V07-10 Combining Lower Fat Pad Excision and Inflatable Penile Prosthesis Insertion Using Two Surgical Approaches

You have accessJournal of UrologySexual Dysfunction/Infertility/Andrology (V07)1 May 2024V07-10 COMBINING LOWER FAT PAD EXCISION AND INFLATABLE PENILE PROSTHESIS INSERTION USING TWO SURGICAL APPROACHES Omar Raheem, Marwan Alkassis, Paulo Vitor Barreto Guimarães, and Ervin Kocjancic Omar RaheemOmar Raheem , Marwan AlkassisMarwan Alkassis , Paulo Vitor Barreto GuimarãesPaulo Vitor Barreto Guimarães , and Ervin KocjancicErvin Kocjancic View All Author Informationhttps://doi.org/10.1097/01.JU.0001008932.49144.fd.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We present the case of 2 obese patients with erectile dysfunction. After failing medical treatment and injections, we decided to proceed with the insertion of an inflatable penile prosthesis combined with low fat pad excision, using 2 different approaches. METHODS: Both patients were placed in the frog-leg position. They were prepped and draped in usual fashion. An Ioban adhesive was applied and a 14Fr catheter was placed. Portion of the fat pad was marked and incised. The incision is deepened to the level of the underlying fascia of the rectus abdominis muscle. The lower edge of the incision is fixed onto the proximal portion of the rectus muscle fascia to obtain mons lift. The incision is then closed without any tension with multiple layers. A V-shaped penoscrotal incision is realized to remove the excessive webbed scrotal skin. After dissecting the dartos and the bucks fascia, the corporal bodies are identified and dissected. Stay sutures are placed bilaterally followed by corporotomies. The corporal bodies are dilated and measured. The reservoir is inserted in the retropubic space then the cylinders are inserted bilaterally in the corporal bodies. After ensuring the correct position of the cylinders inside the corporal bodies, the corporotomies are closed. The pump is inserted inside a scrotal pouch. The implant components are covered using a dartos layer flap then a surgical drain is inserted inside the scrotum. The deep layers and the skin are closed longitudinally to ensure the ventral scrotoplasty. When inserting the penile implant from the infrapubic incision, the dissection of the fat pad is directed distally toward the cavernous bodies. Careful dissection is carried out to clear the proximal corporal areas on each side and care is taken not to disturb the midline located neurovascular bundle. The rest of the surgery is as described above. A Prevena wound VAC is applied onto the suture line obtaining good sealing effect. RESULTS: Both patients were discharged on the following day with an antibiotic prescription after removing the foley and the drain when inserted. The wound VAC was removed 1 week later. The patient were seen 2 weeks later with no complications reported and excellent mechanical and aesthetic results. CONCLUSIONS: Simultaneous fat pad excision and insertion of an inflatable penile prosthesis is a safe procedure and feasible with 2 approaches. In this step-by-step surgical video, we aim to provide high quality virtual and technique guide to both urology trainees or practicing urologists. This technique provides excellent functional and aesthetic results. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e470 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Omar Raheem More articles by this author Marwan Alkassis More articles by this author Paulo Vitor Barreto Guimarães More articles by this author Ervin Kocjancic More articles by this author Expand All Advertisement PDF downloadLoading ...