(414) Double Distal Fixation Stitch

Abstract

Abstract Introduction Distal cylinder extrusion is not a common complication of penile prothesis surgery when compared to mechanical device failure but can have very serious complications if not addressed properly. Reported revision surgery for IPP implantation is more commonly required for cosmetic and erosion problems as opposed to mechanical failure. Complications such as distal crossovers, delayed distal crossovers, and impending lateral extrusion can be treated with a double distal fixation stitch. This technique addresses stabilization issues and keeps penile implant secure and in place. Objective We demonstrate the Double Distal Fixation Stitch for the meandering distal cylinder Methods 62 y/o white male Hx of erectile dysfunction and Penile implant No significant past medical history Presents with pending left lateral cylinder extrusion Implant functional Patient underwent a corporoplasty and double distal fixation stich in order to ensure distal aspect of cylinder remains in place Results A lateral sub-coronal incision is used on the affected side where cylinder should be positioned. Dissection is carried through the Buck fascia, followed by a transverse incision of the tunica albuginea, where the distal aspect of the affected cylinder is delivered. Two 2-0 Ethibon sutures are threaded through the distal cylinder islet of the implant. A new, properly positioned intracorporal channel is created using a longitudinal capsulotomy and dilation with a 9 Hagar. Two 2-0 Ethibon sutures are passed through the distal islet of the implant cylinder. The first suture is passed through the glans with the cylinder in the native corpora position, a second suture is passed through about .25cm apart from first suture creating a small bridge. A small incision is made connecting the two suture exit sites. Both sutures are then tied down individually leaving one suture on each side to be tied across the bridge. The knots are then buried in the glans by elevating the skin and closing the skin with 3-0 chromic. Conclusions This technique ensured that the cylinder remained in the newly created, appropriately positioned channel. The double distal fixation stitch is safe and effective in securing the distal cylinder of an inflatable penile prosthesis and preventing recurrence. This technique is a useful surgical adjunct to treating patients with prosthetic lateral extrusions or crossovers that can be applied in almost all cases and can ensure distal stabilization of a migrating distal cylinder in weak tunica. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: coloplast, boston scientific.