V1557: PERCUTANEOUS PLACEMENT OF PENILE PROSTHESIS
VideoIntroduction and Objectives
The techniques for placement of penile prosthesis in general destroy the erectile tissue remaining in the dilation process commonly used because of the difficulty of uniformly separating the erectile tissue from Buck's fascia.
The use of a set of coaxial dilators that have been adapted in the creation and expansion of an access path for percutaneous renal surgery inspired us to apply the same principle in the penile prosthesis placement technique . The first step of the technique is the introduction of a special metallic disk-shaped guide arrow sliding through the inner edge of Buck's fascia until the confluence with the glans. The introduction of sequential coaxial dilators allows the erectile tissue to be compressed to the opposite side in a uniform manner without destroying it. A fenestrated sheath allows safe introduction of the proximal shaft, that can be withdrawn without difficulty .
The use of this technique not only fastens the surgical procedure but also allows the preservation of remaining erectile tissue. Smaller caliber prostheses may eventually be used as the erectile tissue has a higher preservation perspective. We know that other techniques intended to preserve erectile tissue have been proposed however the technique of expansion does not ensure the preservation of erectile tissue.
The use of coaxial dilator in percutaneous implantation surgery of penile prostheses seems to represent a significant advance in the surgical procedure for treating erectile dysfunction since it simplifies the surgical technique and increases the chances to preserve the remaining tissue involved in the physiological mechanism of erection.