VJPU - The Video Journal of Prosthetic Urology

YOUR Video Journal of Prosthetic Urology

and Sexual Medicine Surgery

Word from The Editor-In-Chief

It is with great pride that I welcome you to participate in the Journal of Prosthetic Urology (VJPU). The journal was created by the ISSM to serve as a forum for sexual medicine to allow its members to exchange notable ideas via the visual medium. Our members are scattered across the globe and prosthetic urology is a tiny subspecialty of sexual medicine. A specific goal was to facilitate the transmission of surgical technique knowledge regarding the implantation of surgical devices related to sexual medicine.

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Double Distal Corporal Anchoring Stitch For Lateral Penile Implant Cylinder Extrusion: A Step-by-Step Surgical Technique

Authors: Omer A. Raheem, Senthooran Kalidoss, Alfredo Suarez-Sarmiento, Paul E. Perito

Key Words: Double fixation stitch, surgical technique, impending lateral extrusion, penile implant, surgical revision procedure

This video covers the surgical technique for the correction and fixation of laterally extruded distal inflatable penile prosthesis (IPP) implant cylinders from the surgical capsule they are sealed within. This patient, with a 20-year history of diabetes, presented 3 years post IPP implantation with a lateral extrusion of one cylinder tip. This double distal fixation stitch technique, when performed after a corporoplasty and capsulotomy, anchors the distal cylinder tip more securely in place medially under the glans penis by creating a bridge between sutures. The fibrotic reactions created by the two sutures under the skin also help fixate the extruded cylinder to the proper position behind the glans. We demonstrate a step-by-step technique to use this double fixation stitch to secure extruded distal cylinders of an IPP implant placement.

Acknowledgements: None

Disclosures: The authors have no disclosures.

References:

1. Antonini, G., Busetto, G. M., Del Giudice, F., Ferro, M., Chung, B. I., Conti, S. L., Suarez Sarmiento, A., Pacchiarotti, A., De Berardinis, E., & Perito, P. E. (2017). Distal corporal anchoring stitch: A technique to address distal corporal crossovers and impending lateral extrusions of a penile prosthesis. The Journal of Sexual Medicine, 14(6), 767–773. https://doi.org/10.1016/j.jsxm.2017.04.669
2. Clavell-Hernández J. (2021). Proximal Extracapsular Tunneling: A Simple Technique for the Management of Impending Cylinder Erosion and Complications Related to Corporal Dilation. Sexual medicine, 9(3), 100379. https://doi.org/10.1016/j.esxm.2021.100379
3. Mulcahy, John J. (1999). Distal corporoplasty for lateral extrusion of penile prosthesis cylinders. Journal of Urology, 161(1), 193–195. https://doi.org/10.1016/s0022-5347(01)62094-9
4. Tran, V. Q., Lesser, T. F., Kim, D. H., & Aboseif, S. R. (2008). Penile corporeal reconstruction during difficult placement of a penile prosthesis. Advances in urology, 2008, 370947. https://doi.org/10.1155/2008/370947

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Is There a Place for Immediate 3-Component Prosthesis Implantation Following Priapism?

Authors: Stavros Kontogiannis, Obaidat Mohammed, Anastasios Natsos, Petros Drettas

Key Words: Penile Prosthesis, Priapism, Erectile Dysfunction, Cavernotomes

One of the most difficult challenges in prosthetic urology is the insertion of penile implants into corpora scarred from an episode of priapism. In this video, we show such a case of penile prosthesis after an episode of ischemic priapism. Priapism is defined as a penile erection lasting more than 4 hours unrelated to sexual interest or stimulation [1]. It can be classified into ischemic, arterial or stuttering [2]. Ischemic priapism is a compartment syndrome inside the two cavernosal bodies and it leads to severe pain. This ischemic state can cause cavernosal artery thrombosis and corporeal fibrosis. With extensive corporeal fibrosis, a penile implant is the only viable option to alleviate sexual dysfunction [3,4]. In cases of scarred penile cavernosal bodies, surgery becomes challenging even for experienced surgeons, as it can be very difficult to dilate the corpora [5,6,7]. Usually, initial insertion of a malleable device as temporary measure, helps to maintain the penile length and simplify the insertion of an inflatable device [8]. In this case, we dilated the corpora cavernosa initially with Metzenbaum scissors in a very thorough and careful way. We placed the tip of the scissors at the outer side of each cavernous body (away from the urethra) and we advanced it to the tip of corpus cavernosum. Then, we used the cavernotomes. The cavernotomes feature bayonet handles and wood rasp surfaces with backward cutting teeth [9]. We advanced them in an oscillating fashion and a tunnel was created in the fibrotic tissue. Then, by withdrawing them, we utilized their backward cutting teeth to “drill” a space [10]. Interestingly, as shown in the video, the initial proximal left dilation was uneven. So, we dilated again the left side with a cavernotome and then, we further dilated with Brooks dilators. Finally, we put the penile prosthesis in place.

Acknowledgements: None

Disclosures: The authors have nothing to disclose

References:

1. Salonia A, Eardley I, Giuliano F et al. European association of urology guidelines on priapism. European Urology 2014; 65.
2. Kim NN, Kim JJ, Hypolite J et al. Altered contractility of rabbit penile corpus cavernosum smooth muscle by hypoxia. Journal of Urology 1996; 155.
3. Tran VQ, Lesser TF, Kim DH, Aboseif SR. Penile Corporeal Reconstruction during Difficult Placement of a Penile Prosthesis. Advances in Urology 2008; 2008.
4. Egydio PH, Kuehhas FE. Treatments for fibrosis of the corpora cavernosa. Arab Journal of Urology 11 2013.
5. Wilson SK. Reimplantation of inflatable penile prosthesis into scarred corporeal bodies. International Journal of Impotence Research, 2003.
6. Sansalone S, Garaffa G, Djinovic R et al. Simultaneous Total Corporal Reconstruction and Implantation of a Penile Prosthesis in Patients with Erectile Dysfunction and Severe Fibrosis of the Corpora Cavernosa. Journal of Sexual Medicine 2012; 9.
7. Hellstrom WJG, Montague DK, Moncada I et al. Implants, mechanical devices, and vascular surgery for erectile dysfunction. Journal of Sexual Medicine 2010; 7.
8. Ralph DJ, Garaffa G, Muneer A et al. The Immediate Insertion of a Penile Prosthesis for Acute Ischaemic Priapism. European Urology 2009; 56: 1033–1038.
9. Rosselló Barbará M, Carrión H. Cavernotomy. Archivos españoles de urología 1991; 44.
10. Wilson SK, Delk JR. Historical advances in penile prostheses. International Journal of Impotence Research 2000; 12.

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.

Artificial Urinary Sphincter Pressure Regulating Balloon Exchange: a Step-By-Step Guide

Authors: Jeffrey C. Loh-Doyle, Jeffery Lin, Stuart D. Boyd

Key Words: artificial urinary sphincter, pressure regulating balloon, revision, reservoir, lateral retroperitoneum

This video provides detailed instruction on how to exchange the pressure regulating balloon of the artificial urinary sphincter (AUS) when placed in the lateral retroperitoneum. This location has been used in all patients at our institution for over 35 years during AUS placement. With its intrinsically low pressure, ease of accessing, and absence of intestinal structures and major vasculature, the lateral retroperitoneum space can be safely used for prosthetic reservoir placement. Exchange of the pressure regulating balloon is a useful revision strategy in patients with persistent incontinence or if the urethra requires less pressure. All three reservoirs (51-60, 61-70, 71-80) are used for a variety of indications.

Acknowledgements: None

Disclosures: Jeffrey Loh-Doyle and Stuart Boyd are Consultants for Boston Scientific

References:

1. Loh-Doyle JC, Nazemi A, Ashrafi A, Doumanian LR, Ginsberg DA, Boyd SD. Predictors of Device-related Complications After Exchange of the Pressure-regulating Balloon in Men With an Artificial Urinary Sphincter. Urology. 2020 Jan;135:154-158.