Shaeer’s Corporopexy for Divarication of the Corporal Bodies

O. Shaeer

penile implant; penile prosthesis; corporopexy; divarication of the corpora; instability; rotation; hypermobility

Over several decades of practice in penile prosthesis surgery, we have seen several patients complaining of hypermobility of the malleable penile implant, where it rotates around the longitudinal axis in a relatively wide range. We have mostly dismissed this complaint, after excluding mechanical fractures 1, oversizing length-wise, under-sizing length and girth-wise, extrusions and crossing-over. Yet some patients were still dissatisfied despite reassurance.

This video demonstrates a case where we detected this condition intra-operative and successfully addressed it in the same session; by corporopexy. It also demonstrates a gap between the corpora cavernosa indicating poor coherence, what we termed “divarication of the corporal bodies”.

Through a median raphe incision, dilatation was performed up to 13.5 Hegars, followed by sizing and implantation of girth 13 malleable rods. Tips of the cylinders were well-seated in the glans with no over-sizing or under-sizing. Implantation was anatomically correct with no crossing over. The edges of the corporotomies could be approximated with neither tension nor overlap, indicating adequate girth of the rods. We observed that the rods were hypermobile, rotating over one another along the longitudinal axis. We applied four methods to correct this condition.

The first method was anchoring the rods to the midline septum through the corporotomies, with non-absorbable sutures (2/0 Polyester). The second method was “Dorsal Corporopexy”, accessing the dorsum of the penis by retracting the same skin incision, exposing the deep dorsal vein, and anchoring the two corpora cavernosa together with 2/0 Polyester on either sides of the vein. The third method was “Ventral Corporopexy”: The spongiosum was retracted laterally, exposing the two corpora cavernosa and the midline. Retraction of the spongiosum was quite easy, due to a longer-than-usual mesorchium, further asserting our concept of divarication. The two corpora cavernosa were anchored together with Polyester sutures across the midline. For the fourth method, the corpora cavernosa were tightened around the cylinders, by closing the corporotomies with wider suture bites. The collective result of all four techniques was a more stable penis, with no post-operative complications.

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Pedersen B, Mieza M, Melman A. Instability and rotation of silver silicone penile prosthesis. Urology. 1988;31: 116-8.