222 Beyond the Bench: Surgical Technique Development for Implantation of a Novel Penile Prosthesis in Human Corpora Cavernosa

Abstract

With development of a novel class of penile prosthesis that uses shape memory alloys (SMA), we sought to develop and troubleshoot the optimal surgical technique for implantation into the corpora cavernosa of human cadavers as no established technique exists. Development of such surgical techniques is necessary to move forward to human applications. Two pelvic human cadavers were obtained. A lasercut SMA prosthesis that has been previously described surrounding a spongy core and covered in a latex sheath was inserted into the corpora cavernosa through various established surgical approaches: (1) transglanular, (2) subcoronal, and (3) penoscrotal. Challenges in technique were documented and activation/deactivation of the device was carried out. Similar to malleable penile prosthesis implantation, techniques for inserting a cylindrical device involved creating a space in the corpora using standard dilation techniques. Unlike malleables, we are able to crimp our device and reduce cross sectional diameter prior to implantation. The numerous ribs in our prototype, despite being encased in a latex sheath, made implantation from a distal approach (transglanular and subcoronal) challenging. A penoscrotal approach was more successful. Seating the prototype into the proximal crura was also difficult, as our prototype did not have rear tip extenders or proximal tapering. Fixation proximally was found to be important for stability. During the activation process with magnetic induction, the intrapelvic portion was difficult to access, while the penile component responded readily and demonstrated a force resistant to buckling of 1.2 kgf.