Minimally Invasive Penile Implant

VJPU 2014; 1:031

Paul Perito

Keywords: Minimally Invasive, Infrapubic, Penile Implant

This video serves as an expansion on a minimally invasive technique for infrapubic penile implant placement, originally described by the author in 2006. Since that time, the surgeon has performed over 3,000 infrapubic penile implants and trained over 300 physicians in the technique worldwide. The patient is placed on the operating table in supine position with the pelvis flexed. An artificial erection is created with injectable saline or lidocaine, elucidating any penile pathology and providing for initial dilation of the corpora. A 1.5 cm infrapubic incision is made and finger dissection is used isolate the corpora, taking care to avoid the neurovascular bundle. After stay sutures are placed, corporotomies are made on each side with a curved blade . Furlow dilation is then performed with traction and countertraction along the axis of the penis to prevent proximal and distal perforation. Measurements are taken. The reservoir is placed by perforating the transversalis fascia and using a 70mm nasal speculum to create a space posterior to the transversalis. The prepped reservoir is then inserted into this space. The corporal cylinders are placed and filled as the functional and cosmetic result is inspected. This also provides for mid glans and proximal seating of the implant. The corporotomies are closed. A subdartos pouch is created in the scrotum with the nasal speculum. The pump is then placed in the most dependent portion of the scrotum. A drain is placed in the scrotum and exits through a separate incision lateral to the infrapubic location. Wound closure is performed in several layers and the skin is closed with staples. Each patient has a sandbag placed on the incision area in the recovery room for hemostasis.