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BackTable / Urology / Article
Penis Implant Surgery Pain, Care, & Recovery
Quynh-Chi Dang • Jun 22, 2021 • 4k hits
Diligent penis implant surgery post-operative care is essential because infection, capsule formation, and pain after penile implant surgery are possible. A strict regimen of antibiotics, pain medications, and patient education can improve post-operative patient outcomes.
We’ve provided the highlight reel in this article, but you can listen to the full podcast below.
The BackTable Urology Brief
• Dr. Clavell recommends prescribing patients at least a week of antibiotics after penis implant surgery. His antibiotic prescription typically includes fluoroquinolone, Levaquin, Keflex, and cephalosporin. Furthermore he administers Diflucan, an antifungal medication, intraoperatively.
• Gabapentin, meloxicam, and Tylenol are all acceptable medications for possible pain after penile implant surgery management. Dr. Clavell notes that his patients’ post penile implant surgery pain has reduced as a result of EXPAREL, a local anesthetic injected intraoperatively that serves as a post-operative analgesia.
• Capsule formation is a potential postoperative risk of an inflatable penile implant surgery. If no cycling (successive cycles of penile implant inflation and deflation) occurs soon after surgery, penis size may be reduced due to the growth of a psuedo-capsule around the inflatable cylinders.
• Dr. Clavell advises his patients to meet with him and start cycling their penile implants at 4 to 6 weeks post-operatively after soreness has subsided and the incision site has healed. He does not recommend engaging in sexual intercourse before cycling for at least a few weeks.
Table of Contents
(1) Penis Implant Surgery Post-Operative Antibiotics
(2) Pain After Penile Implant Surgery Medications
(3) Post-Operative Cycling of Penile Implants
Penis Implant Surgery Post-Operative Antibiotics
To prevent infection, Dr. Clavell prefers to have his patients start on antibiotics the day before surgery and recommends that they continue taking them for a whole week after the surgery. He typically prescribes fluoroquinolone, Levaquin, Keflex, and cephalosporin. Following a strict antibiotic regimen allows Dr. Clavell to rule out bacterial infection as a cause of post-operative swelling. Although he does not prescribe antifungals post-operatively, he administers Diflucan for all patients intraoperatively.
[Dr. Jose Silva]
That's definitely good advice. Let's talk about the logistics of proceedings in terms of after the procedure. How long do you give them antibiotics for? When do you see them after the procedure?
[Dr. Jonathan Clavell]
Of course, we all know that the most common risk is infection. I actually start them on an antibiotic a day before the surgery. They take an antibiotic and they continue with the antibiotics for one week after the surgery. I think it's voodoo. I think it's just for me to be able to sleep better at night.
[Dr. Jose Silva]
To sleep better, yeah, that's important.
[Dr. Jonathan Clavell]
Because whenever they start calling your office, "Hey, Doc. I'm still a little bit swollen." I'm like, "You're still on antibiotics so it's not an infection."
[Dr. Jose Silva]
Which one do you use? What antibiotic?
[Dr. Jonathan Clavell]
I use fluoroquinolone, Levaquin, Keflex, and cephalosporin. I've been thinking about going off fluoroquinolones just because of the side effects. But again, I tell them, "It's just for a few days." If I'm concerned about their joints or anything like that, I give them something else just to cover for gram negatives.
[Dr. Jose Silva]
Also, I think there's some implants that use a couple of days of antifungal medication.
[Dr. Jonathan Clavell]
That is correct.
[Dr. Jose Silva]
Do you use it always or just sometimes?
[Dr. Jonathan Clavell]
I do use them for preop and basically preop in the operating room. In the operating room, I give them vancomycin, gentamicin, and Diflucan. Initially, I was just using Diflucan for only diabetics and guys who had Coloplast because they don't have the InhibiZone from Boston Scientific. But now I just started telling the staff, "Just give it to everyone." That would just to make it easier for the staff because they were always asking, "Oh, are we getting Diflucan or not?" Just do it for everyone.
In terms of post-op, I really don't give them that unless I'm really concerned that they will have it. I haven't been burned by it before though. I've had two infections and they were both bacterial.
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Pain After Penile Implant Surgery Medications
Dr. Clavell prescribes gabapentin, a nerve pain medication, and meloxicam, a nonsteroidal anti-inflammatory drug (NSAID), to help his patients with pain after penile implant surgery. Because the side effects of meloxicam may include damage, he doesn’t recommend continuing meloxicam for more than two weeks--Tylenol can be substituted instead.
Furthermore he notes that, since he has started injecting EXPAREL, a local anesthetic he delivers intraoperatively through an intracavernosal injection at the surgical site, he has seen a reduction in post-operative pain and pain medication usage. Both Dr. Clavell and Dr. Silva strongly avoid prescribing narcotics for penile implant pain.
[Dr. Jose Silva]
Some patients with neuropathy are more sensitive. After you do an intervention, they continue to complain about that urethral persistent pain so I don't know. I haven't looked into it, but definitely, it's a good thing to see if there's a difference in terms of pain medication after which.
[Dr. Jonathan Clavell]
That said, all my patients, I give them gabapentin post-op.
[Dr. Jose Silva]
For how long?
[Dr. Jonathan Clavell]
My post-op regimen is meloxicam and gabapentin. Meloxicam, I give them for two weeks. I don't want them to be longer than two weeks just to avoid kidney damage. But the gabapentin I usually tell them that's your go-to. And Tylenol. And then I also give them tramadol for breakthrough. But most patients don't need it because the hospital that I'm doing my surgeries at allows me to use Exparel.
[Dr. Jose Silva]
Exactly. Are you injecting in the corpora during the procedure?
[Dr. Jonathan Clavell]
Yes. I do a full block and I also do intracavernosal injection. I induce an erection for all my patients. I just do so many Peyronie's cases that I don't want any surprises. I basically induce everybody with the Exparel.
[Dr. Jose Silva]
When you're doing the artificial erection, you're using Exparel at that moment?
[Dr. Jonathan Clavell]
That's right. I combine Exparel with saline. I tell anesthesia, "You're going to have some changes in your EKG. Don't freak out." And I haven't had any issues.
[Dr. Jose Silva]
I think using that is the key to just not giving Percocet or anything stronger. I was doing it before but now, the hospital lets me use the Exparel and it's a game changer in that sense.
[Dr. Jonathan Clavell]
Yeah, I've only prescribed narcotics twice since I started practicing. The only patients that needed it were guys who were already taking narcotics for chronic back pain issues. Their pain tolerance was very low, and I told them, "Man, I'll just give it to you." But again, most of the time, they don't need it. They don't need it.
Post-Operative Cycling of Penile Implants
Cycling through penile implant inflated and deflated states before using it during sexual intercourse is essential to preventing capsule formation. If penile implant inflation does not occur soon after surgery, a pseudo-capsule may grow around the deflated cylinders and prevent full prosthesis expansion. As a result of capsule formation, penis size will be reduced.
Dr. Clavell usually schedules a follow up visit with his patients at six weeks, after soreness has subsided. If the incision site is healed by 4 to 6 weeks, he recommends that his patients start cycling the implant. (Dr. Clavell has posted Youtube videos in English and Spanish that gives penile implant inflation and deflation instructions for the Coloplast Titan and AMS 700 penile implants.) He also advises patients to hold off sexual intercourse until after a few weeks of cycling in order to prevent the closure site from opening up again.
[Dr. Jose Silva]
...When do you see the patients afterwards?
[Dr. Jonathan Clavell]
I usually see my patients at six weeks. I did that during fellowship. My partner has his patients come back in four weeks. If you go penoscrotal they will sometimes still be sore at four weeks.
That's why I tell them, "Man, go at six weeks," and they have my cell phone so I just text them, "If you feel great by four or five weeks, just shoot me a picture of your incision. If the incision looks fine and you feel comfortable cycling the implant, just go ahead and cycle." The good thing is that I was able to create a really good video on how to best inflate and deflate both devices, both the AMS and Coloplast.
[Dr. Jose Silva]
That's on your YouTube channel?
[Dr. Jonathan Clavell]
They’re on my YouTube channels. It's actually my two latest videos. Yeah, it's a great resource. It's saved me a lot of conversations with patients.
[Dr. Jose Silva]
You can go to YouTube and just put Jonathan Clavell?
[Dr. Jonathan Clavell]
Yeah, that's right. You just put my name Jonathan Clavell, C-L-A-V-E-L-L, and you'll be able to find basically most of my work.
I've had colleagues tell me, "Don't put your videos like that. You're basically spilling out all your secrets." Again, that's the way that I show and tell patients, "This is how I do it and this is what you're going to get yourself into." And they know. It's actually even brought more patients in to see me.
[Dr. Jose Silva]
That's awesome. I'll definitely look into them. I have seen a few. After six weeks, you see them, they start cycling, how long does it take prior to start using it?
[Dr. Jonathan Clavell]
At six weeks, I tell them, "You're good to use it." Usually, by four or five weeks, they should be okay. For those that do infrapubic, guys were able to cycle a lot sooner two or three weeks. I know there are docs that, as soon as you can start cycling, they allow them to have sex. I don't encourage that because again, I want those corporotomies to hold well and not burst open.
I've actually seen, not my patient, but patients who started having sex beforehand. The corporotomy opened up, and the cylinder just slipped right through that corporotomy. Again, it wasn't my patient but it's actually a really cool video that I actually have to post at some point.
[Dr. Jose Silva]
And do you leave the cylinder a little bit full?
[Dr. Jonathan Clavell]
All my patients are about 70% inflated post-op.
[Dr. Jose Silva]
They're going to be like that for six weeks?
[Dr. Jonathan Clavell]
Especially whenever you have a thin guy who has a big penis, I tell them, "Your penile implant recovery is going to suck, but in a good way." Of course, by two or three weeks, if they say, "Doc, I just can't take it." Then I tell them, "You can start cycling if you feel comfortable doing it." They can start cycling up to six weeks, and then at five or six weeks, that's when I tell them, "You can start having sex."
Additional resources:
Podcast Contributors
Dr. Jonathan Clavell
Dr. Jonathan Clavell is a high-volume prosthetic urology surgeon and assistant professor of urology at UT Health Science Center Houston.
Dr. Jose Silva
Dr. Jose Silva is a board certified urologist practicing in Central Florida.
Cite This Podcast
BackTable, LLC (Producer). (2021, June 2). Ep. 8 – Men's Sexual Health [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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