V3-04: Subcoronal Approach to Inflatable Penile Prosthesis Placement with a Modified No Touch Technique
Surgical treatments for erectile dysfunction can be performed from a variety of approaches. Inflatable penile prosthesis (IPP) design and implantation techniques through penoscrotal and infrapubic incisions have evolved over recent years. Here we present our surgical experience and outcomes with a single subcoronal incision for IPP placement with a modified no touch technique. This approach allows for access to the entire corporal shaft for prosthesis placement and simultaneous additional male reconstructive procedures.
The index patient is 60 year old male, status-post radical prostatectomy with 2 years of erectile dysfunction refractory to medical therapy. Work up consisted of history and physical. The patient underwent placement of an IPP through our subcoronal approach with a modified no touch technique. The penis was degloved to the level of the penoscrotal junction, and the cremaster muscle was everted and secured to the drapes to allow scrotal and penile skin exclusion from the operative field. The implant is placed through ventral corporotomy incisions similar to standard penoscrotal approach.
The procedure was unevenful and was performed entirely in the ambulatory setting, without the use of a foley catheter or a Jackson Pratt drain. There were no complications during this surgery and the patient was satisfied with his functional and cosmetic results. To date, 228 subcoronal IPP placements have been performed at our institution.
Subcoronal IPP placement with modified no touch technique is an appealing approach and shows promising early outcomes. Urologists can safely and easily perform multiple procedures simultaneously with IPP placement through this incision, including circumcision, glanulopexy, Peyronie's disease correction, length preservation and urethral reconstruction. The subcoronal approach allows for access to the entire corporal shaft providing excellent visibility and allows exclusion of surrounding skin through a modified no touch technique.