Patients with a penile implant infection can develop dense scar tissue in the corporal bodies, making prosthesis reimplantation extremely challenging even for the most experienced urologic surgeons. Without immediate reimplantation, patients typically lose two to four inches of penile length and the corporal bodies become fibrotic—often shrinking to the diameter of a pencil.
Urologists at the Duke Urology Men’s Health Center have developed an innovative surgical technique for prosthesis reimplantation for patients with corporal fibrosis.
“The preferred way to treat an infection is to remove the infected device and perform a thorough washout, then try to salvage the space by putting an implant back in,” says urologist Aaron C. Lentz, MD. “Unfortunately, that’s only done about 17% of the time because of the non-elective nature of these cases and surgeon inexperience with salvage techniques. Subsequently, these patients will develop severe corporal fibrosis and they often come to Duke for a chance of implant replacement.”
Historically, says Lentz, there were three primary ways of managing corporal fibrosis:
- Don’t attempt reimplantation, subjecting the patient to life without erectile function.
- Perform corporal excavation, a lengthy surgery with multiple incisions and a high infection rate.
- Perform corporal drilling, in which space is created through the corporal scar tissue using specialized cavernotomes and dilators which can cause urethral injury.
Duke’s reimplantation technique involves a staged approach, first making a small perineal incision and invaginating the penis through the incision—completely exposing the corpora from tip to base and enabling corporal excavation in a controlled setting. After scar tissue is removed, surgeons implant a rigid, noninflatable rod to keep the space open, then exchange the rod for an inflatable device in approximately six to 12 months.
“It’s a combination of techniques used in urethral reconstruction and complex penile implant revision surgery,” Lentz explains. “The procedure doesn’t restore lost penile length, but with enough length left over we can give patients a usable erection, which we’ve been able to do in every one of our patients so far.”
Lentz says the Duke Urology Men’s Health Center started as a way to empower men to take control of their own health. “Sexual dysfunction and conditions like Peyronie’s disease are very strongly linked to heart disease, hyperlipidemia, and diabetes. Low testosterone and voiding dysfunction can be related to sleep apnea and obesity. A man’s sexual health is a direct reflection of his overall health, and if he’s struggling in that area there are probably other issues as well.”
To view a video of Lentz and colleagues performing corporal excavation and penile prosthesis placement for corporal fibrosis, visit http://www.asvide.com/watch/32899