(596) Inflatable Penil Prosthesis Implantation in Low Lithotomy Position

Abstract Introduction Erectile dysfunction (ED) is a common condition that significantly affects patients’ quality of life, particularly when refractory to medical therapy. Penile prosthesis implantation remains the gold-standard surgical treatment for patients who do not respond to pharmacological or less invasive options. Proper patient positioning plays a crucial role in ensuring optimal surgical exposure, minimizing complications, and improving operative ergonomics. The low lithotomy position offers several advantages during penile prosthesis implantation, including improved access to the perineal and scrotal regions, better visualization, and enhanced comfort for the surgical team. In this presentation, we demonstrate the penile prosthesis implantation technique performed in the low lithotomy position, emphasizing key anatomical considerations, surgical steps, and technical nuances that contribute to procedural safety and efficiency. Objective The aim of this presentation is to demonstrate the surgical steps and technical considerations of penile prosthesis implantation performed in the low lithotomy position. We seek to highlight the advantages of this positioning technique in terms of surgical exposure, ergonomics, and patient safety, and to provide a standardized approach that may improve procedural outcomes and reduce complications. Methods A three-piece inflatable penile prosthesis implantation was performed using the low lithotomy position. Following sterile preparation and draping, a penoscrotal raphe incision was made to access the corpora cavernosa. Blunt and sharp dissections were carried out to expose the anatomical layers, and stay sutures were placed bilaterally. After corporal dilation with Hegar dilators, the appropriate prosthesis size was measured using a Furlow inserter. The reservoir was positioned in the right Retzius space through blunt dissection, and the pump was placed in a dartos pouch within the scrotum. All components were connected, the system was tested, and the layers were closed anatomically. Throughout the procedure, the operative field was irrigated repeatedly with an antibiotic solution containing rifampicin and gentamicin to minimize infection risk. Results The procedure was completed successfully without any intraoperative complications. The low lithotomy position provided excellent surgical exposure of the perineal and scrotal regions, allowing safe and efficient access to the corpora cavernosa, reservoir pocket, and pump placement site. This positioning improved the surgeon’s ergonomics and facilitated hemostasis through stable operative control. Postoperatively, the prosthesis functioned properly, and no device-related or positioning-related complications were observed. Conclusions The low lithotomy position provides excellent exposure and ergonomic advantages during penile prosthesis implantation. It allows safe access to all components of the procedure - including corporal exposure, reservoir placement, and pump positioning - while minimizing the risk of complications. This standardized approach enhances surgical precision, reduces operative difficulty, and may contribute to improved functional and aesthetic outcomes for patients. Disclosure No