(241) Shaeer’s Cavernotome: A New Cavernotome to Facilitate Penile Prosthesis Implantation into Scarred Corporal Bodies

Abstract

Abstract Introduction Penile prosthesis implantation into scarred corporal bodies is one of the most challenging prosthetic urology procedures, with high risks of corporal perforation, urethral laceration & lack of success. Objective: We introduce a novel Cavernotome (patent application number PCT/EG2021/050003) which cuts the channel as it is passed forward. The instrument relies on controlled coring rather than forward stabbing, with resected tissue accumulated into the hollow core. Objective We introduce a novel Cavernotome (patent application number PCT/EG2021/050003) which cuts the channel as it is passed forward. The instrument relies on controlled coring rather than forward stabbing, with resected tissue accumulated into the hollow core. Methods After ethical committee approval, we utilized the cavernotome in 18 patients with severe corporal fibrosis. Scarring was due to penile prosthesis removal after infection in twelve patients, and neglected ischemic priapism in six. Surgical Procedure: Surgery is performed through a peno-scrotal incision with urethral catheter placed for identification. Corporotomies are 2-5 cm long depending on the implant to be used. A 2cm core of fibrous tissue is excised with scalpel or electrosurgical pencil. The appropriate size for Shaeer’s Cavernotome (ShC) is determined according to the maximum that fits in the fore mentioned excavated space, mostly size 11 Hegar. ShC is advanced proximally and distally in a screwing / coring motion, rather than the customary oscillating or forward thrusting motion. To prevent inadvertent direction, the stretched corpus is held between the thumb and index fingers of the non-dominant hand ahead of the tip. ShC doubles as a sizer with a ruler marked on the shaft. Following coring, the excavated corpora and crura are dilated with minimal resistance using Hegar or Brook’s dilators. Penile prosthesis implantation proceeds in the usual fashion. The surgical technique is available at VJPU: https://www.vjpu-issm.info/videos/peer-reviewed/1-penile-prosthesis-malleable-inflatable-penile-prosthesis-ipp/1-a-first-time-implant/item/198-shaeer-s-cavernotome Results Prosthesis implantation was successful in 17 out of 18 patients. In one patient, coring was not possible. the corpora were thinned out and calcified. Size 6 ShC could not be introduced. Corporal reconstruction was performed. Average coring time was 8 minutes. Dilation to 13mm Hegar in 12 patients, and 11mm in 5. The implant used was Rigicon Rigi10® (n=12), Rigicon Infla10® (n=2) and Coloplast Genesis® (n=3). No perforations or infections in the 17 successful implantations. Conclusions Shaeer’s Cavernotome is a new instrument that, in its initial study by the inventor, facilitates penile prosthesis implantation into scarred corporal bodies. Disclosure No