PENILE IMPLANT SURGERY • BRISBANE
Penile Implant Revision Surgery
Assessment and revision surgery for penile implants that have stopped working, become difficult to operate, changed position or developed complications.
Penile implants are mechanical devices and problems can sometimes develop over time. Revision surgery may involve repositioning a component, replacing part or all of the prosthesis, treating infection or undertaking reconstruction where significant scarring or altered anatomy is present.
UNDERSTANDING REVISION SURGERY
What is penile implant revision surgery?
Penile implant revision refers to any further operation involving an existing penile prosthesis. It may be a focused procedure, such as repositioning a scrotal pump, or it may involve removal and replacement of an entire inflatable penile prosthesis.
Revision operations can be more technically complex than first-time implantation because previous surgery may produce scar tissue and altered anatomy. Infection risk is also an important consideration in revision surgery, so careful assessment and operative planning are required.
The appropriate operation depends on why the implant requires revision, how long it has been in place, previous implant operations and the condition of the surrounding tissues.
REVISION MAY BE CONSIDERED FOR
- Mechanical implant failure
- Loss of rigidity or inflation
- Pump malfunction
- Fluid leakage or tubing failure
- Cylinder malposition
- Reservoir-related problems
- Implant infection
- Erosion or threatened erosion
- Difficult pump positioning
- Complex fibrosis after previous surgery
COMMON PROBLEMS
Why might a penile implant need revision?
Mechanical failure and infection are important causes of penile prosthesis revision, although positioning problems, erosion and complications affecting individual components can also occur.
Mechanical failure
The implant may stop inflating, fail to maintain rigidity or no longer deflate normally.
Pump problems
A pump may become difficult to operate, change position or develop a mechanical problem.
Cylinder problems
Revision may occasionally be required for malposition, asymmetry, crossover, inadequate support or another cylinder-related issue.
Reservoir problems
Reservoir displacement, herniation or other reservoir complications may occasionally require intervention.
Infection or erosion
Increasing pain, wound changes, discharge or exposure of part of the prosthesis requires prompt assessment.
Position or functional concerns
Some implants remain mechanically functional but require assessment because a component is uncomfortable, difficult to access or positioned poorly.
MECHANICAL PROBLEMS
My penile implant has stopped working — does it need replacing?
Not every change in implant function represents true mechanical failure. Difficulty inflating or deflating an implant can occasionally relate to the way the device is being operated.
Assessment usually begins by establishing exactly what has changed and examining and cycling the implant. Knowing the manufacturer, implant model and date of implantation can also help identify the likely cause. If genuine mechanical failure is confirmed, surgery is generally required to restore prosthesis function.
Does the entire implant need to be replaced?
Not always. In selected situations it may be technically possible to replace or reposition an individual component. However, replacing only one component may leave older components in place that could subsequently fail. The most appropriate strategy depends on the age and condition of the implant, the location of the problem and the risks associated with removing existing components.
USEFUL INFORMATION TO BRING
- Your penile implant identification card, if available
- Previous operation reports
- Implant manufacturer and model
- Date of implant insertion
- Details of any previous revisions
- Records relating to previous implant infection
IMPLANT INFECTION
Penile implant infection and salvage surgery
Infection is an important complication of penile prosthesis surgery and should be assessed promptly when suspected. Seek prompt medical assessment if you develop increasing penile or scrotal pain, redness, swelling, wound discharge, fever, skin breakdown or exposure of any component of the penile implant.
An established prosthesis infection commonly requires removal of the infected device together with appropriate antimicrobial treatment.
Can a new implant be inserted at the same operation?
In selected patients, immediate penile prosthesis salvage may be considered. This involves removing the infected prosthesis, irrigating the operative spaces and inserting a replacement prosthesis during the same operation. Salvage is not suitable in every clinical situation; the severity of infection, tissue condition, systemic illness, erosion and operative findings all influence the plan.
COMPLEX REVISION
Revision after previous implant infection or multiple operations
Reimplantation can become more difficult when previous infection, implant removal or multiple operations have caused significant scar tissue. Fibrosis within the corpora cavernosa can reduce the space available for new cylinders and make corporal dilation more challenging.
Depending on the anatomy, surgery may require additional reconstructive techniques or alternative implant strategies. The aim is safe placement of a functional prosthesis while minimising injury to the urethra and surrounding tissues.
What about penile length?
Penile implants do not create additional penile length. Long-standing erectile dysfunction, Peyronie’s disease, previous infection, implant removal and corporal fibrosis can all affect penile dimensions and the space available for replacement cylinders. Where fibrosis is significant, the priority is safe placement of an appropriately sized device rather than achieving a predetermined penile measurement.
Explore penile, genital & urinary reconstruction →COMPLEXITY MAY BE INCREASED BY
- Previous implant infection
- Previous implant removal
- Multiple prior revisions
- Corporal fibrosis
- Peyronie’s disease or altered penile anatomy
- Previous pelvic, prostate or reconstructive surgery
POSITIONING PROBLEMS
Revision for pump, cylinder or reservoir position
A penile implant can remain mechanically functional but still cause difficulty because of where one of its components sits.
Scrotal pump
A pump that sits high, is difficult to access or causes persistent discomfort may require assessment and occasionally repositioning.
Penile cylinders
Cylinder position, asymmetry, distal support and interaction with scar tissue may affect the final functional result.
Reservoir
Previous pelvic surgery can alter reservoir anatomy and may influence how a reservoir-related complication is approached.
SECOND OPINIONS & PREVIOUS SURGERY
Revision after penile implant surgery performed elsewhere
You do not necessarily need to return to the surgeon who inserted the original implant to have a new problem assessed. Patients may seek review after penile implant surgery performed elsewhere in Queensland, interstate or overseas.
Previous operation reports and implant details can be useful when available, but assessment is still possible when the original records cannot be obtained.
BEFORE TRAVELLING
Where appropriate, an initial review can help establish which previous records, implant details or investigations may be useful before travelling for further assessment or surgery.
YOUR ASSESSMENT
What happens at a penile implant revision consultation?
The first priority is to identify why the existing implant is no longer functioning as expected.
Understand what has changed
We discuss when the problem began, how the implant behaves and whether there is pain, difficulty cycling the device, deformity or another concern.
Examine and cycle the implant
The penis, scrotal pump and surrounding tissues can be assessed, and the implant may be cycled where appropriate.
Review previous surgery
Implant details, operative reports and previous revision or infection history are reviewed where available.
Plan the most appropriate next step
Management may involve observation, assistance with device operation, component repositioning, revision, complete replacement, implant removal or infection salvage depending on the findings.
INDIVIDUALISED SURGERY
Planning penile implant revision surgery
Penile implant revision is not a single standard operation. Surgical planning depends on several factors.
Reason for revision
Mechanical failure, infection, erosion and positioning problems require different approaches.
Previous operations
Previous penile, prostate, pelvic or prosthetic surgery can alter anatomy and surgical planning.
Scar tissue
Corporal fibrosis can influence cylinder selection, implantation technique and expected complexity.
Infection risk
Revision procedures generally carry a greater infection risk than first-time penile implant surgery.
Existing implant
Device age, type and condition influence whether partial revision or complete replacement is appropriate.
Patient priorities
Implant function, ease of use, anatomy and previous experience are considered when discussing options.
AFTER SURGERY
Recovery after penile implant revision
Recovery depends on the reason for revision and the complexity of the operation. A straightforward device replacement for mechanical failure may have a recovery broadly comparable with primary penile prosthesis surgery, while revision involving infection, significant fibrosis or reconstructive work may require a longer recovery.
Individual instructions are provided regarding wound care, implant cycling, physical activity and when sexual activity can safely resume.
SEEK URGENT REVIEW FOR
- Increasing or severe pain
- Rapidly increasing swelling
- Redness or wound discharge
- Fever or systemic illness
- Skin breakdown over the implant
- Exposure of a prosthesis component
- Difficulty passing urine
FREQUENTLY ASKED QUESTIONS
Penile implant revision FAQs
How long does a penile implant last?
There is no fixed lifespan for an inflatable penile implant. Mechanical problems become more likely as a device ages, but the timing varies between patients and devices.
Does needing revision mean my original surgery failed?
Not necessarily. Penile implants contain mechanical components that can eventually wear or fail even after a long period of satisfactory function.
Can just the penile implant pump be replaced?
Sometimes. Whether isolated component replacement is appropriate depends on the implant, its age, the reason for revision and the condition of the remaining components. In other circumstances, complete device replacement may be preferable.
Can I change implant type during revision?
Potentially. Revision surgery can provide an opportunity to reconsider prosthesis configuration, but the appropriate choice depends on anatomy, previous surgery, fibrosis, device use and the reason for revision. There is no single implant type that is appropriate for every patient.
Is revision more difficult than first-time implant surgery?
It can be. Scar tissue, altered anatomy, previous components and infection risk can make revision procedures more complex than primary implantation.
Can an infected penile implant be replaced immediately?
In selected patients, an infected prosthesis can sometimes be removed, the operative spaces irrigated and a replacement prosthesis inserted during the same operation. This is often referred to as penile prosthesis salvage and is not appropriate in every clinical situation.
Can you assess an implant inserted by another surgeon?
Yes. Penile implant problems can be assessed even when the original procedure was undertaken elsewhere. Previous operative records and implant information are helpful when available.
PENILE IMPLANT ASSESSMENT
Concerned about an existing penile implant?
If your implant has stopped working, become difficult to operate, changed position or developed another problem, assessment can help determine the cause and whether revision surgery is required.
Medical disclaimer: This information is general in nature and is not a substitute for individual medical advice. The appropriate management of a penile implant problem depends on the implant, previous surgery, examination findings and individual medical circumstances. Seek prompt medical assessment if you develop symptoms suggesting infection, erosion or another acute implant complication.