Penile prosthesis implant: tips and tricks

Abstract

Erectile Dysfunction (ED) affects nearly 52% of men between the ages of 40 and 70 worldwide, causing overall lifestyle difficulties and is often a symptom of an underlying disease. Although more invasive than some of the other currently available therapies, penile prosthesis surgery has the advantages of high patient satisfaction rates and avoidance of systemic adverse events in the vast majority of cases. After a penoscrotal incision is made, the dissection is carried down through dartos fascia. Two-centimeter corporotomies are made and 2 horizontal mattress sutures are placed on each side of the corporotomy. These sutures are used as guide during dilatation and measurement, and they are also used to close the corporotomy. Dilatation starts with an 10-mm Hegar dilator and proceeds to 14-mm. The dilator are directed laterally to avoid urethral injury. After corporeal measurements are taken, the appropriate cylinder size is selected. The prosthesis components are prepared for implantation and distal cylinder insertion is aided by use of the Furlow cylinder inserter. The Furlow inserter directs the Keith needle (with the device pulling-suture attached) through the glans penis and allows the attached cylinder to be positioned appropriately. If the cylinder fit is proper, the proximal portion is all the way down to the attachment of the crus to the pelvic bone and the distal portion is in the distal corpus cavernosum under the midglans penis. The corporotomies are closed and in preparation for pump placement, a pouch is developed in the scrotal septum. The pump is placed in this pouch and the connections between the pump and each cylinder are made. Safe reservoir insertion into the retropubic space through the primary penoscrotal incision is possible only if the bladder is completely empty. Metzenbaum scissors is used to perforate the transversalis fascia. Using a nasal speculum, the empty reservoir is introduced into the retropubic space and it is then filled with the requisite amount of saline solution. Dartos fascia and skin are then closed. Penile prostheses were first developed 30 years ago; despite ongoing advances in the pharmacotherapy for ED, prosthetic surgery continues to occupy an important therapeutic role. Improvements in reducing the incidence of infection, treating infection with antiseptic washes, enhancing device longevity, and instituting new techniques to manage complicated implantation procedures have made them more acceptable to patients. Although penile implants are the least often chosen and most invasive treatment for erectile dysfunction, they have the highest satisfaction rate among both patients and partners.