Fluoroscopy guided implantation of penile prosthesis in cases of severe fibrosis

Abstract

Penile prosthesis implantation in men with scarred corpora presents a challenge to surgeons due to the fibrosis created and the loss of normal anatomic boundaries. We present a new technique to recreate corporal spaces and preserve circulation in a patient with a neophallus that we believe can be used in other circumstances of atypical anatomy such as extensive fibrotic scarring. The operation was performed in a hybrid operating room that was capable of complete angiography as well as complete sterility for operative procedures. Angiography of the femoral vessels documented the blood supply to the neophallus and decreased the risk of accidental injury to its vascular supply. Under fluoroscopic guidance a 16 cm needle was extended through the pseudo-corpora of the neophallus to provide a channel for a super stiff guide-wire to be advanced. The needle was then removed and an inflatable Amplatz dilator was advanced along the wire. The balloons were inflated with contrast media under fluoroscopic guidance to create two pseudo corporeal spaces. Appropriately sized inflatable penile prosthesis cylinders were then advanced into these spaces. Successful outcome was maintained at 2 year and 5 months follow-up. Corporoplasty provides an alternative to standard approaches in patients with fibrosis and atypical blood vessel anatomy.