Multi-component penile implant procedure infrapubic approach

Other:

• Preoperative Prophylaxis: Vancomycin + Gentamicin

Procedure Steps:

• Create an Artificial Erection using a mixture of saline and Lidocaine.

• Make initial 2 cm infrapubic incision.

• Once you have gone through the Scarpas fascia, bluntly dissect down to the corpora.

• Stay sutures are placed laterally in corpora, staying well away from the dorsal nerves.

• Make each corporatomy no more than 1.5 cm in length.

• Measure corporal length proximally and distally using a Furlow inserter. Make sure you work along the axis of the penis.

• Develop space for a reservoir posterior to the transversalis fascia with a 3½-inch nasal speculum for patients with a compromised pelvis.

• Deploy the reservoir with a pediatric Yankauer.

• Insert the cylinders using the Furlow.

• Perform rapid inflation.

• Close the cavernotomies using stay sutures.

• Place the pump midline posterior and drop in with the nasal speculum

• Place #10 JP drain in the most dependent portion of the scrotum and bring ut out through a separate stab wound in the infrapubic area

• Close the Scarpus and skin as desired.

• Place a 10 lb. sandbag on the infrapubic incision for 2 hours in recovery.

Learning Points:

• Clearly define the pre-operative pathology and abnormal anatomy.

• Minimize the corporatomy.

• Always make sure to stay along the axis of the penis.

• Insert each Cylinder separately, first distally, then proximally.

• Test the result applying rapid inflation.

• Drain all patients.