The Minimally Invasive Infrapubic approach to penile prosthesis implantation is both expedient and effective. Post-operative outcomes are similar to or surpass other approaches described in the clinical literature. By saving motions and time, the Minimally Invasive Infrapubic approach to penile implantation offers the patient a safe and rapid return to sexual function.
Clinical Case:
54 y/o WM with no comorbidities presented with ED. The patient has failed PDE5 inhibitors. The patient was maintained on ICI for >1 year and subsequently failed those as well. The patient’s only past surgical history is a splenectomy. Pertinent PE includes diffuse intracorporal fibrosis in the topography of previous ICI. A penile duplex revealed severe bilateral veno-occlusive disease.
Clinical History:
Other:
- Preoperative Prophylaxis: Vancomycin + Gentamicin
Procedure Steps:
- Create an Artificial Erection using a mixture of saline and Lidocaine.
- Primary Goal: To clearly define the pre-operative pathology that needs to be surgically addressed.
- 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.
- Goal: To identify the persistent pathology and/or problems associated with correct cylinder implantation.
- 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.
