The other day I saw a new patient, who came to see me to discuss problems he was having with his penile implant. It was placed by another surgeon, a few years ago, before he relocated to Seattle. The problem was not with the mechanics of the penile implant. He was delighted with how adept he had become inflating and deflating the device. He was happy with the firmness of the erection and said everything was great except…
He did not like the position of the pump in the scrotum. He wondered if there was anything we could do to correct this. I examined him and found the pump to be sitting high up in the scrotum. It seemed to crowd the under surface of his penis. He described to me that it commonly got in the way during intercourse.
I explained to him the importance of pump positioning and the approach that I take in placing the pump. I try to place it at or slightly above the testicles. Doing this gets the pump ‘out of the way’. The goal is to have the pump placed just under the skin, where it is easy to palpate. If the pump is placed too low or too far back it may be difficult for men to function the penile implant.
Common pump position problems include:
- high-riding pump under the penis or up into the groin
- pump placed too deeply making it hard to hold
- tubing is too long and it coils up or causes pain for the partner
- pump is too low and is out of reach
- skin is too thin and I’m worried that it will erode through the skin
- The best time to get it right is the first time. Care and attention at the time of the initial surgery usually avoids pump position problems.
- Usually, I spend time troubleshooting the device to look for a solution that does not involve re-operation.
- If it is early in the recovery phase I instruct men to massage the pump gently several times per day and gently tug and pull the device. This can improve the final position after healing.
- Often times, the pump is in a good position, but the problem is ‘too much tissue’. Men who gain weight will sometimes have more difficulty finding their pump. It gets buried in the extra tissue and losing weight may solve the issue.
- Surgery is an option if all else fails
Surgery to Reposition a Penile Implant Pump
This is usually performed as an outpatient, and men will go home the same day. The recovery is much quicker and simpler than it is for the initial surgery to place the penile implant. Rarely, is it necessary to replace the pump or any of the other components of the implant.
In the pre-op area I mark the skin when the patient is standing. This indicates the ‘ideal’ final resting place for the pump. I use the previous incision to open the scrotum and this allows me to free up the pump. The tissues are irrigated with antibiotic solution to reduce infection risk. The pump is then relocated and secured into place. If the tubing is too long, I may trim it. If the tubing is too short, one option is to replace the existing pump with a new pump.
Once the swelling has resolved in 7-14 days, men can resume using the penile implant.
- Pump position matters and attention at the time of implantation can avoid problems.
- Issues with pump position are actually uncommon and many men do not require re-operation.
- Surgical reposition is a straight forward procedure and yields a high rate of satisfaction