Implantation of inflatable penile prosthesis in patients with severe corporeal fibrosis: introduction of a new penile cavernotome.

摘要

PURPOSE: Implantation of penile prosthetic cylinders into scarred corpora remains a challenge in the field of prosthetic urology. We describe a new penile cavernotome, which allows for easier dilation of fibrotic corpora cavernosa and facilitates inflatable penile prosthesis cylinder insertion. MATERIALS AND METHODS: A set of 5 cavernotomes between 6 and 13 mm. in diameter are used to drill a space in fibrotic corpora with controlled 1 mm. cuts. The cavernotomes are advanced in an oscillating fashion and also allow shaving of severely stenotic areas for easier cavity development. They were used in 16 patients with fibrotic corpora secondary to different etiologies. A high transverse scrotal incision was used in all cases. Of the 16 patients 14 received downsized cylinders. RESULTS: Implantation of both cylinders of an inflatable 3-piece device was successful in all cases. Proximal crural perforation occurred intraoperatively in 5 patients and was corrected by attaching the rear tip extender to the tunica with nonabsorbable suture. Postoperatively, distal tunical perforation of the corpora in 4 patients was repaired with natural tissue. Operative time was reduced compared to our previous experience with implantation in cases of corporeal fibrosis using extensive corporotomies or the Carrion-Rossello cavernotomes. In no case was the procedure terminated for urethral laceration or inadequate dilation for cylinder insertion. No grafting materials were necessary to close the corporotomy. CONCLUSIONS: The new cavernotomes along with the high transverse scrotal incision and downsized prostheses resulted in successful implantation in all of our cases. Dilation of fibrotic corpora was easier and quicker with the new cavernotomes because extensive corporeal resection was not necessary. Complications were acceptable for these difficult cases and prosthesis survival is 100% to date.