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Nuances of infrapubic incision for inflatable penile prosthesis

Abstract

This workshop completes the trilogy of nuances of the various incisions used to place an inflatable penile prosthesis (IPP). Infrapubic placement was the original technique employed 50 years ago for the very first IPP surgeries. The historical perspective of the development of implantation incisions and the original Scott prosthesis highlighted in this work should be fascinating to today’s younger prosthetic urologists. The developing surgeon should also find some surprising maneuvers considered important technique nuances from the highest volume infrapubic implanter in the world. Among the wonders of the infrapubic approach covered are: The surgery is conducted without the aid of an in-dwelling Foley catheter or post-operative inflation. Hydrodistension of the corpora substitutes for corporal dilatation. The “chicken choke” protects the urethra from damage. Closed suction drainage is employed despite minimal scrotal dissection. Motivated patients may use their new device as early as 14 days after implantation.

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Fig. 1: Historical pictures of infrapubic implantation.
Fig. 2: Drs William Furlow & Brantley Scott IPP tool inventions.
Fig. 3: Development of AMS 700 IPP cylinders.
Fig. 4: IPP through an infrapubic incision.
Fig. 5: Instrumentation to facilitate infrapubic IPP.
Fig. 6: Stay sutures facilitate corporotomy.
Fig. 7: Work along axis of penis when dilating/measuring.
Fig. 8: Fossa navicularis has weakest tunica albuginea anatomy.
Fig. 9: Reservoir placements through infrapubic incision: PTF & ATF.
Fig. 10: Placement of reservoir facilitated by nasal Speculum & Yankaur.
Fig. 11: Deployment of cylinders.
Fig. 12: Surrogate reservoir test for penile deformity & proper pump positioning.

References

  1. Scott FB, Bradley WE, Timm GW. Management of erectile impotence: use of implantable inflatable prosthesis. Urology. 1972;2:80–82.

    Article  Google Scholar 

  2. Fishman IJ, Scott FB, Light JK. Experience with inflatable penile prosthesis. Urology. 1984;23:86–92.

    CAS  Article  Google Scholar 

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

    CAS  Article  Google Scholar 

  4. Barry J, Seifert J. Penoscrotal approach for placement of paired penile implants for impotence. J Urol. 1979;122:325–6.

    CAS  Article  Google Scholar 

  5. Wilson SK, Bella AJ, Delk JR. Dilatation is not necessary for insertion of new AMS 700MS. J Sex Med. 2008;5(suppl 1):16.

    Google Scholar 

  6. Donghua Xie, Nicholas M, Gheiler V, Perito D, Siano L, Kislinger IM, et al. A prospective evaluation of penile measures and glans penis sensory changes after penile prosthetic surgery. Trans Androl Urol. 2017;6:529–33.

    Article  Google Scholar 

  7. Wilson SK, Simhan J. Is modeling and inflatable penile prosthesis obsolete for patients with Peyronie’s disease? Int J Impot Res. 2020;32:267–73.

    Article  Google Scholar 

  8. Lucas JW, Gross MS, Barlotta RM, Sudhakar A, Hoover CRV, Wilson SK, et al. Optimal modeling: an updated method for safely and effectively eliminating curvature during penile prosthesis implantation. Urology. 2020;146:133–9.

  9. 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  Google Scholar 

  10. Perito PE, Wilson SK. Traditional (retroperitoneal) and abdominal wall (ectopic) reservoir placement. J Sex Med. 2011;8:656–59.

    Article  Google Scholar 

  11. Wilson SK, Simhan J, Osmonov D. Should occasional implanters learn ectopic placement of IPP reservoirs? Int J Impot Res. 2020;32;371–8.

  12. Gross MS, Stember DS, Garber BB, Perito PE. A retrospective analysis of risk factors for IPP reservoir entry into the peritoneum after abdominal wall placement. Int J Impot Res. 2017;29:215–8.

    CAS  Article  Google Scholar 

  13. Madiraju SK, Wallen JJ, Rydelek SP, Carrion RE, Perito PE, Hakky TS. Biomechanical studies of the inflatable penile prosthesis: a review. Sex Med Rev. 2019;7:369–73.

    Article  Google Scholar 

  14. Sadeghi-Nejad H, Ilbeigi P, Wilson SK, Delk JR, Siegel A, Seftel AD, et al. Multi institutional outcome study on the efficacy of closed suction drainage of the scrotum in three-piece inflatable penile prosthesis surgery. Int J Impot Res. 2005;17:535–8.

    CAS  Article  Google Scholar 

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Correspondence to Lexiaochuan Wen.

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Perito: Consultant Boston Scientific, Coloplast. Mulcahy: Consultant Boston Scientific, Coloplast. Wen: None. Wilson: Consultant AMT, Coloplast, International Medical Devices, Lecturer Boston Scientific. Stockholder NeoTract.

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Perito, P., Mulcahy, J., Wen, L. et al. Nuances of infrapubic incision for inflatable penile prosthesis. Int J Impot Res 34, 524–533 (2022). https://doi.org/10.1038/s41443-020-00370-y

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  • DOI: https://doi.org/10.1038/s41443-020-00370-y

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