I’m Dr Sébastien Beley, urological surgeon in Paris, and today I’d like to talk to you about an important subject that concerns many diabetic men: the placement of a penile implant. This surgical solution is often considered for patients suffering from severe erectile dysfunction, particularly diabetic men who frequently encounter these difficulties after several years of disease progression. But what are the specific constraints associated with diabetes during this operation? And how can you best prepare for the operation to limit the risks? In this article, I explain penile implants and diabetes in detail.

Why penile implants are often used in diabetic men

Diabetes is a chronic disease which, when poorly balanced or over several years, frequently leads to severe erectile dysfunction. Indeed, after a decade or so of diabetes, the vascular and neurological mechanisms required for a normal erection are often impaired. As a result, many diabetic men turn to a penile implant to regain satisfactory erectile function.

This procedure is considered an effective, long-lasting solution when drug treatments such as Viagra or Cialis are no longer sufficient. A significant proportion of patients undergoing penile implant surgery are men with diabetes, often directly related to the severity of their erectile dysfunction.

Diabetes-related constraints during penile implant surgery

Diabetes imposes several constraints to be taken into account by the surgeon and the patient when placing a penile implant:

• Timing of the operation: To limit the inconvenience of pre-operative fasting, it’s best to schedule the operation early in the day. This reduces the duration of fasting, which is important for diabetic patients to avoid excessive variations in blood sugar levels.
• Pre-operative check-up: It is essential to check for any diabetes-related complications that could complicate surgery or the post-operative period. This includes rigorous monitoring of blood sugar levels and renal function, and checking for infections and skin lesions.
• Glycemic control around surgery: This is undoubtedly the most important constraint. Diabetes control in the four weeks before and four weeks after surgery is a key factor in preventing surgical site infections.

The vital importance of glycemic control

Poorly balanced diabetes, particularly when glycosylated hemoglobin (HbA1c) exceeds 7.5% or even 8%, significantly increases the risk of infection after penile implant surgery. These infections can be so severe as to require urgent re-intervention to remove the implant, a situation which should obviously be avoided.

Studies show that the risk of infection is multiplied by two to three when diabetes is poorly controlled. This is because episodes of chronic hyperglycemia impair wound healing and weaken the local immune response, making the surgical site more vulnerable to bacteria.

How to prepare your body before surgery

To minimize risks and ensure proper healing, several precautions are essential:

1. Strict blood glucose monitoring: It’s crucial to strictly monitor your diabetes therapy and maintain optimal blood glucose control in the weeks leading up to surgery.
2. Adherence to the right diet: The right diet helps stabilize blood sugar levels and improves overall health.
3. Absence of infectious outbreaks: All wounds, whether on the feet, hands or even teeth, must be treated before surgery. Uncontrolled infection can spread and contaminate the implant, leading to serious complications.
4. Pre-operative consultation and check-up: A full medical examination is essential to ensure that the patient is in good condition to undergo the procedure, and that the risks are under control.

Wounds and infections to avoid

Poorly healed or infected wounds, particularly in diabetic patients, represent a potential starting point for generalized infection. This may involve :

• Foot ulcers or lesions, common among diabetics.
• Sores or skin infections on the hands or elsewhere.
• Dental infections, often underestimated, can contaminate blood and the surgical site.

It is therefore essential to report any such problems to your surgeon before surgery, so that appropriate treatment can be put in place.

The post-operative period: continuing to manage your diabetes

After insertion of the penile implant, vigilance is essential. Healing may be slowed by fluctuations in blood sugar levels, and the risk of infection persists until the wound is completely closed.

Here are the essential recommendations for the period after surgery:

• Continue to take your diabetes medication as prescribed.
• Maintain a balanced, appropriate diet to avoid blood sugar spikes.
• Monitor the condition of the surgical wound and immediately report any signs of infection: redness, pain, swelling, discharge.
• Avoid any activity that could delay healing or contaminate the operated area.

What should I do if my penile implant becomes infected?

Despite all precautions, infections can occur. In such cases, care is urgently required:

• Immediate removal of implant to prevent spread of infection.
• Appropriate antibiotic treatment.
• A new implant placement is generally not possible in the same operating time.
• It is necessary to wait several weeks, or even months, before considering a second operation.

This situation is obviously very restrictive for the patient, who must then wait and manage a new waiting period before regaining satisfactory erectile function.

Practical advice for diabetic patients prior to penile implant surgery

To summarize, here are the key points to remember if you have diabetes and are considering penile implant surgery:

1. Make sure your diabetes is well controlled at least one month before and one month after the operation.
2. Respect your medical treatment and never change your diet without medical advice.
3. Have a complete medical check-up to detect and treat any infection or complication.
4. Report any wounds or infections before surgery to avoid risks.
5. Schedule your procedure early in the day to limit fasting and glycemic fluctuations.

Conclusion

Penile implants are an effective solution for treating severe erectile dysfunction, particularly in diabetic men. However, diabetes imposes specific constraints that must be taken into account to reduce the risk of complications, particularly infection. Good glycemic control, rigorous medical monitoring and the absence of infectious foci are essential to ensure the success of the procedure and good healing.

If you are diabetic and are considering this surgery, I encourage you to work closely with your doctor to optimize your health before and after the operation. This will give you the best chance of regaining your confidence and quality of life.

For more information on male sexual health, erectile dysfunction and available treatments, please consult our resources and book a personalized assessment.