Penile Prosthesis in India and UAE | Complete Patient Guide

• Men with confirmed organic erectile dysfunction refractory to optimised PDE-5 inhibitor therapy (maximum dose, adequate trial duration) AND intracavernosal injection therapy

• Peyronie's disease (penile curvature) with concurrent ED requiring simultaneous plication, grafting, or implant-assisted straightening

• Post-radical prostatectomy or post-pelvic radiation ED where cavernosal nerve recovery has plateaued (typically ≥18–24 months post-surgery)

• ED secondary to spinal cord injury, multiple sclerosis, or other confirmed neurogenic aetiology

• Priapism sequelae with cavernosal fibrosis

• Diabetes mellitus–associated severe vasculogenic ED with documented cavernosal arterial insufficiency on penile Doppler ultrasound (peak systolic velocity <25 cm/s)

Required Pre-Operative Diagnostics:

• Dynamic penile duplex Doppler ultrasonography (PDU) with intracavernosal vasoactive agent injection (alprostadil 10–20 mcg) to characterise arterial and venous haemodynamics

• Fasting serum testosterone (total and free), LH, FSH, prolactin—to exclude treatable hormonal aetiology

• HbA1c and fasting glucose (metabolic baseline; critical for peri-operative infection risk stratification)

• Complete blood count, coagulation profile (PT/INR, aPTT), renal and hepatic function panel

• Urinalysis and urine culture (mandatory—active UTI is a contraindication to prosthesis placement)

• Validated ED severity scoring: International Index of Erectile Function (IIEF-5/SHIM) questionnaire

• Cardiovascular risk assessment: resting ECG; stress ECG or cardiology clearance if Princeton Consensus III high-risk classification applies

• Penile length measurement (stretched penile length, SPL) for cylinder sizing planning

Contraindications:

• Active urinary tract infection or any active systemic infection (absolute contraindication)

• Uncontrolled diabetes mellitus (HbA1c >10% without optimisation; relative contraindication pending glycaemic control)

• Uncorrected coagulopathy or anticoagulation that cannot be safely bridged

• Significant untreated lower urinary tract obstruction (BPH/urethral stricture requiring concurrent management)

• Penile or urethral malignancy

• Active psychiatric condition rendering informed consent unreliable or patient unable to operate device mechanism

• Prior penile prosthesis infection with less than 6 months post-explant recovery (relative; salvage implantation may be considered by experienced surgeons using Mulcahy salvage protocol)

Three-Piece Inflatable Penile Prosthesis (IPP) — Gold Standard:

Devices such as the AMS 700 CX/LGX (Boston Scientific) and the Coloplast Titan OTR (One-Touch Release) are placed via a penoscrotal or infrapubic incision. The paired cylinders are sized intraoperatively using Furlow inserter and Keith needle technique. The reservoir is placed in the space of Retzius (retropubic) or, in patients with prior pelvic surgery (radical prostatectomy, cystectomy), ectopically within the submuscular plane using the ectopic reservoir technique to avoid bowel or vascular injury. Modern IPP devices feature antibiotic-impregnated coatings (InhibiZone—rifampicin/minocycline; Hydrophilic coating on Titan for dipping in antibiotic solution) which have independently reduced device infection rates by up to 50% in comparative registry studies.

Malleable (Semi-Rigid) Rod Prosthesis:

Devices such as the AMS Spectra or Coloplast Genesis consist of paired bendable rods implanted bilaterally into the corpora cavernosa through a similar penoscrotal approach. The procedure is technically less complex, operates without a pump or reservoir, and is preferred in: patients with significant manual dexterity limitations (neuropathy, arthritis), those undergoing combined artificial urinary sphincter (AUS) implantation, or in resource-optimised settings. The trade-off is a permanently semi-rigid state, which some patients find less discreet.

Minimally Invasive & Advanced Techniques:

• Transverse Scrotal (TS) Approach: Single transverse incision in the scrotal raphe providing excellent cylinder, pump, and reservoir access; associated with lower wound complication rates compared to the traditional penoscrotal vertical incision in high-volume series.

• No-Touch Sterile Protocol (Eid Technique): Irrigation of surgical field with triple antibiotic solution (gentamicin, vancomycin, amphotericin B), use of impermeable adhesive drape, and strict non-touch cylinder handling; reduces infection risk to <1% in primary cases.

• Salvage Implantation (Mulcahy Protocol): For infected device removal, immediate copious washout with 7-solution antibiotic irrigation, and same-setting reimplantation. Reported salvage success rates of 82–84% in specialised centres.

• Concurrent Penile Straightening for Peyronie's Disease: Modelling (intraoperative manual straightening post-inflation), tunical plication sutures, or combined incision/grafting with implant placement for severe curvature (>60°).

• Revision / Explant Surgery: Management of mechanical failure (cylinder aneurysm, S-shaped deformity, connector leak), device infection, or autoinflation—requiring sub-specialist revision expertise available at GAF Healthcare's partner centres.

Week -2 to -1 — Pre-Operative Workup & Optimisation: GAF Healthcare's case management team coordinates remote review of existing investigations. Patients submit IIEF-5 scores, prior treatment records, and recent blood work. A teleconsultation is arranged with the designated urological surgeon. Any metabolic optimisation (glycaemic control, antibiotic skin decolonisation with mupirocin nasal ointment and chlorhexidine body wash for 5 days pre-operatively) is initiated. Antiplatelet or anticoagulant agents are bridged or discontinued per institutional protocol.

Day of Arrival (Day 0): Patient and attendant arrive at destination (India or UAE). GAF Healthcare provides private airport transfer to partner hotel or hospital guest house. Pre-admission investigations are confirmed or completed: urine culture, HbA1c, full blood count, coagulation screen, ECG. Anaesthesiology pre-assessment is conducted.

Day 1 — Surgical Procedure: Procedure is performed under spinal or general anaesthesia (typical duration: 60–90 minutes for primary IPP; 90–120 minutes for revision or Peyronie's cases). The no-touch antibiotic protocol is observed. Intraoperative cylinder sizing is confirmed. A urethral catheter (Foley) is placed intraoperatively and typically removed within 24 hours. Post-anaesthesia care unit (PACU) monitoring for 2–4 hours.

Day 2–3 — In-Hospital Recovery: Oral analgesia (NSAIDs + paracetamol; opioids only if required), scrotal support/ice pack application to minimise oedema, and wound inspection. Foley catheter removal on Day 1 or 2 post-operatively. Patient is mobilised. Discharge is typically on Day 2 or 3 with oral antibiotics (fluoroquinolone or cephalosporin for 7–10 days), wound care instructions, and scrotal support garment.

Weeks 1–3 — Outpatient Recovery (In-Country): Patient remains in-country for outpatient wound review at Day 7 (suture/staple removal if non-absorbable) and Day 14. Scrotal oedema and bruising resolve progressively. Device must remain in the deflated/flaccid state during this period—no device cycling. Light walking is encouraged from Day 3; strenuous activity, heavy lifting, and cycling are restricted for 6 weeks.

Week 4 — Fit-to-Fly Assessment: Surgeon confirms wound healing, absence of infection signs, and haemodynamic stability. International flight of ≤8 hours is generally approved at 3–4 weeks; longer haul may require individual assessment. Compression stockings and in-flight ambulation are advised for DVT prophylaxis.

Week 6 — Device Activation: Patient is instructed (in-person or via video consultation with GAF telehealth) to begin device cycling: inflating and deflating daily to promote cylinder expansion and tissue accommodation. This is critical for achieving maximum functional penile length.

Week 6–8 — Return to Sexual Activity: Once wound is fully healed and device cycling is comfortable, sexual intercourse is typically approved by 6–8 weeks post-operatively. Patient satisfaction assessments (IIEF-EF domain, Erectile Dysfunction Inventory of Treatment Satisfaction—EDITS) are completed at 3 months.