapy Duolith SD-1 for the treatment of vascular erectile dysfunction.
6. TRADIM Research Grant Scheme 2015 in conjunction with the National Critical Care and Trauma Response Centre (NCCTRC): Genitourinary injury and adult pelvic trauma: Clinical outcomes, multidisciplinary delivery of healthcare service, and guideline implementation in the management of urinary and sexual dysfunction.
7. MAIC-RACS (joint Queensland Motor Accident Insurance Commission/Royal Australasian College of Surgeons) Trauma Scholarship 2014: Genitourinary injury, urinary and sexual dysfunctions following adult pelvic trauma – Clinical outcomes, healthcare advocacy, and guideline implementation.
8. American Medical Systems Investigator Sponsored Research (AMSISR) Grant 2013: A pilot study in the evaluation of the perception and use of penile prosthesis implant in Australian men – Myths, Sexual Health, and Quality-of-Life issues.
9. American Medical Systems (AMS) Andrology/Prosthesis Fellowship Grant 2010.
10. Canadian Male Sexual Health Council/Pfizer Clinical Grant 2010: Sexual Health in Adult Men Evaluation (SHAME) study – Assessing the sexual health profile in young university men through the identification of sexual behavior, erectile dysfunction, and quality of life questionnaires.
11. Australian Urological Foundation (AUF)/Astra Zeneca Grant 2009: An in-vivo telemetric study evaluating the cellular basis of erectile recovery post-cavernous nerve injury using SELDI to define the alterations in proteomic profile.