Minimally invasive infrapubic – Original article

Minimally invasive infrapubic inflatable penile prosthesis implant for erectile dysfunction: evaluation of efficacy, satisfaction profile and complications.

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The Journal of Sexual Medicine – Surgical Technique

Minimally Invasive Infrapubic Inflatable Penile Implant

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Hydraulic Tricomponent Penile Prosthesis or Penile Implant

MINIMALLY INVASIVE SURGERY TECHNIQUE
with Infra-pubic approach.

By using the minimally invasive technique we are able to implant all the components of the hydraulic three-component prosthesis through an incision of 2 cm at the base of the penis.

The procedure can be safely performed under general anesthesia, spinal or local in less than 25 minutes.

Usually patients can resume sexual activity after 4 to 6 weeks.

Description of the Technique

After trichotomy performed strictly in the operating room, the skin is cleansed and disinfected for 10 minutes with a solution of iodiopovidone and injected cefazolin intravenously. The first step is the induction of hydraulic artificial erection by injecting cavernosa with 0.9% salinity inside the corpora cavernosa. This maneuver allows identifying any conditions that need correction (e.g. “Hourglass” deformities or curvatures of the penis), furthermore, it promotes the expansion of the corpora cavernosa and facilitates the identification of the dorsal nerve and positioning it sideways towards the points of suture.

Implantation of penile prosthesis hydraulic tricomponent

Access is via a 'skin incision of 2.5 cm infrapubica

By blunt dissection with the finger opens the Colles fascia and blocks the corpora cavernosa bilaterally.

They are placed on the corpora cavernosa four suspension points, two on each side, in acidopoliglicolico 2/0 for later use to close corporotomies

They are placed on the corpora cavernosa four suspension points, two on each side, in acidopoliglicolico 2/0 for later use to close corporotomies

They are placed on the corpora cavernosa four suspension points, two on each side, in acidopoliglicolico 2/0 for later use to close corporotomies

They are placed on the corpora cavernosa four suspension points, two on each side, in acidopoliglicolico 2/0 for later use to close corporotomies

At this point they are carried out two bilateral minimum corporotomy 1.5 centimeters each such as to allow the passage of the prosthetic cylinders.

At this point they are carried out two bilateral minimum corporotomy 1.5 centimeters each such as to allow the passage of the prosthetic cylinders.

Using only the introducer Furlow to maintain the erectile tissue residue, the corpora cavernosa

Using only the introducer Furlow to maintain the erectile tissue residue, the corpora cavernosa

They are dilated and measured proximally and distally.

They are dilated and measured proximally and distally.

Using a nasal speculum 8 cm paravesical create the space for the flat tank (Conceal filled with 100 ml of saline solution), subsequently to the transversalis fascia proceeding from the top downwards through the external inguinal ring which is perforated.

Using a nasal speculum 8 cm paravesical create the space for the flat tank (Conceal filled with 100 ml of saline solution), subsequently to the transversalis fascia proceeding from the top downwards through the external inguinal ring which is perforated.

Using a nasal speculum 8 cm paravesical create the space for the flat tank (Conceal filled with 100 ml of saline solution), subsequently to the transversalis fascia proceeding from the top downwards through the external inguinal ring which is perforated.

Using a nasal speculum 8 cm paravesical create the space for the flat tank (Conceal filled with 100 ml of saline solution), subsequently to the transversalis fascia proceeding from the top downwards through the external inguinal ring which is perforated.

The cylinders are then implanted prosthetic and performed proof hydraulics that demonstrates the proper operation and positioning

The cylinders are then implanted prosthetic and performed proof hydraulics that demonstrates the proper operation and positioning

The cylinders are then implanted prosthetic and performed proof hydraulics that demonstrates the proper operation and positioning

The cylinders are then implanted prosthetic and performed proof hydraulics that demonstrates the proper operation and positioning

The cylinders are then implanted prosthetic and performed proof hydraulics that demonstrates the proper operation and positioning

The cylinders are then implanted prosthetic and performed proof hydraulics that demonstrates the proper operation and positioning

The corporotomies are closed bilaterally with the suspension points previously positioned.

The corporotomies are closed bilaterally with the suspension points previously positioned.

Again, the nasal speculum is used to develop a "pouch subdartoico" in a portion of the scrotum housing for activating the pump of the hydraulic system.

Again, the nasal speculum is used to develop a "pouch subdartoico" in a portion of the scrotum housing for activating the pump of the hydraulic system.

Again, the nasal speculum is used to develop a "pouch subdartoico" in a portion of the scrotum housing for activating the pump of the hydraulic system.

Again, the nasal speculum is used to develop a "pouch subdartoico" in a portion of the scrotum housing for activating the pump of the hydraulic system.

They connect the pipes of the prosthetic system and leaves a Jackson-Pratt drain planted for about 24-48 hours, and finally closes the skin with stitches

They connect the pipes of the prosthetic system and leaves a Jackson-Pratt drain planted for about 24-48 hours, and finally closes the skin with stitches

They connect the pipes of the prosthetic system and leaves a Jackson-Pratt drain planted for about 24-48 hours, and finally closes the skin with stitches

The average time to complete the installation is 25 minutes as compared to the 50 minutes required in accomplishing the one peno-scrotal approach, the process is conducted to deal with the post-operative pain, which is almost non-existent, and the risk of infection decreases considerably and is close to zero percent if one is not using the urinary catheter and does not have a contamination in the skin of the scrotum which is much more prone to bacterial localization as compared to the infra-pubic region. The access is so mini-invasive in corporotomies and in the installation of the activator pump, that it decreases haematomas and collections of serum drastically, so much so that even if present, the streaks of contamination gets eliminated with the help of the drainage left in the scrotal sac for about 24/48 hours post operating. Last consideration is that the infra-pubic access allows an easier and convenient access to the external inguinal ring for the positioning of the reservoir, be it in the para-vesical position or the ectopic position over the transversalis fascia. 

The decrease of discomfort over the course of time after the surgery and the ability to manage the scrotum almost immediately allows the patient to activate the hydraulic system just after 7 days of surgery and to resume the sexual activity after a month.

The latter figure is a determining factor to exploit the full potential of the new model LGX of the AMS. In fact, this device allows the penis to gain at least 2 cm in length and 2 cm in width over the time. The more prompt the activation time, fewer gets the chances for the immediate formation of pseudocapsule of the corpora cavernosa which inhibits this elongation.

After the surgery, a single dose of gentamicin is given and a treatment of ten days with cefazolin. We can conclude that the surgical technique is very fast, safe and aesthetic result is guaranteed with a small skin incision of just 2.5 cm.

Penile Cosmetic Surgery