72. (From “101 Aphorisms, adages, and illustrations for the urological resident.”)
A Silk Purse out of Sow’s Ear
When it comes to advising a patient to have an inflatable penile prosthesis placed, you’d better make sure it is the last resort. I don’t care how hard, or not hard, they push you to skip to that treatment option. You should you use the neurosurgeon’s technique of making it very clear that “We are operating on your back because conservative measures have not worked and I can make no guarantees regarding outcome” or “This procedure destroys the natural ability of the penis to get erect; you can’t go back once we do this.”
But this is only the start. You see, some patients think that the prosthesis makes things bigger. You can say it ten times but they don’t hear it and they don’t hear that the head does not engorge and the girth will be less. Initially, you should try to talk them out of it because there is no wrath like the impotent man scorned. If they persist, know the downside risk and that you are only promising a firm penis and that is all, you may want to proceed. Make sure they know about the potential for prolonged post-operative pain after insertion. Oh, and don’t forget that there may be an infection and that the prosthesis may need to be removed and if removed, you may not be able to put another one in. And since the cavernosa are now sclerotic, “happy days” will not be here again.
After all this and every “I” is dotted and all “Ts” crossed, you successfully put in the prosthesis and you are now showing the patient how to cycle it up a month later. It turns out the patient has poor hand to eye coordination, and this is a task that he can’t master in one office visit. But even now, this isn’t the kicker.
“Doc, my penis was much bigger than this before you put this in. I bet it is at least an inch and half shorter,” he says as his wife, who is in the room as well, nods in agreement.
Rule: You can make a penis firm; you can’t make a purse from a sow’s ear.