Cavernosal Banding - A New Procedure to Address Significant Weakening of Albuginea in Complex Penile Prosthesis Surgery: A Proof-Of-Concept Case With a Follow-up of 2 Years

Edoardo S Pescatori, Andrea Loreto

Penile implant, albuginea, extrusion, bovine pericardium, complicatio

This video present an original technique to address weakening of albuginea in a patient with inflatable penile prosthesis.

In this case A 52 y.o. white male with four former implant surgeries (penoscrotal) presented with an atypical device malfunction: upon activation no erection developed, while the scrotum enlarged. MRI disclosed bilateral cylinders herniation at the site of former corporotomies.

Surgical procedure through penoscrotal approach: in the herniation area there was bilaterally a wide albuginea defect. 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 defect. 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 bovine pericardium was fashioned. CAVERNOSAL BANDING was achieved transferring the fashioned rectangle patch 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. Patient had to daily cycle the device for three months, not exceeding the tumescence status, to allow a sound remodeling process of the graft. At 2 years from surgery patient is having regular sexual intercourse without any clinical evidence of bulging, with high satisfaction, according to the QoLSPP questionnaire.

The outcomes of this first case suggest that CAVERNOSAL BANDING with bovine pericardium is a working solution for challenging cases of albuginea weakening/loss in patients with penile prosthesis.

Boston Scientifics supported the costs of professional drawings.

The authors have nothing to disclose

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