Penile prostheses in spinal cord injured patients: combined psychosexual counselling and surgical regimen

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Abstract
Since 1981, forty spinal cord-injured patients have received penile prostheses using a combined approach of early sexual counselling during the acute rehabilitative phase of injury, followed by implantation in suitable candidates no less than nine to twelve months following injury. Early counselling is begun in private and group sessions, and stresses reassessment of body image, sexuality and sexual alternatives. The penile prosthesis is mentioned briefly during the acute phase of rehabilitation. Further counselling at the patient's request following discharge from the unit identifies those patients with continued interest in a penile prosthesis. Suitable surgical candidates must (1) have a stable bladder program, (2) have had a recent urologic X-ray evaluation, (3) have sterile urine at the time of implantation, and (4) be free of decubiti. All preoperative patients undergo MMPI testing and are seen by a sexual counsellor. Both the semi-rigid and inflatable penile prostheses are offered to the patient with a thorough discussion along with printed material on the advantages and disadvantages of each prosthesis, as well as surgical and postoperative complications. Patients are given a preoperative parenteral antibiotic regimen along with supervised antibiotic cleansing of the genitalia. Surgical techniques for each prosthesis is discussed. Following surgery, the patients are continued on antibiotics and are instructed not to engage in intercourse for six weeks. They are also seen by a sexual counsellor postoperatively. There have been a total of forty implantations; thirty-four patients having had semi-rigid implants and six inflatable prostheses. There have been three implants which necessitated removal secondary to infection; these were semi-rigid rod patients. There has been one paraphimosis which necessitated secondary circumcision. The patients were given a sexual questionnaire in order to determine whether they had realized their preoperative expectations of an implant as well as good partner acceptance. The results are described, and appear to be favourable. We stress the selection of good candidates for sexual implantation in order to lessen potential complications and insure good results.