Abstract
Penile prosthesis placement is the third line therapy to treat erectile dysfunction. It is gold standard on those who do not respond to more conservative options (1). Place-ment of the penile prosthesis, specially the three piece inflatable, has been reported from various different approaches, including penoscrotal, infrapubic, suprapubic and perineal locations (2). Each approach has its own advantage and disadvantages, however every implanter should be able to perform a few of these techniques depending on specific ana-tomy or revision cases. The penoscrotal approach is the most widely used and according to manufacturer data, reaches 80% of all implants in the United States of the America. Historically, the suprapubic approach was the first used to implant prosthesis (3). Howe-ver, the incisions were too big and there was some concern to bury the tubing underneath the fascia as it was not kink-resistant as today. Many physicians were afraid of injuring the dorsal nerve as well.The infrapubic incision used today is a variation of the old one. The new techni-que utilizes smaller incision and corporotomies, minimal corporal dilatation and decrea-ses tissue dissection allowing for a rapid recovery and possibility of engaging in sexual activity on a shorter time. We have adopted this approach to implant 3-piece inflatables prosthesis since visiting Dr. Paul Perito from Miami, USA (4). I do not recommend this approach for semi rigid ones, as I believe a penile midline ventral incision is perfectly adequate.Regarding the infrapubic technique there are several advantages:
Highlights
Penile prosthesis placement is the third line therapy to treat erectile dysfunction
The penoscrotal approach is the most widely used and according to manufacturer data, reaches 80% of all implants in the United States of the America
From the infrapubic incision is possible to create a space between the testicles through the introduction of a nasal speculum just parallel to the corpora
Summary
Penile prosthesis placement is the third line therapy to treat erectile dysfunction. It is gold standard on those who do not respond to more conservative options (1). Placement of the penile prosthesis, specially the three piece inflatable, has been reported from various different approaches, including penoscrotal, infrapubic, suprapubic and perineal locations (2). Each approach has its own advantage and disadvantages, every implanter should be able to perform a few of these techniques depending on specific anatomy or revision cases. The suprapubic approach was the first used to implant prosthesis (3).
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