Authors: Osama Shaeer
Key Words: Penile prosthesis, penile implant, single corporotomy, infrapubic, dorsal nerve
The infrapubic approach (IPA) for penile prosthesis implantation is known for being minimally invasive and of shorter operative time 1,2,3. However, sensory deficit may possibly result from injury of the dorsal nerve of the penis considering that the dual lateral corporotomies are in the course of or close to the neurovascular bundle. We introduce the “Midline Single Corporotomy Infrapubic Technique”. The midline corporotomy in the bed of the deep dorsal vein (DDV) avoids the course of the dorsal arteries and nerves. Theoretically -speaking, the single corporotomy saves operative time and may decrease post-operative pain, though proving this requires comparative studies.
2. Case presentation
Semi-rigid (SR) penile prosthesis was implanted in 11 patients with erectile dysfunction refractory to medical treatment.
The procedure is performed through the infrapubic incision. The DDV is stripped for a distance of 3-5cm. A single corporotomy is incised in the bed of the DDV, into the midline septum. Access to both corpora is gained by lateral subtunical dissection using Metzenbaum scissors on either sides of the septum. Dilatation and implantation proceed as usual. Direction of dilatation and implantation in the distal corpora is dorsolateral. In the crura, the direction is lateral.
No particular obstacles were encountered throughout surgery. Average operative time was 22.8 +/-4.7 minutes. No sensory deficit, implant infection or extrusion were encountered.
IPA has its loyal advocated. Sensory deficit may result in permanent disability. In expert hands, this is highly unlikely though still a rare possibility. However, new entrants are more likely to face this possibility. With Shaeer’s single corporotomy technique, the midline corporotomy avoids this complication altogether. While SR penile implants can be easily implanted via a single midline corporotomy, inflatable implants may require minor design modifications.
Disclosures: The authors have nothing to disclose.
1. Perito PE. Minimally invasive infrapubic inflatable penile implant. J Sex Med 2008;5:27–30.
2. Antonini G, Busetto GM, De Berardinis E, Giovannone R, Vicini P, Gentile V, et al. Penile prosthesis implant for erectile dysfunction: A new minimally invasive infrapubic surgical technique. Arch Ital Di Urol Androl Organo Uff [Di] Soc Ital Di Ecogr Urol e Nefrol 2016;87:322–4. https://doi.org/10.4081/AIUA.2015.4.322.
3. Park SH, Wen L, Mulcahy J, Wilson SK. Nuances of subcoronal inflatable penile prosthesis for physicians accustomed to penoscrotal approach. Int J Impot Res 2020. https://doi.org/10.1038/S41443-020-00349-9