Corporoscopic Excavation of the Fibrosed Corpora Cavernosa for Penile Prosethesis Implantation: Optical Corporotomy and Trans-Corporeal Resection, Shaeer’s Technique

Abstract

Introduction Implantation of a penile prosthesis in cases of neglected or resistant ischemic priapism, or delayed re-implantation following prosthesis infection and extraction, is usually a difficult and risky procedure due to fibrosis of the corpora cavernosa. Among the common complications are perforation of the urethra, tunica albuginea, and infection. The complications are usually due to the use of blind force against resistance. Aim We propose the techniques of Trans-Corporeal Resection and Optical Corporotomy as adjuvant measures for excavating the fibrosed corpora cavernosa under vision, without the use of force against resistance. Methods Six patients with diffuse fibrosis of the corpora cavernosa were operated on. The instruments and technique are the same as for optical urethrotomy and transurethral resection. Optical Corporotomy was started with, where the corpora are incised from within. After establishment of a satisfactory passage, Trans-Corporeal Resection followed to scrape the fibrous tissue. Implantation of penile prosthesis was completed as usual. The procedure was performed through 1.5 cm incision in the tunica albuginea. Main Outcome Measures Length, girth, and straightness in the erect position, as well as the incidence of complications. Results Operative time was an average of 90 minutes. No difficulty was encountered during the procedure. No complications were noted through 1 year of follow-up. Conclusion Optical Corporotomy and Trans-Corporeal Resection allow for force-free, visually monitored excavation of the fibrosed corpora cavernosa, aiming at safer penile prosthesis implantation.

Use of a microdebrider for corporeal excavation and penile prosthesis implantation in men with severely fibrosed corpora cavernosa: a new minimal invasive surgical technique

“…[10,11] The main limitations of these techniques include blind instrumentation without tactile feedback and extensive manipulation, which potentially causes a prolonged operative time and an increase in urethral injury, perforation, and postoperative infection rates. In 2007, Shaeer [12] described optical corporotomy and trans-corporeal resection for the visually guided excavation of the fibrosed corpora cavernosa. The technique described by Shaeer et al [12] promised a force free and relatively safer penile prosthesis implantation.…”

“…In 2007, Shaeer [12] described optical corporotomy and trans-corporeal resection for the visually guided excavation of the fibrosed corpora cavernosa. The technique described by Shaeer et al [12] promised a force free and relatively safer penile prosthesis implantation.…”

“…In addition, all extended corporotomy techniques require blind dissection, resulting in an increased risk of perforation because none of these procedures can reach deep down to the fibrous crural tissue. [12] In 2007, Shaeer et al [12] introduced a new technique. In this technique, the same instruments and techniques were used as for endoscopic urethrotomy and transurethral resection.…”

“…[9,12,21,22] Therefore, we think that the ideal surgical technique that can be used in patients with severe corporeal fibrosis to excavate the fibrosed corpora cavernosa for penile prosthesis implantation should be safe, easy, fast, and effective. To the best of our knowledge, the recent study represents the first reported use of a microdebrider in patients with severe corporeal fibrosis to excavate the corpora for penile prosthesis implantation.…”

“…Moreover, the blades can be easily introduced into corpora because it is nearly half in diameter (4 mm) of the resectoscope that has been used in Shaeer's technique. [12] The lack of the need to provide electrical energy for resection may avoid possible peripheral tissue damage. The main advantage of the microdebrider is its ability to continuously suck away blood and tissue fragments, thus proving to be a relatively easier and more expeditious procedure.…”