The scrotal approach to penile prosthesis implantation has been the approach most frequently used for this surgery. It is an easy procedure with excellent outcomes that can be performed by a novel urologist or a trainee urologist.
Clinical Case:
67 y/o male presented with ED. The patient had failed PDE5 inhibitors and ICI had been tried without satisfactory outcomes and with pain.
Clinical History:
The patient suffered six years ago a penile fracture that was managed conservatively. Penile Doppler US revealed an ED due to an arterial insufficiency and venous occlusive disease. Autophotographs in erection showed a left lateral deviation of less than 30 degrees.
Procedure Steps:
- Shaving of the penoscrotal area with razors
- Alcoholic clorhexidine solution is used for the skin
- Urethal catheterization to empty the bladder
- Installation of the Scott retractor
- Transverse 2cm scrotal incision
- Go through the Dartos fascia, bluntly, until complete dissection of both corpora cavernosa is achieved
- Place both sutures for corporotomies as proximal as possible: 2 stitches of Vycril 2/0 in each corpora cavernosa
- Make each corporotomy no more than 1.5 cm long
- Measure corporal length proximally and distally using a Furlow inserter without previous dilatation of the corpora, except in cases of corporal fibrosis
- Check the absence of a urethral lesion by filling the corpora cavernosa with an antibiotic solution
- Change of gloves and preparation of penile prosthesis
- AMS 700LGX cylinders placement and closure of corporotomies
- Place the pump in the scrotum in the midline deeply at first, and then superficially
- Create space for a reservoir posterior to the transversalis fascia (Retzius space) using scissors in case it cannot be opened with your finger
- Perform a complete inflation of the prosthesis to check adequate placement and correction of possible curvatures
- Close the Dartos and the skin with Vycril sutures.
- Place a Coban type dressing for penile and scrotum
Learning Points:
- Use always a single window approach
- Minimize the corporatomy
- Always make sure to stay along the axis of the penis, try to go lateral with the Furlow
- Use of instilled antibiotics
- Insert each cylinder separately, first distally, then proximally
- Test the result applying inflation
- Be as fast as you could be without losing safety
