Removal & Replacement of Inflatable Penile Prosthesis with Salvage Washout, Ectopic Reservoir Placement & Scrotoplasty Under Local Anesthesia

Sung Hun Park MD1
1: SeWan Prosthetic Urology Clinic, Seoul Korea

Objective: To demonstrate removal & replacement of the IPP with salvage washout, ectopic reservoir placement & scrotoplasty under local anesthesia.
Material: Replacement of the IPP was done to 63 years old patient because of 3 major complaints: short penile length, floppy glans penis and auto-inflation. Original IPP surgery was done with girth enhancement surgery in June of 2011 by other surgeon. The patient also had Vaseline injection to & removal 20 years ago.
Methods: Local anesthesia with caudal block was done. Foley catheter was placed. High transverse scrotal approach with Wilson retractor system was utilized. With deaver maneuver & cowboy blanket roll, proximal corpora was fully exposed. Due to the Teflon boot of tubing exit, strenuous dissection was necessary to remove the cylinders. Reservoir was drained & retained. Salvage wash out was done with half strength peroxide, half strength betadine and vancomycin & gentamycin solution. Previous AMS CXR 15cm cylinders with 1cm RTE on both sides were replaced with Coloplast Titan OTR standard 16cm cylinders with 2cm RTE on both sides. Lt. high submuscular reservoir placement was done. Suction drain was placed. Scrotoplasty to further enhance penetrative length was done. Compressive dressing was applied.
Results: Subjective pain score during the surgery was 3. Total 28cc of 1% lidocaine & 0.5% bupivacaine mixture was injected. OR time was 90 minutes. No postoperative hematoma was seen. Preoperative pubis to sulcus stretch penile length was 8.5cm and 12.5cm right after the surgery which maintained during 18 months F/U.
Conclusion: Uncomplicated IPP replacement could be safely done under local anesthesia. Removing Teflon boot of AMS cylinders could prevent strenuous dissection with redo IPP surgery.