SST correction with proximal extracapsular tunneling after inflatable penile prosthesis surgery

Abstract

ObjectiveTo describe a single incision approach to correction of an SST deformity after penile implantation. Patient and surgical procedureEight months after inflatable penile implant (IPP) surgery via a penoscrotal approach at an outside institution, patient presented with a complaint of a floppy glans and penile shortening. Exam revealed SST deformity, reservoir herniation in his groin and a high riding pump. He was a diabetic with a HgA1C of 7.5%. The recommendation was to proceed with removal of all components of his IPP, proximal extracapsular tunneling, re-sizing and re-implantation of his IPP through a single infrapubic incision. A decision to add a distal biologic cap if necessary was discussed pre-operatively. ResultsThe patient had a successful removal and replacement of all his components of the IPP through a single incision and proximal extracapsular tunneling. The original implant was 18cm with 2.5 cm rear tip extenders (RTE). All compartments were washed out with Irrisept® irrigation only. We replaced it with a hydrophilic coated implant dipped in Irrisept® measuring 22cm with 2 cm RTE through a single infrabubic incision for an additional 3.5cm in length. The pump and reservoir were placed in their appropriate locations. The surgery lasted approximately 60 minutes. Intraoperative cultures grew out Enterococcus species, Bacillus species and Coagulase Negative Staphylococcus. Patients are routinely given sulfamethoxazole/trimethoprim for 5 days pre-operatively and 9 days post-operatively. No additional antibiotics were given after surgery. The patient resumed sexual activity 3 weeks after surgery as is the case with our virgin surgery IPP patients. The patient has a functional implant without any signs of infection or SST 6 months after surgery. ConclusionCorrection of SST deformity can be successfully performed through a single operative incision with proximal extracapsular tunneling. This can be done with either a penoscrotal or infrapubic approach. Recovery times are no different than an original surgical implant surgery at our institution. Irrisept® washout and dipping provides effective intraoperative infection control.