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Perineal Minimally Invasive Technique for Cylinder Length Adjustment
© 2012 International Society for Sexual Medicine
Surgical Techniques Perineal Minimally Invasive Technique for Cylinder Length Adjustment Seth Cohen and Jean-Francois Eid New York, NY Preop photo showing glans unsupported because implant cylinders are too short
Implant cylinders are too short
Unsupported glans
Implant cylinder is correct length
Corpus spongiosum
Implant cylinder is incorrect length
Tunica albuginea of corpus cavernosum
Scrotum
FIGURE 1 The Perineal Minimally Invasive Technique for Cylinder Length Adjustment is designed to adjust up or down penile prosthesis cylinder length with minimal dissection. Rear tip extenders can be added or removed through this approach. In addition the proximal tip of oversized cylinders (without rear tip extenders) can be trimmed with sharp serrated scissors avoiding the need to replace the entire device. This approach through the perineum results in little to no post-operative pain and swelling and leaves the scrotal pump and reservoir undisturbed. The glans deformity and position of cylinders that are too short are illustrated here.
2738
J Sex Med 2012;9:2738–2741
Surgical Techniques Incision marked on skin
Vertical perineal skin incision
Scrotum
3-0 PDS stay sutures placed on either side of the corporotomy
Perineal skin incision Corporotomy incision
Corpus spongiosum
Visualization of implant through corporotomy incision
FIGURE 2 Exposure is obtained by dividing skin and all subcutaneous tissue on the midline of the perineum down to the corpus spongiosum bulb. Five blunt yellow hooks and the Scott retractor are utilized to secure the skin. The right and left corpora cavernosa are dissected on either side of the midline corpus spongiosum to visualize the tunica albuginea. A small vertical incision is made, using the Bovie eletro cautery, into each corpora cavernosa until the rear tip of each cylinder is visualized. 3-0 polydioxanone stay sutures (PDS) on a RB-1 needle are placed on either side of the corporotomy.
J Sex Med 2012;9:2738–2741
2739
Surgical Techniques Proximal end of implant prior to addition of rear tip
Scrotum
Stay suture
Stay suture Corpus spongiosum
Proximal end of implant after addition of rear tip. Corpus spongiosum with vessel loop is medial to the implant
Perineal skin incision
Rear tip added to lengthen implant
FIGURE 3 With the cylinders deflated, the proximal tip of the cylinder is mobilized from the corporal cavity and brought into the operative field. Next, the appropriately sized rear tip extender is placed and the proximal portion of the cylinder repositioned in the corporal space. Before the corporotomy is closed, the cylinders should be inflated to ensure that the appropriately sized rear tip extender was used.
2740
J Sex Med 2012;9:2738–2741
Surgical Techniques Preop photo showing glans unsupported because implant cylinders are too short
Postop photo showing implant cylinders of correct length
Implant cylinders are correct length
Corporotomies are closed with 3-0 PDS running sutures
Perineal skin incision is closed with 4-0 Prolene vertical mattress sutures
Corpus spongiosum Scrotum
FIGURE 4 The corportomies are closed with the same 3-0 PDS RB-1suture in a running fashion to ensure a tight, hemostatic seal. Buck’s and Colles fascia are re-approximated using a 3-0 Vicryl suture and the skin is closed with a 4-O Prolene suture utilizing a vertical mattress stitch. The Perineal Minimally Invasive Technique for Cylinder Length Adjustment allows for cylinder length adjustment with minimal dissection, without disturbing the scrotal pump and reservoir and without the need to replace the entire device.
The Surgical Techniques Section is sponsored in part by Coloplast
J Sex Med 2012;9:2738–2741
2741
Surgical Techniques Perineal Minimally Invasive Technique for Cylinder Length Adjustment Seth Cohen and Jean-Francois Eid New York, NY Preop photo showing glans unsupported because implant cylinders are too short
Implant cylinders are too short
Unsupported glans
Implant cylinder is correct length
Corpus spongiosum
Implant cylinder is incorrect length
Tunica albuginea of corpus cavernosum
Scrotum
FIGURE 1 The Perineal Minimally Invasive Technique for Cylinder Length Adjustment is designed to adjust up or down penile prosthesis cylinder length with minimal dissection. Rear tip extenders can be added or removed through this approach. In addition the proximal tip of oversized cylinders (without rear tip extenders) can be trimmed with sharp serrated scissors avoiding the need to replace the entire device. This approach through the perineum results in little to no post-operative pain and swelling and leaves the scrotal pump and reservoir undisturbed. The glans deformity and position of cylinders that are too short are illustrated here.
2738
J Sex Med 2012;9:2738–2741
Surgical Techniques Incision marked on skin
Vertical perineal skin incision
Scrotum
3-0 PDS stay sutures placed on either side of the corporotomy
Perineal skin incision Corporotomy incision
Corpus spongiosum
Visualization of implant through corporotomy incision
FIGURE 2 Exposure is obtained by dividing skin and all subcutaneous tissue on the midline of the perineum down to the corpus spongiosum bulb. Five blunt yellow hooks and the Scott retractor are utilized to secure the skin. The right and left corpora cavernosa are dissected on either side of the midline corpus spongiosum to visualize the tunica albuginea. A small vertical incision is made, using the Bovie eletro cautery, into each corpora cavernosa until the rear tip of each cylinder is visualized. 3-0 polydioxanone stay sutures (PDS) on a RB-1 needle are placed on either side of the corporotomy.
J Sex Med 2012;9:2738–2741
2739
Surgical Techniques Proximal end of implant prior to addition of rear tip
Scrotum
Stay suture
Stay suture Corpus spongiosum
Proximal end of implant after addition of rear tip. Corpus spongiosum with vessel loop is medial to the implant
Perineal skin incision
Rear tip added to lengthen implant
FIGURE 3 With the cylinders deflated, the proximal tip of the cylinder is mobilized from the corporal cavity and brought into the operative field. Next, the appropriately sized rear tip extender is placed and the proximal portion of the cylinder repositioned in the corporal space. Before the corporotomy is closed, the cylinders should be inflated to ensure that the appropriately sized rear tip extender was used.
2740
J Sex Med 2012;9:2738–2741
Surgical Techniques Preop photo showing glans unsupported because implant cylinders are too short
Postop photo showing implant cylinders of correct length
Implant cylinders are correct length
Corporotomies are closed with 3-0 PDS running sutures
Perineal skin incision is closed with 4-0 Prolene vertical mattress sutures
Corpus spongiosum Scrotum
FIGURE 4 The corportomies are closed with the same 3-0 PDS RB-1suture in a running fashion to ensure a tight, hemostatic seal. Buck’s and Colles fascia are re-approximated using a 3-0 Vicryl suture and the skin is closed with a 4-O Prolene suture utilizing a vertical mattress stitch. The Perineal Minimally Invasive Technique for Cylinder Length Adjustment allows for cylinder length adjustment with minimal dissection, without disturbing the scrotal pump and reservoir and without the need to replace the entire device.
The Surgical Techniques Section is sponsored in part by Coloplast
J Sex Med 2012;9:2738–2741
2741