The Use of Nasal Speculum in The Placement of Infrapubic Inflatable Penile Prosthesis; a Novel Technique for Proximal Positioning

David Shi MD1, Doron Stember MD1, Ted Vellos MD1
1: Mount Sinai Beth Israel, New York, USA

Introduction: Placement of inflatable penile prosthesis (IPP) is a definitive therapy for erectile dysfunction (ED). Proper positioning is crucial to proper function and good outcomes. Proximal cylinder placement during Infrapubic approach can be a difficult and crucial step during the procedure that can lead to false passage formation or inadequate seating of the cylinder translating to increased operative times, or at worst corporal crossover.
Our study aims to describe a technique which may help in proximal cylinder positioning to avoid false passage formation, decrease manipulation of the device and operative time.
Protocol: The operative experience of 41 cases of IPP surgery with nasal speculum (NS)-assisted proximal cylinder placement is reviewed.
Our surgical approach for all IPP cases is via an infrapubic incision. The case proceeds as previously described with bilateral corporotomy incisions, dilation and measurements of the corporal space.
Our technique begins with a NS passing through each corporotomy proximally. The speculum paddles are opened and the proximal cylinder ends are placed between them. A Furlow inserter is used to exert pressure on the cylinder ends to drive them proximally. Once the proximal cylinder is well-seated, the NS is removed. The case proceeds as previously described.
Outcome: With IRB approval pending we retrospectively reviewed the charts on patients who underwent this operative technique between 2014 -2015. A total of 41 patients (median age of 63) received IPP for ED (associated Peyronie’s disease was found in 11 patients). 6 patients (14.6%) underwent IPP exchange for prior malfunctioning device. No patient experienced complications and proximal seating was adequate on the first attempt meaning operative time was reduced.
Discussion: A minor adjustment in operative technique, using readily available instruments can reduce manipulation of the implant, ensure proper positioning and reduce operative times during Infrapubic inflatable penile prosthesis placement. We have shown our technique to be safe and easy to perform.