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Penuma(R) Concealed Technique Featuring A New Scrotal Incision

Authors: Steven K Wilson, James J. Elist, Kambiz Tajkarimi, Laurence Levine, Robert Valenzuela, Shawn Blick

Key Words: Penuma Implant, Girth, Enhancement, Cosmetic Urology, Penile Implant, Cosmetic Improvement of Penis

The purpose of this video is to demonstrate the “concealed” technique with the insertion of the Penuma® implant through a scrotal incision. Multiple prosthetic urologists have conducted the Penuma® insertion procedure, employing the “concealed” technique. The technique is demonstrated and narrated in the video. Patients were followed post-operatively for at least three months following the procedure to help identify the benefits of the “concealed” technique versus the traditional infrapubic approach. The new scrotal approach appears to be a simpler, quicker, and more aesthetically favorable alternative to the traditional suprapubic approach. The “concealed” technique is especially ideal in cosmetic surgery where peno-centric patients are focused on penile appearance. Physicians employing the use of the scrotal incision seem to agree that there is a lessened chance of seroma formation, simpler post-operative care, and favorable immediate results. Further evaluation must be conducted to identify additional benefits, but the initial benefits appear to be very promising.

Acknowledgement: We acknowledge International Medical Devices for sponsoring the production of this video.


Steven K Wilson:  Consultant for AMT, Coloplast, International Medical Devices, Uramix

James J Elist: Medical Director of International Medical Devices

Laurence Levine: Consultant for International Medical Devices

Robert Valenzuela: Consultant for International Medical Devices


  • Elist J, The Penuma® Silicone Implant: A new implantable device improving penile appearance and adding additional girth and length of penis outside the body. VJPU 2018; 2: 119

Penoscrotal Decompression of Refractory Ischemic Priapism: Surgical Technique

Authors: Nicholas Ottaiano, Ganesh Sanekommu, Christopher Koller, Wayne Hellstrom, Allen Morey, Omer A. Raheem

Key Words: Priapism, Penoscrotal Decompression, Refractory Ischemic Priapism

The video covers the etiology and multiple causes of each subtype of priapism with a special emphasis on a newer surgical technique, penoscrotal decompression. Outcomes after distal shunting have low rates of success in cases of refractory ischemic priapism lasting more than 48 hours. Current American Urological Association (AUA) guidelines recommend proximal shunting following a failed distal shunt; however, proximal shunting is no longer common practice due to the technically challenging nature of the procedure. Corporal decompression via a penoscrotal incision has recently emerged as a viable alternative to proximal shunting with favorable outcomes. In the video, we describe the technique in a step-by-step fashion as well as the preoperative workup and outcome.

Acknowledgement: None

Disclosures: The authors have nothing to disclose


  • Montague DK, Jarow J, Broderick GA, Dmochowski RR, Heaton JP, Lue TF, et al. American Urological Association guideline on the management of priapism. J Urol. 2003;170(4 Pt 1):1318-24.
  • Salonia A, Eardley I, Giuliano F, Hatzichristou D, Moncada I, Vardi Y, et al. European Association of Urology guidelines on priapism. Eur Urol. 2014;65(2):480-9.
  • Muneer A, Ralph D. Guideline of guidelines: priapism. BJU International. 2017;119(2):204-8.
  • Sikka SC, Hellstrom WJ, Brock G, Morales AM. Standardization of vascular assessment of erectile dysfunction: standard operating procedures for duplex ultrasound. J Sex Med. 2013;10(1):120-9.
  • Fuchs JS, Shakir N, McKibben MJ, Mathur S, Teeple S, Scott JM, et al. Penoscrotal Decompression—Promising New Treatment Paradigm for Refractory Ischemic Priapism. The Journal of Sexual Medicine. 2018;15(5):797-802.
  • Baumgarten AS, VanDyke ME, Yi YA, Keith CG, Fuchs JS, Ortiz NM, et al. Favourable multi-institutional experience with penoscrotal decompression for prolonged ischaemic priapism. BJU International. 2020;126(4):441-6.

Simple Orchiectomy for Genital Dysphoria: A Step-By-Step Surgical Technique

Authors: Jacob Tannenbaum, Bryan Herzog, Omer Raheem. Department of Urology, Tulane University, School of Medicine, New Orleans Louisiana  

Key Words: Simple Orchiectomy, Surgical technique, gender dysphoria

In this video we demonstrate a step-by-step surgical technique for a simple orchiectomy of a neonatal male who identifies as female. An orchiectomy is the complete removal of both testicles and their surgical indications including gender dysphoria, metastatic prostate cancer, and chronic orchalgia. According to World Professional Association for Transgender Health (WPATH), patients who elect to undergo gender affirming surgeries can proceed with bilateral simple orchiectomy as standards of care. It is critical that the simple orchiectomy is performed meticulously to avoid any potential surgical complications as demonstrated in this video.  

Acknowledgement: None

Disclosures: None

References: None

Surgical Technique for Concurrent Penile Plication and Excision with Grafting for Severe Peyronie’s Disease

Authors: Jacob Tannenbaum, Bryan Herzog, Omer Raheem. Department of Urology, Tulane University, School of Medicine, New Orleans Louisiana  

Key Words: Penile plication; surgical technique; Grafting; Peyronie’s disease

This video covers the surgical technique used for grafting and the removal of the plication caused from a severe case of Peyronie’s disease (PD). Individuals with severe PD may elect to undergo surgical treatment to improve their sexual satisfaction during sexual intercourse. Indications for surgical treatment with grafting of PD include a penile deviation > 60 degrees, short penis, hourglass deformity, and satisfactory preoperative erectile function. In this video, we demonstrate the usage of preoperative imaging using penile duplex ultrasound and CEEVRA MRI penis 3D imaging to identify and model the plication. Furthermore, this video is a step-by-step guide to the health professional on the meticulous technique that can be used for a successful removal of a plication, grafting, as well as correction of penile curvature from PD.

Acknowledgement: None

Disclosures: None

References: None

ARAS (Augmented reality assisted surgery): A surgical planning tool for penile prosthesis

Authors: Rafael E. Carrion Jr, Raul Fernandez-Crespo, Gerard D. Henry, Jay Simhan, Anand Shridharani, Rafael E. Carrion, Tariq S. Hakky

Key Words: Augmented reality (AR)- Augmented reality assisted surgery (ARAS)- Optical head mounted displays (OHMD) - penile prosthesis (PP) - Surgical planning

ARAS uses superimposed images in physicians' fields to integrate common elements of surgical planning process in more advanced detail. OHMD has proven effective in clinical and operative settings and can be used as an AR interface for surgical planning. We used this tool to plan surgery for a patient who received a malfunctioning penile implant. To plan this procedure. We used the Hololens 2 developer edition holographic windows for business (OS 203481447). We used ApoQlar VSI version 1.8 to load CT Scan DICOM images of the patient's deflated penis. We obtained patient consent, and his information was expunged. Three surgeons were equipped with a HoloLens unit and installed ApoQlar VSI on each unit. Each surgeon was then meshed into the VSI application on their respective HoloLens with the primary surgeon to evaluate the case and to preplan surgical procedure. With a 3D scalpel, we examine a cross-section of CT scan images from whatever perspective might find it helpful. We detected aneurysmal dilation of the cylinder and marked it on 3D shapes. Additionally, we load virtually a Furlow and reservoir unit and manipulate them in 3D, placing them in their respective positions to depict the surgical procedure accurately. Measurements were made to help plan virtually PP devices placement, allowing accurate visualization and preplanning of the procedure. We performed a penile prosthesis revision case with an infrapubic approach, reduction corporoplasty, and a Tutoplast grafting. We deflated the left cylinder, which had a proximal aneurysmal defect before its removal. A new cylinder was placed in the left corpora after the corpora were plicated. Our surgical time was 32 minutes, and blood loss was quantified as 25mLs. We demonstrate the first example of ARAS as a planning tool for penile prosthesis surgery and how this technology could assist surgeons in the future.

Acknowledgement: Coloplast helped fund the study

Disclosures: Rafael Carrion Jr-none; Raul Fernandez-Crespo-none; Gerard D. Henry-consultant Boston Scientific, Coloplast, Microgen, Signati; Jay Simhan-consultant Coloplast; Anand Shridharani, Rafael E. Carrion-Consultant Coloplast, Boston Scientific, Endo, Rigicon; Tariq S. Hakky-Consultant Signati, Coloplast.


  • Dickey RM, Srikishen N, Lipshultz LI, Spiess PE, Carrion RE, Hakky TS. Augmented reality assisted surgery: a urologic training tool. Asian J Androl. 2016 Sep-Oct;18(5):732-4. doi: 10.4103/1008-682X.166436. PMID: 26620455; PMCID: PMC5000796.
  • Alrishan Alzouebi I, Saad S, Farmer T, Green S. Is the use of augmented reality-assisted surgery beneficial in urological education? A systematic review. Curr Urol. 2021 Sep;15(3):148-152. doi: 10.1097/CU9.0000000000000036. Epub 2021 Aug 17. PMID: 34552454; PMCID: PMC8451320.