Streamlined Approach for Infrapubic Placement of an Inflatable Penile Prosthesis

The streamlined approach for infrapubic placement of an inflatable penile prosthesis is a variation of the traditional infrapubic approach. A better understanding of operative techniques and recent clinical outcome studies have led to an evolution of the original infrapubic approach. Small incisions and efficient operative maneuvers can shorten operative times and expedite postoperative recovery. 1. Introduction The penile prosthesis is the gold standard of treatment for men with erectile dysfunction (ED) refractory to more conservative therapy [1]. Placement of the inflatable penile prosthesis (IPP) has been reported from several different approaches including penoscrotal, infrapubic, suprapubic, and perineal locations [2–4]. Each approach has its own unique advantages and disadvantages and it is ideal that any surgeon performing penile prosthetic surgery has some familiarity with at least a few of the approaches. Oftentimes, unique patient anatomy or previous surgery can make one approach more difficult, or easier, over another. The penoscrotal (PS) technique is currently the most popular approach with approximately 80% of IPPs placed in this manner based on manufacturer data [5]. Historically, the suprapubic approach was the initial approach for IPP placement [2]. Large incisions were required to bury the tubing under the fascia to prevent kinking and malfunction. The development of kink-resistant tubing was one of the major advancements for IPP surgery allowing for smaller incisions and more options for surgical incision sites. The infrapubic approach (IP) was a natural transition to a less invasive approach utilizing the same principles and orientation of the suprapubic approach. The penoscrotal approach was developed shortly thereafter. It offered the advantages of close proximity to the corpora, visualization for placement, and fixation of the pump in the scrotum and less concern for damaging the penile neurovascular bundle. However, the PS approach made reservoir placement more difficult raising the potential risk of reservoir herniation postoperatively [6]. The streamlined approach for infrapubic placement of a penile prosthesis is a variation of the traditional IP approach. This approach utilizes smaller incisions and corporotomies, minimizes corporal dilation and decreases tissue dissection allowing for shorter operative times and early return to sexual function. 2. Technique 2.1. Patient Preparation The patient is laid supine on the operating table with the table flexed. The bladder is catheterized and the catheter is removed. The patient is