Reoperative Penile Implantation following Fournier's Gangrene: Technical Considerations for Scarred Corpora

VJPU 2017; 2: 105

Title: Reoperative Penile Implantation following Fournier's Gangrene: Technical Considerations for Scarred Corpora

Authors: Nora Baker, Ryan Barlotta, Lauren Rittenberg, Jay Simhan

Key words: Fournier's gangrene, penile implant, penile prosthesis, reoperation

This video demonstrates the unique operative case of a 75-year-old diabetic male undergoing a repeat inflatable penile implant placement months after multiple debridement and skin graft procedures were conducted for the treatment of Fournier's gangrene. Notably, the patient had a previous surgical history of an inflatable penile implant placement that was removed during his initial Fournier's debridement. The video highlights key steps that were taken throughout the re-implantation. We began the procedure with a penoscrotal approach and carefully identified the corporal bodies. The use of backwards cutting scissors and cavernotomes helped to establish a cavernosal lumen that could accommodate a narrow penile implant. While measuring for corporal length, a minor proximal perforation was noted on the right corpora, and was subsequently repaired by using a suture sling technique. We were able to successfully place the pump on the patient's favored left side by creating a subdartos pouch using non-grafted, virginal tissue. The patient underwent high submuscular reservoir placement via the left inguinal ring and is demonstrated as well. The 90-minute procedure consisted of minimal blood loss and demonstrated no intraoperative or postoperative complications. On follow-up, the patient was using his new device regularly and was pleased with the outcome of the procedure. This video demonstrates our technique for difficult implant placement in the setting of scarred corpora. In select patients who are highly motivated, successful reoperative penile implantation is possible even in the most severe of cases.

Acknowledgements: None

Disclosure: Jay Simhan, MD is a paid consultant of Boston Scientific, Inc. and Coloplast, Inc. The remaining authors have no disclosures to report.

References:

  1. Chung PH, Morey AF, Tausch TJ, Simhan J, Scott JF. High submuscular placement of urologic prosthetic balloons and reservoirs: 2-year experience and patient-reported outcomes. Urology 2014; 84: 1535.