Miami, Florida, USA
Key Words. Urethral injury, Penile Prosthesis, Primary Closure or urethral injury
Distal corporal injuries involving the urethra occur infrequently, but are more likely with aggressive dilation required with scarred corporal bodies. The classic management has been to abort the penile prosthesis implantation, placement of a Foley catheter and a return to the operating room for a secondary attempt following urethral healing. This new repair offers the potential for preservation of the implanted prosthesis and avoiding the issues related to a secondary attempt at prosthesis placement. Primary closure of the distal urethral injury during penile implant can be attempted in select patients. The video helps to identify the true distal, or meatal, perforation that might allow the option of immediate correction without abandoning the placement of the penile prosthesis.
An iatrogenic hypospadiac defect is created to access the injury which is repaired with 3-0/4-0 monocryl. The hypospadiac meatus minimizes the pressure differential between the urethral cylinder and the corporal cylinder by allowing the urine to exit proximal to the injury. A 14 Fr Foley catheter is left in place for 3-5 days. The prosthesis is not cycled for 4-6 weeks and no intercourse is permitted for 6 weeks. After 6 weeks the hypospadiac meatus can be repaired. Failures have been associated with narrow anatomy and premature cycling of the IPP. One should abort placement of the penile prosthesis with any injury of the urethra that directly communicates with the corpora cavernosa. The current repair is only for distal urethral/meatal injury only.
Acknowledgments: Education from Coloplast
Disclosures: Consultant Coloplast, AMS, Neotract