High-volume surgeons show multiple options for IPP placement

With “manopause” recently the subject of a TIME magazine cover, testosterone sales at record levels, and a national emphasis on the overall and reproductive health of men, there has never been a greater focus on men’s health. Urologic conditions, such as erectile dysfunction, disproportionately impact quality of life and often prompt care seeking in men.

‘Y’tube, a new video section of UrologyTimes.com, is intended to serve as a resource for urologists who focus on men’s health. We will cover surgical aspects of a variety of men’s health issues with a goal of accumulating a library of videos that can help serve as a reference for urologists and other clinicians. Resources such as these videos are becoming an important part of clinical practice as more and more patients are finding health care providers on the Internet rather than through directed referrals.

In this first installment of ‘Y’tube, we present videos from high-volume prosthetic surgeons performing inflatable penile prosthesis (IPP) placement and discussing diagnosis and management of ED. William O. Brant, MD, offers the following general commentary about these procedures, as well as specific comments in the text accompanying each individual video.

Dr. Brant: There have been a variety of refinements of surgical techniques for IPP that have improved surgical efficiency as well as likely decreased prosthetic infections. Rafael Carrion, MD, and Thomas Walsh, MD, demonstrate different approaches to incorporating a “no-touch” technique to minimize contamination of the prosthesis with skin flora. Dr. Carrion has also popularized a simple technique to recreate the penoscrotal junction without using more time-consuming techniques such as Z-plasty skin advancements.

LeRoy Jones, MD, demonstrates two elegant approaches to simultaneously treating post-prostatectomy stress urinary incontinence as well as erectile dysfunction. 

Penoscrotal IPP placement with ventral phalloplasty

By Rafael Carrion, MD

This video demonstrates our step-by-step process, including positioning, ventral phalloplasty, and our modified “no-touch” technique, utilized in the placement of an inflatable penile prosthesis. A Titan Touch inflatable penile prosthesis is placed in this case, the newest prosthesis in the lineup from Coloplast (Minneapolis).

Surgical pearls are provided throughout the description of our technique to aid in troubleshooting when necessary.

Dr. Brant: This video and the one that follows demonstrate a simple scrotoplasty developed by Dr. Carrion. Although this does not truly lengthen the penis, it gives the appearance of a more external penis. His “check mark” incision prevents a substantial dog-ear deformity in the scrotum.

Ventral phalloplasty and IPP placement

By Rafael Carrion, MD

This video first demonstrates the ventral phalloplasty, used at our institution to take down the penoscrotal web and provide adequate exposure. We then proceed to demonstrate our technique used for the placement of an inflatable penile prosthesis, in this case, an AMS 700 CX MS (American Medical Systems, Minnetonka, MN). Surgical pearls for each step are provided. These two techniques are utilized in conjunction for the management of erectile dysfunction and for optimizing the cosmetic appearance of the phallus.

Next: Semi-rigid prosthesis placed via subcoronal approach

Semi-rigid prosthesis placed via subcoronal approach

By Rafael Carrion, MD

This video demonstrates our technique placing an AMS Spectra penile prosthesis (American Medical Systems) using a subcoronal incision. We describe the advantages and disadvantages utilizing this efficacious technique. It is a quick and safe method of placing a malleable prosthesis, ideal for patients who would benefit from a smaller wound and shorter surgical time.

Dr. Brant: The subcoronal technique is an excellent approach for placement of malleable or semi-rigid prostheses when there is minimal fibrosis within the corpora. In cases requiring more extensive dissection, alternative approaches may be more appropriate, although the surgeon typically will need larger corporotomies.

Retractor-less approach to IPP placement

By Thomas Walsh, MD

This video demonstrates a unique, retractor-less approach to penoscrotal placement of the AMS 700 penile prosthesis (American Medical Systems). Our technique emphasizes surgical efficiency, exposure, and appropriate utilization of tissue tension.

Dr. Brant: Dr. Walsh’s technique forgoes the use of a retractor in favor of a “no-touch” technique that allows proximal corporotomies.

Next: IPP and AUS placement: Two-incision approach

IPP and AUS placement: Two-incision approach

By LeRoy Jones, MD

In this video, we demonstrate the two-incision approach for simultaneous placement of the inflatable penile prosthesis and artificial urinary sphincter. The two-incision approach is a comparable alternative to the single upper-transverse scrotal incision approach.

IPP and AUS placement: Single-incision approach

By LeRoy Jones, MD

This video illustrates the single-incision approach for the simultaneous placement of the inflatable penile prosthesis and artificial urinary sphincter.

Dr. Brant: Dr. Jones’s videos demonstrate the difference in anatomic approach between a single penoscrotal and double perineal/penoscrotal incision technique. The single-incision technique has become less popular due to difficulties in placing the artificial sphincter cuff in an appropriately proximal location. The double incision allows for direct dissection over a variety of locations of the bulbar urethra; with proper retraction, the distal to mid bulbar urethra may be used with a single incision.

Next: Erectile dysfunction: Multiple treatment options

Erectile dysfunction: Multiple treatment options

By William O. Brant, MD

In this video, I present a thorough description of all the treatment options available for erectile dysfunction, including their administration, benefits, and limitations.

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