V9-11: Suprapubic Fat Pad Excision with Simultaneous Placement of Inflatable Penile Prosthesis
Many men suffering from erectile dysfunction (ED) are overweight with separate generous suprapubic fat pads, which often contribute to a decrease in visible exophytic phallic length. We present a novel surgical concept of suprapubic fat pad excision with concomitant placement of inflatable penile prosthesis (IPP).
A transverse incision is made starting 2 cm inferior and medial to the ASIS and carried across the infrapubic region in a curvilinear fashion, passing approximately one finger breath above the base of the penis. The incision continues in a symmetric fashion to the contralateral side. Dissection is carried down to the lower abdominal anterior fascia, which leads to excision of the suprapubic fat pad. Using this same exposure, the IPP is placed via an infrapubic approach following our standard protocol for prosthetic insertion. The wound is reapproximated and two drains are placed, one subcutaneous in the area of the fat pad excision and the other in the scrotum around the pump.
A total of eight patients have undergone suprapubic fat pad excision with simultaneous placement of IPP at our institution. Average BMI of our patient cohort is 36.6. One patient required explant secondary to prosthetic infection after inadvertent removal of his JP drains immediately post-op. At last follow up, all other patients have excellent cosmetic and functional outcomes.
Suprapubic fat pad excision is a safe and reproducible technique that can be performed simultaneously with placement of IPP in appropriately selected patients. Functional outcomes of our initial series have been excellent. This procedure can lead to enhanced patient satisfaction in those with concurrent erectile dysfunction and significant suprapubic fat pad.