Pro tips for penile prosthesis surgery
Urological surgeons offer their best practices for managing the complexities of penile prosthesis surgery.
“Penile prostheses are underutilized,” said Hossein Sadeghi-Nejad, MD, FACS, director of men’s health and professor of surgery, obstetrics and gynecology at NYU Langone Grossman School of Medicine in New York City. There are many reasons, including patient stigma, lack of awareness, cost and accessibility, misconceptions and the general preference for less-invasive therapies, such as medication. “But surgeons also have their reasons for not performing the complex surgery, including lack of training and skills, the risk of complications, low patient demand and psychological factors,” Dr. Sadeghi-Nejad said. Don’t let these hold you back, he added.
In Sunday’s panel discussion, “Tips and Tricks of Penile Prosthesis Surgery,” Dr. Sadeghi-Nejad moderated a team of experts who addressed the challenges of penile prosthesis surgery.
Amy I. Guise, MD, associate professor of urology at the Medical College of Wisconsin in Milwaukee, discussed the safest options for patients following prior pelvic surgery for ectopic reservoir placement, which is a safe and effective alternative to traditional placement. “However, it’s important to be aware that patients may experience an increased risk of reservoir herniation,” Dr. Guise said.
Charles Welliver Jr., MD, associate professor of surgery and director of men’s health at Albany Medical College in New York, offered strategies for managing an infected implant, from removal to salvage surgery. “The body doesn’t like the infected prosthesis, but the salvage success for infected penile implants is high,” he said. Still, the signs of infection are not always evident. “If you find yourself in a gray area, trend toward salvage,” Dr. Welliver said.
Petar Bajic, MD, FACS, director of the Center for Men’s Health at the Glickman Urological Institute at the Cleveland Clinic, explored severe length loss following infected inflatable penile prosthesis removal and the benefit of a vacuum erectile device, also known as a penis pump or vacuum pump. “A VED helps to minimize the loss of size,” Dr. Bajic said. “Penile traction therapy should be something to also consider. It can offer a ‘smoke-and-mirrors’ effect that may help improve patient satisfaction.”
Steven K. Wilson, MD, FACS, FRCS, a urologist at the Institute for Urologic Excellence in La Quinta, California, discussed the management of corporal fibrosis and his tunnel technique for salvage penile prosthetic implantation. “It’s the most difficult surgery in prosthetic urology, even if you’re good at it,” Dr. Wilson said. “Don’t even think about tunneling unless you have special equipment. The most important thing to have in your operating room is a downsized cylinder.”
Jonathan Clavell, MD, FACS, a board-certified urologist with Clavell Urology in Houston, Texas, and adjunct assistant professor at the University of Texas McGovern Medical School, offered his expertise on rerouting procedures for impending erosion, using patient cases as examples. Dr. Clavell urged everyone to reach out to their network if stuck on a particular patient case. “Sometimes all we’ve got is each other’s experience to manage these complex cases,” he said.
