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.

  • Review Article
  • Published:

Penoscrotal approach for IPP: still up-to-date after more than 40 years?

International Journal of Impotence Research volume 32, pages 2–9 (2020)Cite this article

Subjects

Abstract

Inflatable penile prosthesis is the definitive operative intervention utilized for treatment of erectile dysfunction. There are a handful of surgical approaches to perform this operation in a safe and efficient manner. The aim of this review article is to discuss the surgical approaches described in the literature, and describe the preferred approach of authors. Ultimately, the surgical approach utilized by the prosthetic surgeon depends upon their training, patient factors, and surgeon preference.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Jonas U. The history of erectile dysfunction management. Int J Impot Res. 2001;13:S3–7.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  3. Mulcahy JJ, Wilson SK. Current use of penile implants in erectile dysfunction. Curr Sex Health Rep. 2007;4:118–22.

    Article  Google Scholar 

  4. Scarzella GI. Improved technique for implanting AMS 700CX inflatable penile prosthesis using transverse scrotal approach. Urology. 1989;34:388–9.

    Article  CAS  PubMed  Google Scholar 

  5. Small MP, Carrion HM, Gordon JA. Small-Carrion penile prosthesis. New implant for management of impotence. Urology. 1975;5:479–86.

    Article  CAS  PubMed  Google Scholar 

  6. Montague DK, Angermeir KW. Surgical approaches for penile prosthesis implantation: penoscrotal vs infrapubic. Int J Impot Res. 2003;15:S134–5.

    Article  PubMed  Google Scholar 

  7. Graydon RJ, Berlin BB. Improved pump placement with infrapubic penile prosthetic implantation. J Urol. 1992;148:102–3.

    Article  CAS  PubMed  Google Scholar 

  8. Palmisano F, Boeri L, Cristini C, Antonini G, Spinelli MG, Franco G, et al. Comparison of infrapubic vs penoscrotal approaches for 3-piece inflatable penile prosthesis placement: do we have a winner? Sex Med Rev. 2018;6:631–9.

    Article  PubMed  Google Scholar 

  9. Park SS, Wilson SK, Morey AF. Inflatable penile prosthesis implantation is possible under local anesthesia with conscious sedation: technique and results: 098. J Sex Med. 2015;12:136.

    Article  CAS  Google Scholar 

  10. Levine LA, Becher EF, Bella AJ, Brant WO, Kohler TS, Martinez-Salamanca JI, et al. Penile prosthesis surgery: current recommendations from the international consultation on sexual medicine. J Sex Med. 2016;13:489–518.

    Article  PubMed  Google Scholar 

  11. Trost LW, Boonjindasup AG, Hellstrom WJG. Comparison of infrapubic versus transcrotal approaches for inflatable penile prosthesis placement: a multi-institution report. Int J Impot Res. 2015;27:86–89.

    Article  CAS  PubMed  Google Scholar 

  12. Shah BB, Baumgarten AS, Morgan K, Beilan JA, Bickell M, Munarriz R, et al. V-Neck technique: a novel improvement to the infra-pubic placement of an inflatable penile implant. J Sex Med. 2017;14:870–5.

    Article  PubMed  Google Scholar 

  13. Mulcahy JJ, Austoni E, Barada JH, Choi HK, Hellstrom WJ, Krishnamurti S, et al. The penile implant for erectile dysfunction. J Sex Med. 2004;1:98–109.

    Article  PubMed  Google Scholar 

  14. 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;7:1298–305.

    Article  PubMed  Google Scholar 

  15. Montague DK. Penile prosthesis implantation for end-stage erectile dysfunction after radical prostatectomy. Rev Urol. 2005;7:S51–7.

    PubMed  PubMed Central  Google Scholar 

  16. Oberlin DT, Matulewicz RS, Bachrach L, Hofer MD, Brannigan RE, Flury SC. National practice patterns of treatment of erectile dysfunction with penile prosthesis implantation. J Urol. 2015;193:2040–4.

    Article  PubMed  Google Scholar 

  17. Henry GD, Kansal NS, Callaway M, Grigsby T, Henderson J, Noble J, et al. Centers of excellence concept and penile prostheses: an outcome analysis. J Urol. 2009;181:1264–8.

    Article  PubMed  Google Scholar 

  18. Lotan Y, Roehrborn CG, McConnell JD, Hendin BN. Factors influencing the outcomes of penile prosthesis surgery at a teaching institution. Urology. 2003;62:918–21.

    Article  PubMed  Google Scholar 

  19. Montague DK, Angermeier KW. Current status of penile prosthesis implantation. Curr Urol Rep. 2000;1:291–6.

    Article  CAS  PubMed  Google Scholar 

  20. Gupta NK, Ring J, Trost L, Wilson SK, Köhler TS. The penoscrotal surgical approach for inflatable penile prosthesis placement. Transl Androl Urol. 2017;6:628–38.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Clavell-Hernández J, Wang R. Penile size restoration with nondegloving approach for Peyronie’s disease: initial experience. J Sex Med. 2018;15:1506–13.

    Article  PubMed  Google Scholar 

  22. Hatzichristodoulou G. The PICS technique: a novel approach for residual curvature correction during penile prosthesis implantation in patients with severe Peyronie’s disease using the collagen fleece TachoSil. J Sex Med. 2018;15:416–21.

    Article  PubMed  Google Scholar 

  23. Welliver C, Kottwitz M, Ahmad AE, Wilson SK, Köhler TS. Manufacturers’ data show increasing implanted cylinder sizes and measured corporal lengths in inflatable penile implants. World J Urol. 2016;34:993–8.

    Article  PubMed  Google Scholar 

  24. 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;8:2640–6.

    Article  PubMed  Google Scholar 

  25. Henry GD, Carrion R, Jennermann C, Wang R. Prospective evaluation of postoperative penile rehabilitation: penile length/girth maintenance 1 year following Coloplast Titan inflatable penile prosthesis. J Sex Med. 2015;12:1298–304.

    Article  PubMed  Google Scholar 

  26. Pryor M, Carrion R, Wang R, Henry G. Patient satisfaction and penile morphology changes with postoperative penile rehabilitation 2 years after Coloplast Titan prosthesis. Asian J Androl. 2016;18:754.

    Article  PubMed  Google Scholar 

  27. Levine LA, Hoeh MP. Review of penile prosthetic reservoir: complications and presentation of a modified reservoir placement technique. J Sex Med. 2012;9:2759–69.

    Article  PubMed  Google Scholar 

  28. Henry G, Hsiao W, Karpman E, Bella AJ, Carrion R, Jones L, et al. A guide for inflatable penile prosthesis reservoir placement: pertinent anatomical measurements of the retropubic space. J Sex Med. 2014;11:273–8.

    Article  PubMed  Google Scholar 

  29. Morey AF, Cefalu CA, Hudak SJ. High submuscular placement of urologic prosthetic balloons and reservoirs via transscrotal approach. J Sex Med. 2013;10:603–10.

    Article  PubMed  Google Scholar 

  30. Stember DS, Garber BB, Perito PE. Outcomes of abdominal wall reservoir placement in inflatable penile prosthesis implantation: a safe and efficacious alternative to the space of Retzius. J Sex Med. 2014;11:605–12.

    Article  PubMed  Google Scholar 

  31. Wilson SK, Henry GD, Delk JR Jr., Cleves MA. The mentor Alpha 1 penile prosthesis with reservoir lock-out valve: effective prevention of auto-inflation with improved capability for ectopic reservoir placement. J Urol. 2002;168:1475–8.

    Article  PubMed  Google Scholar 

  32. Hernández JC, Trost L, Köhler T, Ring J, Traweek R, Alom M, et al. Emerging complications following alternative reservoir placement during inflatable penile prosthesis placement: a 5-year multi-institutional experience. J Urol. 2019;201:581–6.

    Article  PubMed  Google Scholar 

  33. Wang Q, Goswami K, Shohat N, Aalirezaie A, Manrique J, Parvizi J. Longer operative time results in a higher rate of subsequent periprosthetic joint infection in patients undergoing primary joint arthroplasty. J Arthroplast. 2019;34:947–53.

    Article  Google Scholar 

  34. Baum N, Suarez G, Mobley D. Use of infrapubic incision for insertion of mentor Mark II inflatable penile prosthesis. Urology. 1992;39:436–8.

    Article  CAS  PubMed  Google Scholar 

  35. Perito PE. Minimally invasive infrapubic inflatable penile implant. J Sex Med. 2008;5:27–30.

    Article  PubMed  Google Scholar 

  36. Karpman E, Bella A, Brant W, Kansas B, Jones L, Kohler T et al. Outcomes of IPP placement by surgical approach, penoscrotal vs infrapubic, results from a prospective multicenter study. J Sex Med. 2015; 12. https://insights.ovid.com/sexual-medicine/jsmed/2015/05/002/outcomes-ipp-placement-surgical-approach/15/01222926.

  37. Vollstedt A, Gross MS, Antonini G, Perito PE. The infrapubic surgical approach for inflatable penile prosthesis placement. Transl Androl Urol. 2017;6:620–7.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Smith AD. Circumcision incision for insertion of semirigid penile prosthesis. Urology. 1981;18:609.

    Article  CAS  PubMed  Google Scholar 

  39. Weinberg AC, Pagano MJ, Deibert CM, Valenzuela RJ. Sub-coronal inflatable penile prosthesis placement with modified no-touch technique: a step-by-step approach with outcomes. J Sex Med 2016;13:270–6.

    Article  PubMed  Google Scholar 

  40. 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 

  41. Thomalla JV, Thompson ST, Rowland RG, Mulcahy JJ. Infectious complications of penile prosthetic implants. J Urol. 1987;138:65–67.

    Article  CAS  PubMed  Google Scholar 

  42. Kabalin JN, Kessler R. Infectious complications of penile prosthesis surgery. J Urol. 1988;139:953–5.

    Article  CAS  PubMed  Google Scholar 

  43. Garber BB, Marcus SM. Does surgical approach affect the incidence of inflatable penile prosthesis infection? Urology. 1998;52:291–3.

    Article  CAS  PubMed  Google Scholar 

  44. 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;4:1074–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

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

    Matthew D. Houlihan & Tobias S. Köhler

  2. Institute for Urologic Excellence, Indio, CA, USA

    Steven K. Wilson

  3. Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany

    Georgis Hatzichristodoulou

Authors
  1. Matthew D. Houlihan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tobias S. Köhler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Steven K. Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Georgis Hatzichristodoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthew D. Houlihan.

Ethics declarations

Conflict of interest

SKW and TSK provide consulting services to Coloplast and Boston Scientific. The remaining authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Houlihan, M.D., Köhler, T.S., Wilson, S.K. et al. Penoscrotal approach for IPP: still up-to-date after more than 40 years?. Int J Impot Res 32, 2–9 (2020). https://doi.org/10.1038/s41443-019-0206-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-019-0206-z

This article is cited by

Search

Advanced search

Quick links