Shaeer, O, Shaeer, K.M., Shaeer, K

Shaeer’s Cavernotome, priapism, scarred corporal bodies, fibrosis, inflatable penile implant, cavernotomy

Implantation of a penile prosthesis in cases of corporeal fibrosis is a challenging procedure. Scarred corpora cavernosa can result from refractory ischemic priapism, or explantation of an infected penile implant. Cavernotomes aid excavation of fibrous tissue in scarred corporal bodies. However, in many cases, the track established -with risk and difficulty- barely suffices for a narrow base inflatable or girth-9 malleable rods. The patient may have this exchanged with a full-size implant after several months, in another surgery.

Shaeer’s Cavernotome differs from prior cavernotomes in that it cores out and grinds fibrous tissue in gentle rotatory movements rather than forceful forward thrusting. The process is therefore safer, and with lower risk of perforation. By choosing the maximum size of Shaeer’s cavernotome (6-13 Hegar), a track wide enough for full-size cylinder – rather than down-sized cylinders - can be established in one pass. In this video, we demonstrate coring the scarred crura using Shaeer’s Cavernotome in a case of 5-month priapism. We were able to dilate the scarred crura up to 13.5 Hegar. We implanted a full-size three-piece Rigicon Infla10 AX. Total operative time was approximately 60 minutes.

Points of experience include: Sharp excavation of a core of fibrous tissue under the corporotomies to lodge-in the Sheer’s Cavernotome. Choosing the maximum size of Shaeer’s Cavernotome according to what fits into the cored space. Keeping the corpora/crura always stretched. Advancing with gentle rotatory movement rather than forceful thrusting. Looking out for crossing-over by keeping advancement lateral -though short of lateral perforation. Monitoring advancement within the center with the index and thumb fingers of the non-dominant hand. Adopting the “Bouncing Test” to stop excavation short of the pubic bone. Having the tubing exit straight out of the corporotomies, using sufficient length of rear-tip extenders, and a proximal corporotomy.