Milann Achieves Successful Penile Prosthesis Implantation in Rare Post-Polio Deformity Case

Bengaluru, July 29: Milann Fertility and Birthing Hospital, Bengaluru, successfully performed a complex penile prosthesis implantation in a 50-year-old man with a history of post-polio pelvic deformity, type 2 diabetes mellitus, and medically refractory erectile dysfunction, under the supervision of Dr. Praveen B. Joshi, Chief Uro-Andrologist and Urological Surgeon. 

The patient presented with a longstanding history of erectile dysfunction that had progressively worsened over several years. He had been diagnosed with type 2 diabetes mellitus 18 years earlier and was under regular medical management. At the time of surgery, his diabetes was well controlled, with a glycated hemoglobin (HbA1c) level of 7.2%. 

The patient reported an inability to achieve or maintain erections sufficient for satisfactory sexual intercourse. Prior treatment approaches, including oral phosphodiesterase type 5 inhibitors and low-intensity extracorporeal shockwave therapy, did not provide meaningful clinical improvement. He had also undergone intracavernosal injection therapy, but the response was inadequate and did not provide long-term satisfaction.

His medical history was significant for poliomyelitis during childhood, which resulted in persistent right lower limb weakness and residual deformity. Clinical evaluation revealed significant muscle wasting of the affected limb, pelvic asymmetry, and compensatory postural adaptations. Despite these musculoskeletal limitations, the patient remained ambulatory and functionally independent. 

Genital examination showed normal penile skin, adequate stretched penile length, and no evidence of Peyronie’s disease or corporal fibrosis. Both testes were normally positioned within the scrotum. However, the presence of pelvic asymmetry and altered body proportions raised important considerations regarding prosthesis sizing, positioning, and surgical approach. 

Given the failure of conservative treatment options and the patient’s desire for a definitive solution, penile prosthesis implantation was recommended. Extensive counselling was provided regarding the benefits, risks, potential complications, and realistic postoperative expectations. Particular emphasis was placed on the technical considerations associated with his altered pelvic anatomy and the requirement for an individualised surgical plan. 

While penile prosthesis implantation is an established treatment option for erectile dysfunction, this case presented a significant clinical challenge due to the combination of post-polio pelvic deformity, altered musculoskeletal anatomy, and diabetes mellitus. The complexity was not related to the procedure itself but to the need for adapting the surgical approach according to the patient’s anatomical and medical profile. 

Following informed consent, the patient was scheduled for surgery. Dr. Praveen and his team conducted a detailed preoperative assessment to evaluate anatomical suitability, functional requirements, and expected outcomes. The prosthesis selection was carefully planned, considering factors such as patient anatomy, implant positioning, long-term comfort, and functional expectations. 

During the procedure, the surgical team successfully implanted the prosthetic cylinders, which are the components placed within the penis to provide rigidity. Particular attention was given to achieving appropriate alignment and positioning despite the patient’s pelvic asymmetry and altered body proportions. Strict infection-control measures were followed throughout the procedure, especially considering the patient’s diabetic status, and meticulous surgical techniques were adopted to support optimal healing. 

The surgery lasted approximately 150 minutes, slightly longer than a routine penile prosthesis implantation due to the additional anatomical considerations. Despite the challenges, the procedure was completed successfully without complications, and blood loss remained minimal. 

The patient experienced a smooth postoperative recovery. Mild discomfort following surgery was managed effectively, and there were no concerns related to wound healing, bleeding, urinary function, or implant-related complications during the hospital stay. He was discharged on the second postoperative day with detailed instructions regarding wound care, medications, physical activity restrictions, and follow-up care. 

After four-weeks of follow-up, the surgical site had healed well, with no signs of infection, erosion, device migration, or skin-related complications. During subsequent reviews, the implant continued to function effectively, and the patient reported improved penile rigidity, restoration of sexual function, and satisfaction with the outcome. No prosthesis-related complications were observed. 

Dr. Praveen B. Joshi, Chief Uro-Andrologist and Urological Surgeon, Milann Fertility and Birthing Hospital, Bengaluru, said, “Penile prosthesis implantation is a well-established procedure; however, every patient presents unique challenges. In this case, the combination of post-polio pelvic deformity and diabetes required detailed anatomical assessment, careful planning, and an individualised surgical strategy. The success of such cases depends on adapting established techniques to the specific needs of the patient. With meticulous planning, careful execution, and comprehensive postoperative care, we were able to achieve a successful outcome and help restore the patient’s sexual function and confidence.” 

Penile prosthesis implantation remains an effective treatment option for men with erectile dysfunction who do not respond adequately to medications or other therapies. While the procedure has demonstrated high success and satisfaction rates, patients with conditions such as diabetes, neuromuscular disorders, or skeletal deformities require specialised evaluation and customised surgical approaches. 

Post-polio musculoskeletal deformities can result in altered pelvic alignment and anatomical changes, which may create additional considerations during procedures involving the pelvic region. Although similar complex erectile dysfunction cases have been managed by the team previously, cases involving post-polio-related anatomical changes are becoming increasingly uncommon due to the declining prevalence of polio. 

Dr. Dipen Shah, Chief Operating Officer, Milann Fertility and Birthing Hospital, said, “This successful procedure reflects Milann’s commitment to providing advanced and comprehensive Andrology care for men with complex reproductive and sexual health concerns. Through specialised expertise in male infertility, erectile dysfunction, hormonal disorders, and advanced procedures such as penile prosthesis implantation, we continue to deliver personalised treatment solutions that help patients regain function, confidence, and quality of life.” 

This case highlights the importance of personalised surgical planning and specialised care in managing patients with complex medical histories. With appropriate evaluation, advanced surgical expertise, and comprehensive postoperative management, individuals with significant anatomical challenges can achieve successful outcomes and improved quality of life.

The Patient said, “For years, I struggled with a condition that affected both my physical and emotional well-being. The surgery has made a significant difference to my quality of life, and I am thankful to the medical team for helping me regain confidence and normalcy.”