Insertion of inflatable penile prosthesis into a neophallus (single cylinder)

VJPU 2018; 2: 124

Title: Insertion of inflatable penile prosthesis into a neophallus (single cylinder)

Authors: David J Ralph, University College London Hospitals, London, UK
Giovanni Chiriaco, University College London Hospitals, London, UK
Gideon A Blecher, University College London Hospitals, London, UK
Mark Johnson, University College London Hospitals, London, UK
Nim Christopher, University College London Hospitals, London, UK

Key words: neophallus, penile, implant, erectile dysfunction

In this video, we demonstrate insertion of an inflatable penile prosthesis into a patient with a neophallus. Placement into a neophallus provides its own unique challenges. These patients lack a distal corpora increasing the risk of urethral injury and ectopic placement of distal tips. If the proximal corpora is not present a dacron sleeve to the pubis is required. There is also a risk of damage to the vascular pedicle and higher rates of infection and erosion compared to conventional penile implant surgery.

We present a case of a 49 year old male that underwent a partial penectomy with split skin graft, for high grade squamous cell carcinoma. His stump enabled voiding whilst standing, but was insufficient for penetrative intercourse. After being cleared of recurrent disease, he underwent a radial artery phalloplasty, with urethral anastomosis and reservoir placement. At the time of phalloplasty, he had shortened malleable prostheses placed into both remaining proximal corpora.

A transverse scrotal incision is made two finger breadths below the peno-scrotal junction. Diathermy is used to define the tips of the corpora and 0 vicryl stay sutures are placed. A space just ventral to the urethra is created with scissors. In this case one cylinder is used and  the tunnel is made in the midline, to the tip of the glans. Hagar dilators up to size 18 are used to further create the space. A Furlow is used to measure the proximal corpora and phallus length. The urethral meatus is observed to ensure that no urethral injury has occurred.

 An inflatable prosthesis is prepared and 3 to 5cm Silver impregnated Dacron caps are fashioned and are backloaded onto the tip of the cylinder. The implant is placed proximally and distally and inflated to check the position. The corpora are closed and the pump is placed into the scrotum. Tubing is connected and the reservoir filled. A drain is placed and closure with 3-0 vicryl in multiple layers.

Post operatively the drain and catheter are removed the following day. The device is left semi inflated until review in one week. At two weeks, patients are taught and encouraged to cycle their device regularly. Use of the device for penetration can start at 6 weeks.

Acnowledgements: None

Disclosures: The authors have nothing to disclose