PREOPERATIVE DIAGNOSIS:
Organic erectile dysfunction.
POSTOPERATIVE DIAGNOSIS:
Organic erectile dysfunction.
PROCEDURE PERFORMED: Insertion
of inflatable penile prosthesis.
SURGEON: John Doe , MD
ANESTHESIA: General
endotracheal.
ESTIMATED BLOOD LOSS: 65 mL.
COMPLICATIONS: None.
DESCRIPTION OF PROCEDURE: Following induction of general anesthesia, the
patient was shaved and skin prepped for 10 minutes with iodine scrub followed
by Betadine paint. The patient was draped in a sterile fashion including U
drape and previous dressing between the legs, which were placed in frog-leg
position. A sub penoscrotal incision was made with sharp dissection carried
through the dartos muscle with Lone Star retractor placed with double rings,
large above and small below. The transverse Deaver retractor was positioned at
the base of the penis and the Foley catheter was inserted into the bladder with
some difficulty, requiring downsize to a 16 French catheter. Once the catheter
was in position in the bladder, a hook was placed on the inside of the dorsal
aspect of the meatus and the penis drawn cephalad over the transverse
retractor. The penoscrotal incision was deepened and hooks were used to retract
the skin superior to inferior and to either side. The corpora cavernosa was
dissected free of surrounding adventitial tissue on the patient's left, and the
soft tissues were then retracted to the patient's right, allowing exposure of
the contralateral corpora cavernosa.
Once exposure was achieved, stay sutures of 0 PDS suture were
placed in each corpora x2 and a vertical incision was placed between corpora
extending approximately 2-3 cm in length. Metzenbaum scissors was passed
distally and then proximally into the corpora on either side with the points of
the scissors hugging the internal aspect of the corpora cavernosa, tunica
albuginea. Next, Hegar dilators were positioned proximal and distal with
gradual increase in dilator size to 13. Once dilation was complete, the corpora
were irrigated with antibiotic solution consisting of vancomycin and
gentamicin. The assembly was prepared on the back table, including the Ambicor
inflatable penile prosthesis and pump. The corpora cavernosa were measured at
19 cm total with 10 cm distal and 9 cm proximal. We chose a 15 cm prosthesis
with 4 cm extensions and 12 mm caliber. The Furlow insertion device was then
positioned with a Keith needle and positioned to position the distal end of the
prosthesis through the glans penis. This was performed on each side and the
proximal prosthesis was then inserted into the proximal corpora cavernosa.
Once the prosthesis was seated, the tubing was cleared of
air and the rubber-shod clamp removed allowing inflation of the prosthesis to
assure that there was no kinking or cross-over of the prosthesis. Once we were
assured of this, the prosthesis was then emptied and the tubing re-clamped
while the stay sutures were tied transversely to close the corpora cavernosa. The
Lone Star retractor was removed and a subdartos pocket was identified and
created with insertion of gauze soaked in 1% lidocaine with epinephrine. A 65 mL
reservoir was then cycled with water and emptied. The external ring was
traversed with the index finger of the left hand and a Deaver retractor was
positioned, retracting the external oblique fascia of the external ring
cephalad and Metzenbaum scissors then punctured through the transversalis
fascia into the retroperitoneal space. A finger created space within the
retroperitoneal tissues and the reservoir was positioned in the retropubic
space and filled with 65 mL of saline.
The pump was then positioned in the subdartos pocket and the
tubing between the reservoir and the pump was clamped with rubber shods and
excess tubing was cut. The connecting device was then placed and the crimper was
used to secure connection between the reservoir and the pump. The prosthesis was
cycled, showing again good evidence of erection without kinking or aneurysm. The
corpora cavernosa cylinders were left at approximately 70% filled and the
subdartos tissues were closed over the pump, which was secured in the
anterior-inferior aspect of the scrotum. The Lone Star retractor was replaced
with retractors extending the transverse penoscrotal incision to either side
and a round Blake drain was placed through a separate stab incision into the
subdartos space adjacent to the tunica vaginalis.
The dartos and skin were closed in one layer with
interrupted 3-0 chromic sutures, and upon completion of skin closure, a fluff
gauze dressing with Telfa was placed over the incision and a stretch tape
dressing was placed over the scrotum, first vertical and then transverse. The
Foley catheter was taped to the anterior abdominal wall and the Blake drain
attached to a vacuum bulb. The patient was then transferred to the recovery
room in satisfactory condition.
