Peyronie’s Disease Specialist in NYC

An Expert in Penile Reconstruction for Peyronie’s Disease

Novel infrapubic incision and long-acting local anesthesia for pain management with inflatable penile prosthesis implantation

Robert Valenzuela, MD
Assistant Clinical Attending Professor of Urology
Columbia University Medical Center – NY Presbyterian Hospital
New York, NY, USA.

Introduction

Although an infrapubic (IP) surgical approach for placement of a 3-piece inflatable penile prosthesis has an advantage over the penoscrotal approach for reservoir visualization, it has been less favored due to limited corporeal exposure and fear of injury to the neurovascular bundle.

What Methods are Used?

Surgical technique advances employed for 3-piece prosthesis placement include the use of a long acting local surgical block (bupivacaine) for post-operative pain management, hydrodistention of the infrapubic space to facilitate corporeal body and penile neurovascular bundle identification and dilatation, a low curvilinear (vs. transverse or longitudinal) infrapubic incision, creation of a prevesical space pocket prior to corporeal dilation, and limited use of electrocautery to minimize devitalized tissue.

What are the Results?

The low curved incision provides increased lateral exposure, clear neurovascular bundle visualization and good access for placement of all prosthesis components. In 60 patients implanted during the past 12 months, this surgical approach along with bupivacaine block has resulted in significant reduction in post-operative edema and pain, with no neurovascular bundle complications. Patients have required less narcotics in the recovery room and after discharge. Use of prescribed oxycodone/acetaminophen has been reduced from over 40 pills to approximately 20 in the first week after surgery. Reduced pain allows for earlier device activation, cycling compliance and higher patient satisfaction.

Conclusion

A low curvilinear infrapubic incision can be executed, along with bupivicaine infiltration, to allow for easier corporeal identification and implantation of the penile prosthesis with reduced post-surgical edema and pain, allowing for earlier functioning and improved patient outcomes.