The scrotal approach to penile prosthesis implantation has been the approach most frequently used for this surgery. It is an easy procedure with excellent outcomes that can be performed by a novel urologist or a trainee urologist.
67 y/o male presented with ED. The patient had failed PDE5 inhibitors and ICI had been tried without satisfactory outcomes and with pain.
The patient suffered six years ago a penile fracture that was managed conservatively. Penile Doppler US revealed an ED due to an arterial insufficiency and venous occlusive disease. Autophotographs in erection showed a left lateral deviation of less than 30 degrees.
Clinical Background
Shaving of the penoscrotal area with razors
Alcoholic clorhexidine solution is used for the skin
Urethal catheterization to empty the bladder
Installation of the Scott retractor
Transverse 2cm scrotal incision
Go through the Dartos fascia, bluntly, until complete dissection of both corpora cavernosa is achieved
Place both sutures for corporotomies as proximal as possible: 2 stitches of Vycril 2/0 in each corpora cavernosa
Make each corporotomy no more than 1.5 cm long
Measure corporal length proximally and distally using a Furlow inserter without previous dilatation of the corpora, except in cases of corporal fibrosis
Check the absence of a urethral lesion by filling the corpora cavernosa with an antibiotic solution
Change of gloves and preparation of penile prosthesis
AMS 700LGX cylinders placement and closure of corporotomies
Place the pump in the scrotum in the midline deeply at first, and then superficially
Create space for a reservoir posterior to the transversalis fascia (Retzius space) using scissors in case it cannot be opened with your finger
Perform a complete inflation of the prosthesis to check adequate placement and correction of possible curvatures
Close the Dartos and the skin with Vycril sutures.
Place a Coban type dressing for penile and scrotum
Technique Description
Use always a single window approach
Minimize the corporatomy
Always make sure to stay along the axis of the penis, try to go lateral with the Furlow
Use of instilled antibiotics
Insert each cylinder separately, first distally, then proximally
Test the result applying inflation
Be as fast as you could be without losing safety
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