Subcoronal IPP with modified Wilson's Deaver maneuver - Sean, Sung Hun, Park, MD
In this video, Dr. Park demonstrates IPP surgery through a subcoronal approach under local anesthesia with length preservation. The video outlines a stepwise approach to minimizing patient discomfort and surgical complications.
Dr. Valenzuela:In this video, Dr. Park demonstrates his subcoronal IPP under local anesthesia. I had the opportunity to assist Dr. Park in one of these cases. He also demonstrates the injection into the inguinal canal and above the transversalis fascia. The procedure is well tolerated. The use of intra-corpora Trimix with local anesthetic facilitates ventral proximal dissection to the level of the ischio-cavernosum. I typically use papaverine, 60 mg, with 3 cc of ropivacaine 0.5%. This helps with postoperative pain and also allows for placement of the retaining sutures for the corporotomy as proximal as possible. Once this is achieved, the remainder of the procedure is similar to a scrotal approach, including dropping the scrotal septum in order to facilitate pump placement.
Dr. Park is very meticulous and deliberate in his closure. By closing the dartos and the skin separately, he adds an extra layer of protection to the surgical site. As you can imagine, it is very challenging to perform this procedure under local anesthesia, yet Dr. Park is very experienced and makes it look easy.
Dr. Hotaling: Dr. Park’s skill with local and regional blocks is impressive. Once these blocks are achieved, he is able to proceed with an anatomic and efficient placement of an IPP in standard fashion. This video illustrates how the procedure can be done without the need for general anesthesia or even a spinal. This could be a significant benefit for patients whose inability to tolerate a general or spinal anesthesia prevent them from undergoing surgery for an IPP.We typically use 30 cc of 1% lidocaine to induce an artificial erection at the beginning of the case, which enables us to assess for penile curvature while providing significant postoperative pain control.
Dr. Park is clinical associate professor of urology, Ajou University, School of Medicine, Suwon, Korea.
'Y'tube Section Editor James M. Hotaling, MD, MS, is assistant professor of surgery (urology) at the Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City.