Sliding technique + inflatable penile prosthesis implantation

VJPU 2018; 2: 130

Title: Sliding technique + inflatable penile prosthesis implantation

Authors: Giulio Garaffa, University College London Hospitals, London, UK
Giovanni Chiriaco, University College London Hospitals, London, UK
Gideon A Blecher, University College London Hospitals, London, UK
Marta Skrodzka, University College London Hospitals, London, UK
Mark Johnson, University College London Hospitals, London, UK
Marco Capece, University College London Hospitals, London, UK
David J Ralph, University College London Hospitals, London, UK

Key words: sliding technique, penile implant, peyronie’s disease, penile lengthening

The surgical management of Peyronie’s disease can be challenging even for the most experienced surgeons. Men with severe deformities and penile shortening are often the most unhappy and require the most extensive surgical procedures. Our video presents the sliding technique, a surgical modality designed for this group of patients. It enables penile lengthening based on a ventral-dorsal incision of the tunica albuginea, penile prosthesis implantation and double dorsal-ventral patch grafting.

We present a case of man with a severe 90ࣽ° dorsal curvature with marked penile shortening that was demonstrated on an artificial erection prior to surgery. The stretched penile length at the beginning of the procedure was 7.5cm. A circumferential sub-coronal incision followed by circumcision and de-gloving is performed to expose the penile shaft. Buck’s fascia and the neurovascular bundle are mobilised for almost the entire length of the penile shaft. Bilateral incision lines are made on the corporal bodies at the 3 and 9 o’clock positions and are marked laterally and joined dorsally in semicircular fashion. Further partial urethral mobilisation is required to join the incision lines on the ventral side. The final elongation is dependent on the stretching capacity of the neurovascular bundle. An incision of tunica albuginea is made along the marked lines. Gentle traction is applied to the glans to reach the point of maximal stretch of the neurovascular bundle. This allows for the distal and proximal sections to slide apart producing elongation and penile lengthening. After the maximal length is achieved, stitches are applied to the lateral portions of the tunica albuginea, leaving two defects. The dorsal (proximal) defect has rectangular shape whereas the ventral (distal) defect is ellipsoid. The stretched size of the defect is measured and an appropriate sized pericardial graft is produced and sutured into the tunical defects. Once the tunical defects are closed, a ventral corporotomy can be made at the penoscrotal junction for insertion of an inflatable penile prosthesis. This allows for dilatation of the corporal bodies and for the tubing to be hidden. After the dilatation, the corpora areflushed with an antibiotic wash to minimise the infection risk and to exclude a urethral injury. The corporal bodies are measured, and appropriate sized cylinders are prepared and inserted. The corporotomy is closed with a Vicryl 0 suture and he cylinders are inflated to confirm an optimal position of the penile implant. The penile length measurement demonstrates a significant elongation of 2cm. The reservoir is placed ectopically above transversalis fascia. A dartos pouch in the scrotum is created for the pump. Buck’s fascia, dartos and the skin are closed in layers

In conclusion, the sliding techniques is a complex and high-risk andrological operation that should be reserved for men with the most severe penile curvatures and penile shortening.

Acnowledgements: None

Disclosures: The authors have nothing to disclose