Nursing Care Plan for Penile Implantation

The surgical insertion of a penile prosthesis performed to treat erectile dysfunction to allow for the maintenance of an erect penis for sexual function. Penile implantation may be semi-rigid resulting in a permanent semi-erection or inflatable, which is filled with fluid pumped into cylinders placed in the penis resulting in lengthening and firming of the organ (fluid released when activity completed). Impotency may be caused by spinal cord trauma, diabetes mellitus, atherosclerosis, surgery, or radiation of area, or psychological conditions. This plan, which includes interventions specific to this procedure, may be used in association with preoperative care, postoperative care, spinal cord trauma, and diabetes mellitus care plan.

Nursing Diagnoses: Body image disturbance related to biophysical factor of change of sexual activity, appearance and embarrassment of permanent erection of semi-rigid prosthesis. Altered sexuality patterns related to altered structure and functions caused by surgical implantation of penile prosthesis resulting in changes in sexual behaviors and activity.

Expected Outcomes: Progressive adaptation to change in sexual activity and pattern evidenced by verbalization of feeling of improved sexual performance and ability to conceal semi-rigid prosthesis, improved relationship with sexual partner.

Nursing Intervention with Rationale:
I. Assess for:
A. Feelings associated with implant and change in functioning of penis, sexual adequacy.
Rationale: Provides data revealing effect of change in body image, self-worth, sexuality.

II. Perform or Provide:
A. Encourage expression of feelings in attentive, non-judgmental environment.
Rationale: Provides venting of feelings and opportunity to externalize feelings in response to implant.

B. Encourage expression of how implant will affect lives of self and partner.
Rationale: Identifies positive behaviors and willingness to adapt to change in function.

C. Privacy during self-care; offer pajama bottoms.
Rationale: Prevents embarrassment of exposure of penal erection.

D. Inclusion of partner in content of instruction and demonstrations.
Rationale: Maintain relationship with sexual partner.

III. Teach Patient or Partner:
A. Operation of pump, using models, to inflate or deflate daily for 4-6 weeks.
Rationale: Promotes acceptance and satisfactory use of prosthesis; will maintain pump position and promote fibrous tissue growth around implant.

B. Amount of pressure to use for inflation.
Rationale: Pressure that is excessive will obstruct fluid flow.

C. Inform that adaptation to implant takes time.
Rationale: Promotes patience and acceptance of change in function.

D. Suggest wearing snug fitting underwear with penis placed in upward position on abdomen, loose trousers.
Rationale: Assists to conceal semi-rigid prosthesis.

E. Begin sexual activity 6-8 weeks after surgery with physician's permission; use adequate lubrication.
Rationale: Allows for healing; prevents undue trauma to penis after surgery.