The Tunneling Technique: A Universal Approach for Salvage Penile Prosthetic Implantation in Severely Scarred Corporal Bodies

Abstract

ABSTRACT Introduction IPP implantation in severe cases of intracorporal scarring poses a daunting challenge, even to experts in the field, owing to associated difficulty and high rates of complications. Objective In a step-by-step video, we demonstrate the successful implantation of an IPP in a case of total intracorporal fibrosis utilizing the tunneling technique through the subcoronal approach. We aspire this video to serve as an instructive resource for treating these special cases. Methods We present our approach performed on a 32 year old African male patient suffering complete intracorporal fibrosis as a result of a full week episode of ischemic priapism due to sickle cell anemia. The penile shaft was degloved via a subcoronal incision. In addition to the conventional instruments required for IPP implantation, for tunneling and dilation, we used the Wilson's backward cutting scissors, the Uramix original cavernotomes (http://www.uramix.com/category/og/), the Carrion-Rossello cavernotomes (https://www.coloplast.co.uk/rossello-en-gb.aspx), and the Zephyr cavernotomes. Apart from the unique corporal dilation steps, IPP implantation was performed in the classic fashion. A closed suction drain was utilized as part of our routine protocol. Our patient was followed up the patient for one month on a weekly basis then again after 3 months. Results After successful corporal tunneling utilizing our special instruments we were able to seamlessly implant a size 20 Coloplast Narrow-Base Titan Touch prosthesis with 2 cm rear tips on both sides. The patient demonstrated an eventless postoperative follow-up period for up to 3 months and was highly satisfied with his implant. Conclusions We believe that corporal tunneling via the subcoronal approach may be both a successful and universal option for cases of severe intracorporal fibrosis provided both adequate surgeon experience and special instruments were available. It is a minimally invasive approach excluding the need for corporal reconstruction and utilization of additional grafting thus lowering the risk of postimplantation infection. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast