Extra-Corporal Trans-Septal Penile Prosthesis Implantation for Cases of Corporal Fibrosis
1: Kasr El AIni Faculty of Medicine, Cairo University, Egypt
Objectives: Penile prosthesis implantation into scarred corporal bodies is one of the most challenging procedures in prosthetic urologic surgery. Neglected ischemic priapism or infection and extrusion of a penile implant result in fibrosis of the corpora cavernosa. Despite the advent of many excellent techniques that require experienced hands, some cases remain where implantation fails. This work presents experience with extra-corporal implantation as a last resort.
Materials and Methods: After failure of alternative techniques, extra-corporal implantation is resorted to. The corpus spongiosum is identified by palpating the catheter and held up between two fingers. Diathermy knife is used to cut a longitudinal window into one corpus cavernosum, through the septum and into the contralateral corpus cavernosum. A single semirigid implant rod is inserted through the window at the base of the penis, half-way through. The two limbs of the rod are bent upwards towards the glans, to assume a U-shape. The limbs of the U are brought together at mid-shaft by a gathering suture: size-5 Polyester suture passed through the corpora cavernosa and septum, then tied around the limbs of the implant. Finally, the tips of the U are anchored under the glans using the same suture material.
Results: Out of 8 cases of implant infection and extrusion operated upon, the extra-corporal implant allowed coital relationship in seven, followed up for 10-18 months. Enclosure of the implant in the rigid fibrous window, and anchoring the tips under the glans prevented anterior and posterior migration/extrusion. In one case, infection occurred and the implant had to be removed. Re-implantation with the same method was performed 6 months later, and the implant survived adequately.
Conclusion: Extra-corporal implantation can salvage cases with corporal fibrosis when all alternative methods fail.
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