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Cylinder realignment for impending inflatable penile prosthesis erosion

Authors: Daniar K. Osmonov, Ahmed M. Ragheb, Klaus-Peter Junemann and Steven K. Wilson

Key Words: Impending erosion, Mulcahy technique, corporoplasty, inflatable penile prosthesis, IPP

Due the low incidence of impending IPP erosions, low volume implanters may be challenged by these cases. In many situations, capsule formation around the implant may suffice to hinder cylinder migration. Nevertheless, severe cases may require prompt recognition and repair otherwise will transform into infected implantations if the implant exits the skin. In this video, we present, step-by-step, the Mulcahy distal corporoplasty technique and cylinder realignment performed on a case of impending left side IPP erosion. This technique may be considered a safe and feasible approach for these particular cases, excluding the need for total corporal exposure. We hope this video serves as an instructive resource.

Acknowledgements: This video was filmed and edited in the Department of Urology and Pediatric Urology University Hospital Schleswig Holstein in Kiel, Germany.

Disclosures: The authors have nothing to disclose.

References:

1. Mulcahy, J. J. (1999). Distal Corporoplasty for Lateral extrusion of Penile Prosthesis Cylinders. The Journal of Urology, 193–195. https://doi.org/10.1097/00005392-199901000-00053
2. Wilson, S. K. (2010). Surgical Techniques: Rear Tip Extender Sling: A Quick and Easy Repair for Crural Perforation. The Journal of Sexual Medicine, 7(3), 1052–1055. https://doi.org/10.1111/j.1743-6109.2010.01733.x

Efficient Penoscrotal Approach for Multiple Penile Procedures

Authors: Jayson Kemble, Eileen Byrne, Lexiaochuan Wen, J Nicholas Warner, Sevann Helo, Matt Ziegelmann, Tobias S Köhler

Key Words: Penile Prosthesis; Infection; Surgical Time; Surgical Technique

The penoscrotal approach for inflatable penile prosthesis (IPP) implantation accounts for >80% of IPPs placed worldwide. This approach can also be used in Malleable implant placement and in scrotal decompression of priapism. Efficient and effective exposure with this approach can be challenging in inexperienced hands, with longer surgical times associated with an increased risk of infection. Here we demonstrate an efficient exposure for IPP up to corporal dilation using the penoscrotal approach.

Acknowledgements: None

Disclosures: Consultant for Coloplast

References:

1. Fuchs JS, Shakir N, McKibben MJ, Mathur S, Teeple S, Scott JM, Morey AF. Penoscrotal Decompression-Promising New Treatment Paradigm for Refractory Ischemic Priapism. J Sex Med. 2018 May;15(5):797-802.
2. Köhler TS, Wen L, Wilson SK. Penile implant infection prevention part 1: what is fact and what is fiction? Wilson's Workshop #9. Int J Impot Res 2020; 33(8):785-792.
3. Onyeji IC, Sui W, Pagano MJ, Weinberg AC, James MB, Theofanides MC, Stember DS, Anderson CB, Stahl PJ. Impact of surgeon case volume on reoperation rates after inflatable penile prosthesis surgery. The Journal of Urology 2017; 1;197(1):223-9.
4. Wang Q, Goswami K, Shohat N, Aalirezaie A, Manrique J, Parvizi J. Longer operative time results in a higher rate of subsequent periprosthetic joint infection in patients undergoing primary joint arthroplasty. The Journal of Arthroplasty 2019; 34(5):947-53.

Concurrent Penile Plication and Extratunical Pericardial Grafting for Peyronie’s Disease: A Step-by-Step Technique

Authors: Omer Raheem, Crystal Casado, Grace Tanguilig, Haley Watts, Tanya Kristof-Watts, Ervin Kocjancic 

Key Words: Peyronie’s Disease, Penile plication, Extratunical grafting

This video demonstrates step-by-step surgical management of a patient with severe ventral penile curvature with left unilateral corporal hinge effect. Surgical procedures shown in the video include penile plication and extratunical pericardial grafting (Tutoplast). The video outlines the surgical indications for Peyronie’s disease with a specific focus on the Extratunical grafting.

Acknowledgements: None.

Disclosures: The authors have nothing to disclose.

References:

The tunneling technique: a universal approach for salvage penile prosthetic implantation in severely scarred corporal bodies

Authors: Daniar K. Osmonov, Ahmed M. Ragheb, Klaus-Peter Jünemann and Steven K. Wilson

Key Words: Corporal, fibrosis, tunneling, cavernotomes, inflatable penile prosthesis, IPP

IPP implantation in severe cases of intracorporal scarring poses a daunting challenge, even to experts in the field. We present, step-by-step, the tunneling technique to successfully implant an inflatable penile prosthesis via the subcoronal approach in a case of total intracorporal fibrosis. Our patient was a 32 year old African gentleman suffering complete intracorporal fibrosis as a result of a full week episode of ischemic priapism due to sickle cell anemia. With the adequate surgical experience and special instrument utilization, the tunneling technique may be considered a minimally invasive and universal option for implanting cases suffering extensive intracorporal fibrosis while excluding the need for corporal reconstruction. We aspire this video to serve as an instructive resource for treating these special cases.

Acknowledgements: This video was filmed and edited in the Department of Urology and Pediatric Urology University Hospital Schleswig Holstein in Kiel, Germany..

Disclosures: The authors have nothing to disclose.

References:

Artificial Urinary Sphincter Implantation for Severe Post-Prostatectomy Incontinence in Setting of Salvage Radiotherapy and Prior Inflatable Penile Prosthesis

Authors: Sean W. Hou, Caleb A. Cooper, Matthew J. Sloan, Omer A. Raheem

Key Words: artificial urinary sphincter, surgical technique, stress urinary incontinence, radiation therapy, penile implant

This video covers the surgical technique for implantation of an artificial urinary sphincter (AUS) for management of stress urinary incontinence (SUI). Notably, this patient underwent radical prostatectomy (RP) followed by salvage radiotherapy (XRT) for biochemical recurrence of prostate cancer and had prior inflatable penile prosthesis (IPP) placement. AUS implantation is one of the most common treatment options for individuals with severe SUI, which is a common complication after RP.1 The modern AUS consists of a urethral cuff, pump, and reservoir, which serve as a replacement of the native incompetent sphincter. There are various surgical approaches for AUS insertion, including transperineal, transscrotal, and abdominal approaches.2 We demonstrate a step-by-step technique for insertion of an AUS with a transperineal approach in the context of a patient with prior XRT and IPP placement.

Acknowledgements: None.

Disclosures: The authors have nothing to disclose.

References:

  • James, M. H. & McCammon, K. A. Artificial urinary sphincter for post-prostatectomy incontinence: a review. Int. J. Urol. Off. J. Jpn. Urol. Assoc. 21, 536–543 (2014).
  • Suarez, O. A. & McCammon, K. A. The Artificial Urinary Sphincter in the Management of Incontinence. Urology 92, 14–19 (2016).

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