The Double Chop Incision An Easy Open and Close Penoscrotal Access for Penile Prosthesis Implantation

Ragheb, A

The Double Chop Incision An Easy Open and Close Penoscrotal Access for Penile Prosthesis Implantation (2)

The "Double Chop Incision" is a two-step refinement of the classic transverse penoscrotal incision designed to simplify and enhance penile prosthesis implantation (PPI) procedures. This technique facilitates neat and instant exposure of both corporal bodies with minimal tissue manipulation and ensures anatomical closure of scrotal wall layers. The method involves the assistant pulling the scrotal skin at the median raphe with two Allis forceps, while the surgeon’s non-dominant hand pinches the skin directly above the urethra to serve as a manual urethral shield. Using cutting current, the first incision (1st chop) is made through the scrotal skin, stopping at the urethral shield. The urethra is then retracted out of the incision while superficial layers are scraped off, and deep tissue layers are lifted with the two Allis forceps. The second incision (2nd chop), guided by the manual urethral shield, exposes the bluish urethral wall and both corporal bodies with minimal dissection. Closure involves suturing the Dartos muscle layer in the midline, forming and closing lateral windows with single sutures, and finishing with continuous skin closure using a 4/0 Monocryl suture. This technique was effective in all cases, providing rapid access, minimal tissue disruption, and anatomical closure, ultimately refining PPI procedures and reducing operative time. A comparative study with the conventional transverse penoscrotal incision on a larger patient cohort is warranted to further validate these findings.

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