Pescatori Dr. Edoardo, Loreto Dr. Andrea, Dell'Orco Davide

(101) CAVERNOSAL BANDING: A NEW PROCEDURE TO ADDRESSSIGNIFICANT WEAKENING/LOSS OF ALBUGINEA, PARTICULARLY FOLLOWING REITERATED PENILE PROSTHESIS SURGERIES

  • Urology
  • Reproductive Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Psychiatry and Mental health
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Abstract Objectives We present an original technique to address loss and/or weakening of albuginea in patients with inflatable penile prostheses. Methods A 52 y.o. white male with four former implant surgeries (penoscrotal) reported that upon activation no erection developed, while the scrotum enlarged. MRI disclosed bilateral cylinders extrusion at the site of former corporotomies. Surgical procedure. Penoscrotal approach: in the extrusion area there was bilaterally a wide loss of albuginea. In the involved area we circumferentially isolated the albuginea dorsally from Buck’s fascia, inclusive of the neurovascular bundle, and ventrally from urethra. We developed some tissue planes to cover the albuginea loss. The old device was removed and replaced with a new AMS 700CX. We measured: circumference of isolated corpora in tumescence state (12 cm), and distance between the limits of the two isolated circumferences -proximal and distal- (5 cm). A 12x5 cm rectangle of Tutopatch® was fashioned. CAVERNOSAL BANDING was achieved transferring the fashioned Tutopatch® rectangle around the isolated albuginea of the two corpora cavernosa. The two short sides were sutured together and to the ventral albuginea, beneath the urethra, and anchoring stitches fixed the patch to the albuginea, to keep it flat (figure). Patient had to daily cycle the device for three months, not exceeding the tumescence status, to allow a sound remodelling process of the graft. Results At 3 months control MRI: normal appearance of the inflated cylinders, without bulging. At 5 months from surgery patient is having regular sexual intercourse without any clinical evidence of bulging, with high satisfaction: IIEF score at 1 month= 24; QoLSPP scores: 25 - functional domain, 15 - social domain, 19 - relational domain, 18 - personal domain. Conclusions Cavernosal banding with bovine pericardium appears to be a working solution for challenging cases of albuginea loss in patients with penile prosthesis. Conflicts of Interest None

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