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Response to the Commentary on “Anatomic considerations of inflatable penile prosthetics: lessons gleaned from surgical body donor workshops”

International Journal of Impotence Research (2023)Cite this article

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We sincerely appreciate the thoughtful commentary [1] by Matthew J. Ziegelmann on our article “Anatomic considerations of inflatable penile prosthetics: lessons gleaned from surgical body donor workshops” [2], published recently in the International Journal for Impotence Research. Indeed, the generosity of body donation cannot be overstated. The privilege of anatomical dissections is not only fundamental to undergraduate medical education but also enables the advancement and refinement of surgical techniques across all surgical fields. Over the last decade, we have experienced the sustained and effective educational value of surgical training workshops based on body donors [3]; the subspecialties that have benefited include visceral, urologic, gynecologic, orthopedic, ENT, and maxillofacial surgery. We showed that anatomical dissections are useful tools to elucidate essential surgical landmarks and properly illustrate procedural steps, as evidenced in previous studies related to colorectal [4,5,6,7] and pelvic surgery [8, 9]. These aspects have gained further relevance in the context of emerging novel technical advancements such as robot-assisted surgery: the magnified and enhanced three-dimensional visualization of subtle anatomical structures prompted us to revisit the apparently known anatomical topography [10], thereby echoing the notion of the renowned American surgeon and medical illustrator Frank H. Netter: “Anatomy of course does not change, but our understanding of anatomy and its clinical significance does change as do anatomical terminology and nomenclature” [11]. We entirely agree with Ziegelmann in that education concerning prosthetic urology benefits greatly from surgical body donor workshops, given the limited direct visualization of certain surgical steps during penile prosthesis implantation. In recognition of the pivotal role of anatomy education, the European Society for Sexual Medicine has incorporated our surgical body donor workshop at Kiel University/Germany into its fellowship program. The study by Ziegelmann et al. [12] on the high submuscular penile prosthesis reservoir placement carried out in body donors is another prime example of the relevance of applied topographic anatomy to avoid surgical misguidance. The surprisingly high frequency of suboptimal reservoir placement emphasizes the need for further evaluation of the long-term safety of this otherwise attractive technique [13]. In line with these demands, in an upcoming study, we will address the key anatomical landmarks and potential pitfalls of high submuscular reservoir placement. We do corroborate the view that not all patients present a “read the book” anatomy: Ziegelmann found corporal asymmetry in 20% of patients undergoing penile prosthesis implantation [14]. Based on the extensive experience gained from both surgical and anatomical dissections, it must be stated that textbook anatomy provides no more than a rough idea and a vague anticipation of what we will encounter and have to deal with in a given individual case or specimen.

Finally, our plea for clinical anatomical studies in cooperation with experienced surgeons in order to facilitate complex surgical procedures such as penile prosthesis implantation is best justified and summarized by the renowned Austrian anatomist Werner Platzer: “Anatomy without clinic is dead, clinic without anatomy is deadly” [15]. This very principle has been advocated by Ziegelmann and is further endorsed in this response.

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References

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Authors and Affiliations

  1. European Institute of Sexual Health, Ballindamm 3, Hamburg, Germany

    D. Osmonov

  2. Institute of Urologic Excellence, La Quinta, CA, USA

    S. K. Wilson

  3. Institute of Anatomy, Center of Clinical Anatomy, Kiel University, Kiel, Germany

    T. Heinze, M. Heimke & T. Wedel

  4. Department of Urology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic

    J. Novak

  5. Department of Urology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt

    A. Ragheb

  6. Mayo Clinic College of Medicine, Rochester, MN, USA

    T. Köhler

  7. Department of Urology, Martha-Maria Hospital, Nurenberg, Germany

    G. Hatzichristodoulou

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  1. D. Osmonov
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  4. M. Heimke
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  7. T. Köhler
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  8. G. Hatzichristodoulou
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  9. T. Wedel
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All authors contributed equally.

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Correspondence to D. Osmonov.

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Osmonov, D., Wilson, S.K., Heinze, T. et al. Response to the Commentary on “Anatomic considerations of inflatable penile prosthetics: lessons gleaned from surgical body donor workshops”. Int J Impot Res (2023). https://doi.org/10.1038/s41443-023-00786-2

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