Here is my post surgery notes. I decide in the last minute to go with
penile implant as well in addition to incision and grafting.
ROCEDURE PERFORMED:
1- Injection of the penis with vasoactive agent
2- incision and grafting to correct curvature 6 cm x 6 cm tutoplast graft
3- placement of Inflatable penile
prosthesis placement. AMS 700 CX with inhibizone 18 cm +3cm Right, 2 cm Left, 100 ml conceal reservoir
PRIMARY ATTENDING: Bahaa Malaeb, MD
ASSISTING: Yooni Yi, MD
RESIDENT: Roberto Navarette, MD
INDICATIONS FOR PROCEDURE:patient is a 52 year old male patient with severe peyronie's disease and
erectile dysfunction who was evaluated with penile doppler and offered various treatments and elected to proceed with penile incision and grafting in combination with
penile implant. We discussed the surgery and potential complications including infection, scarring, loss of length and recurrent or residual curvature.
DETAILS OF THE PROCEDURE: The patient was met in preoperative holding. History and physical, and consent were confirmed. He was taken to the operating room, placed supine, and underwent induction of general anesthesia. He was placed in the frogleg position and his genitalia and abdomen were shaved, prepped, and draped sterilely.
A preoperative timeout was performed and preoperative antibiotics of gentamicin, vancomycin, and fluconazole were administered.
The procedure was started with injection of 60 mg of papaverine. The patient had a 60% erection.
We started with a
ventral midline horizontal incision and taken that down to the level of the urethra. We then dissected laterally and bucks fascia was lifted off of the corpora just lateral to the urethra.
When the neurovascular bundle was completely mobilized, we were able to identify the full extent of the peyronies. We incised the corpora in a double Y horizontal fashion and trimmed the corners. We then measured the defect around 6 x 6 in its longest dimension. We then used a 6x6 cm tutoplast and sutured it to the defect after fashioning it into a butterfly shape with 5-0 pds.
We ensured hemostasis with bipolar cautery.
Bucks fascia was then closed with running 5-0 pds
We changed the superficial drape and placed a Foley catheter sterilely on the field and cleaned the Foley catheter with Betadine. A Lone Star self-retaining retractor was placed. We then extended our vertical midline incision to the penoscrotal area.The corpora were cleared off bilaterally to prepare for space for the corporotomies. The midline septum was dissected off the urethra in the midline. The scrotal fat was then entered bluntly and a space was developed at the posterior inferior aspect of the scrotum for placement of the
prosthesis pump below the skin and dartos layers. We then made a 3 centimeter corporotomy on each corporal body as proximal as possible. We then performed serial dilation of the corporal bodies using Brooks dilators bilaterally up to a 13 mm, both proximally and distally. There was no evidence of a crossover or perforation. During dilation, there was no apparent injury to the urethra. The measurements of the corpora was 20 cm on the left and 21 cm on the right. The discrepancy was strictly proximal. We preplaced 2-0 Vicryl stitches to close the corporotomies.
We then sterilely prepared an 18 centimeter AMS 700 CX with inhibizone device with 2 and 3 centimeter rear tip extenders on the left and right, respectively. We then accessed the retropubic space through the penoscrotal incision in order for placement of the reservoir behind the pubic bone by elevating the external ring of the inguinal canal. Space was entered without difficulty and the reservoir was placed retropubically. We then filled the reservoir with 95
cc of saline and confirmed that it did not come out of appropriate positioning. We then placed the penile
prosthesis in the predilated corporotomies. There was good fit of the device in the corpora. We then closed the preplaced sutures over the inflatable cylinders. We then used a straight quick connector to connect the pump to the reservoir to complete the circuit and maintain a vacuum seal. We then tested the inflatable erection and noted that the patient had good cosmetic and functional result with good rigidity and appropriate positioning in the glans without evidence of any perforation. There was no significant curvature. The
prosthesis was then partially deflated and the pump was placed in the inferior posterior aspect of the scrotum under the skin and dartos in the most dependent spot. At that point, we irrigated copiously and confirmed hemostasis from the corporotomies, which was excellent. There was no other notable bleeding in the surgical bed. We then closed the subcutaneous tissue over the tubing with a running 4-0 Vicryl stitch and then we closed the dartos with a running 4-0 Vicryl stitch and closed the skin with a running 4-0 Vicryl horizontal mattress stitch and covered the incision with skin glue. The cylinder passing strings from the device were removed from the glans, and Dermabond was applied over the needle poke sites on the glans for hemostasis. The patient was cleaned and a Kerlix was wrapped around the penis and scrotum for a hemostatic compression dressing. A jockstrap, and a Foley catheter strap were applied and the Foley catheter was placed to drainage. The patient was awoken from anesthesia and taken to recovery in stable condition. He tolerated the procedure without apparent complication.
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Topic: Incision and grafting surgery Scheduled on 10/19/21 (Read 520 times)
May 13, 2011, 02:16:59 AM