Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Comparison of infrapubic versus transcrotal approaches for inflatable penile prosthesis placement: a multi-institution report

International Journal of Impotence Research volume 27, pages 86–89 (2015)Cite this article

Subjects

Abstract

Inflatable penile prostheses (IPP) are associated with excellent long-term outcomes. To date, no study has evaluated the significance of surgical approach on IPP intraoperative variables. High-volume surgeons placing the Titan 0-degree prosthesis from March-July 2012 completed questionnaires including pre-/intraoperative variables. Intraoperative data were compared between surgeons performing an infrapubic versus transcrotal approach for total length of prosthesis, proximal and distal measurements, rear-tip extender (RTE) length, reservoir size and fill volume and ability to place the reservoir in the space of Retzius. Forty-six surgeons placed 256 IPPs, with a median of 5 (range 1–10) inserted. Transcrotal placement was performed most commonly (80%). Revision procedures accounted for 13% of cases, with 19% previously undergoing robotic-assisted prostatectomy. Compared with infrapubic, transcrotal placement resulted in a longer total prosthesis (22.3 cm vs 20.6 cm, P<0.0001), increased proximal dilation (10.1 cm vs 8.6 cm, P<0.0001), longer RTEs (1.9 cm vs 1.2 cm, P<0.0001) and larger reservoir fill volume (79 cc vs 71 cc, P=0.0003). No differences were noted in distal measurements or ability to place the reservoir in the space of Retzius. Compared with the infrapubic approach, high-volume surgeons placing the Titan 0-degree IPP transcrotally achieved increased proximal dilation with an ~1–2-cm-longer prosthesis inserted.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Scott FB, Bradley WE, Timm GW . Management of erectile impotence. Use of implantable inflatable prosthesis. Urology 1973; 2: 80–82.

    Article  CAS  Google Scholar 

  2. Trost LW, McCaslin R, Linder B, Hellstrom WJG . Long-term outcomes of penile prostheses for the treatment of erectile dysfunction. Expert Rev Med Devices 2013; 10: 353–366.

    Article  CAS  Google Scholar 

  3. Baum N, Suarez G, Mobley D . Use of infra-pubic incision for insertion of Mentor Mark II inflatable penile prosthesis. Urology 1992; 39: 436–438.

    Article  CAS  Google Scholar 

  4. Scarzella GI . Improved technique for implanting AMS 700CX inflatable penile prosthesis using transverse scrotal approach. Urology 1989; 34: 388–389.

    Article  CAS  Google Scholar 

  5. Kramer A, Chason J . Residents at the University of Maryland Medical System provide insight to learning infrapubic approach for IPP surgery: relative benefits but novel challenges exposed in first 15 cases. J Sex Med 2010; 7: 1298–1305.

    Article  Google Scholar 

  6. Montague DK, Angermeir KW . Surgical approaches for penile prosthesis implantation: penoscrotal vs infrapubic. Int J Impot Res 2003; 15: S134–S135.

    Article  Google Scholar 

  7. Patient Information Forms (PIF) Data. American Medical Systems: Minnetonka, MN, USA, 2012.

  8. Garber BB, Marcus SM . Does surgical approach affect the incidence of inflatable penile prosthesis infection? Urology 1998; 52: 291–293.

    Article  CAS  Google Scholar 

  9. Candela JV, Hellstrom WJ . Three-piece inflatable penile prosthesis implantation: a comparison of the penoscrotal and infrapubic surgical approaches. J La State Med Soc 1996; 148: 296–301.

    CAS  PubMed  Google Scholar 

  10. Montorsi F, Rigatti P, Carmignani G, Corbu C, Campo B, Ordesi G et al. AMS three-piece inflatable implants for erectile dysfunction: a long-term multi-institutional study in 200 consecutive patients. Eur Urol 2000; 37: 50–55.

    Article  CAS  Google Scholar 

  11. Natali A, Olianas R, Fisch M . Penile implantation in Europe: successes and complications with 253 implants in Italy and Germany. J Sex Med 2008; 5: 1503–1512.

    Article  Google Scholar 

  12. Wilson SK, Delk JR, Salem EA, Cleves MA . Long-term survival of inflatable penile prostheses: single surgical group experience with 2384 first-time implants spanning two decades. J Sex Med 2007; 4: 1074–1079.

    Article  Google Scholar 

  13. Wang R, Howard GE, Hoang A, Yuan JH, Lin HC, Dai YT . Prospective and long-term evaluation of erect penile length obtained with inflatable penile prosthesis to that induced by intracavernosal injection. Asian J Androl 2009; 11: 411–415.

    Article  Google Scholar 

  14. Kabalin JN, Rosen J, Perkash I . Penile advancement and lengthening in spinal cord injury patients with retracted phallus who have failed penile prosthesis placement alone. J Urol 1990; 144: 316–318.

    Article  CAS  Google Scholar 

  15. Borges F, Hakim L, Kline C . Surgical technique to maintain penile length after insertion of an inflatable penile prosthesis via infrapubic approach. J Sex Med 2006; 3: 550–553.

    Article  Google Scholar 

  16. Martinez-Salamanca JI, Mueller A, Moncada I, Carballido J, Mulhall JP . Penile prosthesis surgery in patients with corporal fibrosis: a state of the art review. J Sex Med 2011; 8: 1880–1889.

    Article  Google Scholar 

  17. Henry G, Houghton L, Culkin D, Otheguy J, Shabsigh R, Ohl DA . Comparison of a new length measurement technique for inflatable penile prosthesis implantation to standard techniques: outcomes and patient satisfaction. J Sex Med 2011; 8: 2640–2646.

    Article  Google Scholar 

  18. Miranda-Sousa A, Keating M, Moreira S, Baker M, Carrion R . Concomitant ventral phalloplasty during penile implant surgery: a novel procedure that optimizes patient satisfaction and their perception of phallic length after penile implant surgery. J Sex Med 2007; 4: 1494–1499.

    Article  Google Scholar 

Download references

Acknowledgements

We would wish to acknowledge the participation of the surgeons contributing data to the current project, in alphabetical order—Tony Balchunas, Greg Bales, Joseph Banno, Kevin Barlog, Nelson Bennett, William Bogache, Jeffrey Brady, Todd Brandt, Kevin Brewton, Arnold Bullock, Rafael Carrion, Cully Carson, Brian Christine, Douglas Cummings, Daniel Curhan, Edward Dakil, Chirpriya Dhabuwala, Martin Dineen, Francois Eid, Sheldon Freedman, Bruce Garber, Valal George, Edward Gheiler, Fred Grossman, Wayne Hellstrom, Seth Hollenbach, LeRoy Jones, Tobias Kohler, Andrew Kramer, Barry Lee, Laurence Levine, Alan McCool, Andrew McCullough, Jesse Mills, Allen Morey, Hossein Sadehi Nejad, Dana Ohl, Bashar Omarbasha, Paul Perito, Gary Price, Charles Pritchard, Manish Shaw, Ronald Suh, Ryan Terlecki, Robert Valenzuela and Run Wang.

Author information

Authors and Affiliations

  1. Department of Urology, Mayo Clinic, Rochester, MN, USA

    L W Trost

  2. Department of Urology, Tulane University Health Sciences Center, Tulane University School of Medicine, New Orleans, LA, USA,

    A G Boonjindasup & W J G Hellstrom

Authors
  1. L W Trost
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A G Boonjindasup
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W J G Hellstrom
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W J G Hellstrom.

Ethics declarations

Competing interests

The authors delare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Trost, L., Boonjindasup, A. & Hellstrom, W. Comparison of infrapubic versus transcrotal approaches for inflatable penile prosthesis placement: a multi-institution report. Int J Impot Res 27, 86–89 (2015). https://doi.org/10.1038/ijir.2014.35

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijir.2014.35

This article is cited by

Search

Advanced search

Quick links