Shaeer's Cavernotome

Authors: Shaeer, O.

Key Words: Corporal scarring, Corporal fibrosis, Penile prosthesis infection, penile implant infection, cavernotome, scarred corporal bodies

Corporal scarring is one of the most difficult challenges upon penile prosthesis implantation 1. Complications and/or failure are common. Profound experience is required in order to establish a track through the fibrous tissue. Establishing the track is performed by thrusting a blunt dilator or scissors against resistance. A very useful tool in this domain is Wilson’s Backward-Cutting Scissors 1. Once a track is established, several instruments have been designed to dilate it: cavernotomes 2,3.

Shaeer’s Cavernotome (patent application number PCT/EG2021/050003), ( https://www.cavernotome.com ) is a forward-cutting cavernotome that cores out fibrous tissue by slowly advancing rotatory motion, rather than thrust forwards against fibrous tissue.

Cavernotomy and penile prosthesis implantation was performed in a case of severe corporal scarring, two years following explantation of an infected penile implant.

Implantation was performed through a peno-scrotal incision with an indwelling urethral catheter. Following corporotomy, a 2cm-long core of fibrous tissue was excised with scalpel. Shaeer’s Cavernotome was introduced and coring the fibrous tissue was performed with slowly-advancing rotatory motion. The penis was stretched throughout the procedure and the non-dominant thumb and index fingers piched the fibrous tissue ahead of the tip of the cavernotome to identify the part to be cored. Following coring, penile prosthesis implantation proceeded as usual.

Coring the fibrous tissue bilaterally took approximately 10 minutes. Neither crossing over nor distal, proximal or urethral perforation were encountered. A girth 13 malleable prosthesis was implanted. No complications were noted through the 8 months follow-up period.

Establishing the track through scarred corporal bodies is the most difficult step in such procedures. Thus far, the technique to establish the track involves thrusting blunt or sharp instruments against resistance. This is where failure or complications are encountered. This paradigm can change with the proposed cavernotome. Coring is performed in controlled, slowly-advancing rotatory motion, in contrast to forward thrusting that can get out of control. Hence a possibly higher safety profile. The hollow core of Shaeer’s cavernotome embraces the demolished fibrous tissue within, thereby decreasing resistance, and establishing a dilated track. Widening the track further can be aided with the backward cutting scissors or the currently existing cavernotomes.

Acknowledgement: None

Disclosures: None

References:

1. Wilson SK, Simhan J, Gross MS. Cylinder insertion into scarred corporal bodies: prosthetic urology's most difficult challenge: some suggestions for making the surgery easier. Int J Impot Res. 2020;32: 483-94.

2. Mooreville M, Adrian S, Delk JR, 2nd, Wilson SK. Implantation of inflatable penile prosthesis in patients with severe corporeal fibrosis: introduction of a new penile cavernotome. J Urol. 1999;162: 2054-7.

3. Rossello Barbara M, Carrion H. [Cavernotomy]. Arch Esp Urol. 1991;44: 185-6.