(411) The “Unfolding” Technique for Penile Prosthesis Implantation in Post-priapism Corporeal Fibrosis

Abstract

Abstract Introduction `- In neglected cases of ischemic priapism, there is usually severe corporeal fibrosis that can render penile prosthesis implantation later on extremely difficult. - Although many researchers described different approaches to overcome difficulties during surgery, none of them offered satisfactory results. Objective `- to describe a new technique to insert a large sized penile prosthesis in patients suffering from ED after neglected ischemic priapism with resultant severe corporeal fibrosis. Methods `- A new surgical technique was done in 15 patients suffering from ED after prolonged ischemic priapism with severe corporeal fibrosis. - Surgery starts by a circumcision incision, complete degloving & delivery of the penis through a midline perineal incision. - The penile urethra is then dissected away from the ventral surface of both corpora cavernosa - A midline ventral incision is done between both corpora cavernosa. This incision is then deepened till it reaches the inner surface of the tunica albuginea. At this point, the scalpel is then rotated 90 degrees to unfold the core of fibrosis into a flat sheet continuous with tunica albuginea. - The process is then repeated on the other side. - The proximal crura are then dilated in the usual manner by metal dilators. The distal part of the corpora are bluntly dilated by the closed blades of scissors. - After inserting the penile prosthesis, both sheets of fibrosis are closed over both prosthetic rods in the midline and the penile urethra is then fixed back to its position. - The penis is then retuned to its normal anatomical site & the skin is closed. Results `- Successful surgery was achieved in 13 out of 15 patients (86.7%). - 2 patients developed infection that necessitated surgical removal of the rods. - no incidence of urethral injury, crossover or corporal perforation Conclusions `- The new “un-folding” technique is feasible and useful technique in patients with ED after prolonged ischemic priapism - The incidence of complications esp. urethral erosion, crossover and corporal perforation. Disclosure No