Surgical strategies for optimizing distal cylinder placement in penile implant procedures

Jenna Maggin, BA, MS1, Andrew Kramer, MD1
1: University of Maryland School of Medicine

Introduction: One specific technical aspect of placing a penile prosthesis is the location and of the distal tips of the device. This is an essential part of the cosmetic and functional result when performing penile prosthesis surgery.
Case Presentation: This video highlights a compilation of 4 videos that give each a slightly different perspective on placing and perfecting distal cylinder tips, in a variety of challenging situations. Steps, risks, and specific surgical guidance is given for each case.
Protocol: Four distinct surgical cases highlight the challenges involved in placing the distal tips of the device, and the technique required and surgical tools utilized. In some situations, there is distal corporal fibrosis that limits the ability to get a device distal, and steps must be taken to get the tips as far distal and as symmetric as possible. In other situations, a device is already in place, but the distal tip location is sub-optimal. This is also addressed. The risks and ways to mitigate those risks are explained in the videos.
Outcome: Tips should be mid glans and symmetric, with protection of the meatus at all times. Weighing the risks and benefits of perfect tip placement with meatal or corporal perforation is a constant algorithm in the mind of the surgeon. The decision making about this topic is addressed.
Discussion: A stepwise surgical approach can be taken to manage the placement of distal tips of a penile implant. This is a critical component of the procedure, and something all patients will be aware of immediately postoperatively and throughout the lifetime of the device. Meticulous dissection and careful decision making must be executed to accomplish low-risk but successful tip placement.