Editing Penile Prosthesis (section)

== Pre-operative Counselling and Evaluation ==

* Penile prosthesis is a highly effective treatment for ED but considered an '''irreversible procedure accompanied by numerous risks;''' positioning the device permanently results in the loss of any pre-existing erectile capability
* '''Thorough preoperative assessment and education can help identify the best type of prostheses for any specific circumstance.'''
** '''A patient with limited manual dexterity is recommended to receive a semirigid prosthesis'''
** A small, narrow penis should be considered for an AMS LGX.
* '''Evaluation includes history, physical exam including intracorporeal injection of a vasodilating agent, and penile Doppler ultrasound study after intracorporeal injection of a vasodilating agent'''
** '''The stretched penile length should be measured'''
** '''Patients should know that the preoperative length of the fully stretched flaccid penis is typically the maximal length that can be obtained after prosthetic surgery and that the procedure may result in a degree of penile shortening and glans softening'''
** Intracorporeal injection allows assessment for possible concomitant abnormalities such as shortening, hourglass deformity, and curvature
** Penile doppler can evaluate for severity of ED, vascular flow, tumescence, and penile anatomy
* Patients are often concerned about the size of the incision required to implant the device and should be reassured that only a 1-inch incision is necessary.