V1558: Subcoronal placement of semi-rigid penile prostheses can be performed with adequate two layered closure
VideoIntroduction and Objectives
Semi-rigid or malleable penile prostheses may be placed through a variety of approaches. The subcoronal approach to placement of semi-rigid prostheses has been previously described. This technique has the benefit of a short operative time, short recovery time for wound healing, and improved cosmetic results when utilizing the previous circumcision scar. However, it has been criticized due to the poor availability of local tissue for coverage at the time of closure. We propose that with careful elevation of the dartos fascia, a thick layer can be developed allowing for a two layered closure with minimal overlap of suture lines.
In this video, we demonstrate our technique for subcoronal placement of a semi-rigid penile prosthesis. A hemi-circumfrential skin incision can be made on the ventral surface of the phallus 1-2 cm proximal to the glans at the previous circumcision scar. The underlying dartos layer can then be carefully elevated off the tunica albuginea and urethra and incised transversely. Longitudinal corporotomies are made allowing for dilation and placement of the implant cylinders. A retractor is utilized to lift the distal end of the corporotomy to allow for placement of the distal cylinder tip. The corporotomies are then closed and the preserved dartos fascia is reapproximated with a running suture. The skin is then closed as a second layer.
8 patients successfully underwent placement of AMS Spectra penile prosthesis through a subcoronal approach. Mean operative time was 30 minutes with minimal blood loss. No perioperative or postoperative complications were observed. Distinct dartos flaps were successfully raised in all patients allowing a successful two layered closure and minimal overlap of suture lines.
The AMS Spectra penile prostheses can be successfully placed through a subcoronal incision. This allows a rapid placement and good cosmetic result. The criticism of inadequate tissue for closure does not appear to apply as thick dartos flaps can be carefully created to allow for a two layered closure with minimal overlap of suture lines.