Circumcision incision for insertion of semirigid penile prosthesis

SUHGEON’S VVORKSHOP

CIRCUMCISION SEMIRIGID ARTHI’R

INCISION

PENILE

D. SMITH.

FOR INSERTION

OF

PROSTHESIS

\I.D.

From the Department of Urologic Surgery, Uni\-ersity College of Health Sciences. Minneapolis. Minnesota

A semirigid penile prosthesis (Small-Carrion, Finnel.1 cm be inserted with a single skin incision that provides simultaneous circumcision. Besides its obvious utility in patients with phimosis, the technique is helpful in men impotent as a rrslllt of priapism or Peyronie disease, because it makes carving out the corpora caver~osa and excision of plaques easier. There is less isk of cross-over during dilatation of the corof the prosthesis, and the 1:bora and placement ,osmetic results are excellent. Two parallel circumferential incisions are made, one in the unretracted skin one-half inch distal to the corona and the other in the retracted mrlcosa immediately proximal to the corona. Skin and subcutaneous tissues are mobilized oft‘Buck facia to preserve blood s11pply and then retracted along the penile shaft. The sites of the lateral longitudinal incisions in the corpora are selected in the proximal portion of the shaft and marked with 2-O Prolene sta!. slltures on each side. The corpora are opened wit11 three-quarter-inch incisions, cnlarged with Hegar dilators. and irrigated with 0.25 per chent neomycin solution. The appropriate size of l)rosthesis is inserted, and the cor-

of Minnesota

pora are closed. The knots at tile ends of the hemostatic sutures are ljuried 1~~ threading them through a loop of Prolent buried under the running suture used to close the corpora and then removing the loop (Fig. I!. The skin incision is closed in two layers ot interrupted chromic catgut (Fig. 2). Two of the 18 patients in whom NY’llsed this technique had wound problems, (me lwcause the skin was mobilized at the level ‘of the superficial subcutaneous tissues and the postoperative compression dressing was too tight. alld the other becallse a condom catheter was applied too soon postoperatively. III the formt*r, A skin graft was siiccessf;il; in the latter. the wolind

l~ecamt~ inf’ected and prosthesis mu? eutrucled. \\‘c tle\ised this techniclue fix th(? insertion of Small-Carrion and Finne\. penile pwsthesrs and have iised it for the last fif‘teen months. A sirnilal incision is now being used t~lse\vhw-tl for inplating the Jonas prostht+Gs. FSOX :3w Mayo

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