Andrew Kramer, M.D. – How Penile Implants Work

A Step-by-Step Guide to Penile Implant Surgery


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Penile Implant Procedure Steps

The inflatable penile implant placement is done in this practice in about 25 minutes. Dr. Kramer’s implant surgeries are performed optimally to ensure high patient satisfaction.

The steps of the penile implant surgery generally include:

  1. Scrotal incision, 1.5 inches long
  2. Placement of self-retaining retractor
  3. Incision and separation of two filmy layers of muscle and reflecting of Bucks fascia to show the pearly white, cleaned corpora on both sides
  4. Placement of holding sutures on the low tunica albuginea overlying the corpus cavernosa (erectile body) on the left and the right
  5. Creation of the reservoir space, typically on the left,  placement of the fluid reservoir, and filling of the reservoir
  6. Incision in the corpora on the left and right, measuring proximally and distally, and irrigation of both sides with antibiotic fluid
  7. Preparation of the device (placed on a new towel, with new gloves)
  8. Placement of left and right cylinders into the corpora, then irrigation
  9. Closure of corpora on both sides, irrigation, and connecting of the pump to the reservoir
  10. Testing of the implant, checking tips and making sure there is no buckling, and modeling if necessary
  11. Tucking the pump into the sub-dartos scrotal pouch, irrigation, placement of fibrillar (hemostatic agent) if necessary, and three layer closure

Penile Implant Cycling

Cycling of a penile implant is the practice by which a patient, once he has recovered, inflates and deflates the implant on a regular basis. He does this even in the absence of sexual activity and the goals are outlined below.

How much should I cycle the penile implant?

Dr. Kramer feels cycling should be done about twice per day, for 12 to 18 months after surgery. Cycling should be done by inflating the implant as much as it possibly can be inflated. Once it is inflated, then it should be left that way for about 5 minutes. Then, it’s important to pump even more fluid into the device, around three to four additional pumps, until the device is very full. Then deflate it. Repeat these steps again.

What is the point of cycling?

Cycling the implant (inflating/deflating twice a day) has several goals:

  • To take advantage of the tissue expander qualities of the penile implant so that the penis can stretch in length and girth, maximizing penis size after implant placement. While only the LGX brand implant gains length with inflation, the other models gain girth with inflation.
  • To learn how to master the pump, so when the timing is right, the patient is comfortable with how to effectively operate the prosthesis and knows how to efficiently pump it up.
  • To break in the pump so it softens, is easier to squeeze, and requires less force to move fluid back and forth.
Does cycling reduce the lifespan of the implant?

It is possible that cycling reduces the lifespan of the implant by simply putting more wear and tear on it. However, Dr. Kramer feels that cycling DOES maximize the length and girth of the penis, and the more cycling one does the better.

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