Simultaneous Suprapubic Lipectomy and Penile Prosthesis Implantation

Abstract

Introduction A shorter penis is a frequent complaint following penile prosthesis implantation (PPI), and a large redundant suprapubic fat pad can conceal the penis and possibly compromise patient and partner satisfaction with length. Aim To evaluate feasibility and outcome of same-session, same-incision, PPI and suprapubic lipectomy (SPL). Methods In 22 patients, SPL was performed through an abdominal crease incision. Through the same incision, the superficial perineal pouch was opened to gain access to the base of the penis. Penile prosthesis was implanted (semirigid in 16 patients and girth-expanding 3-piece inflatable in 6). Scarpa’s fascia, subcutaneous fat, and the abdominal crease skin incision were closed. Main Outcome Measure Evaluation was in terms of implant survival, preoperative vs postoperative patient and partner satisfaction with penile length on a 5-point rating scale, subjective opinion over penile length postoperatively, compared with recall of erect length before erectile dysfunction (ED) had set in (longer, same, or shorter), and penile length with the implant rigid, compared in the supine and standing positions postoperatively (pubic skin to tip, using a rigid ruler). Results No infections or extrusions or mechanical failures were encountered. There was a 53.3% increase in patient satisfaction with length comparing preoperative (2.55 ± 0.67) to postoperative (4.77 ± 0.43) ratings, P < .0001. Partner satisfaction showed a 40.2% increase, from 1.77 ± 0.61 to 4.41 ± 0.50, P < .0001. 19 of 22 patients reported that postoperative length was longer than their recall of erect length before ED had set in, and 3 patients reported that length was the same. With the implant rigid, there was no statistically significant difference in visible length between the supine and standing positions (14.1 cm ± 2.3 and 13.9 cm ± 2.3, respectively, P = .38). Clinical Implications Patients with refractory ED and a concealed penis can be counseled as to the option of simultaneous SPL and PPI (SPL-PPI), a modification that may help avoid patient and partner dissatisfaction with length. Strength & Limitations Strengths include objective evaluation of the efficacy of the procedure by comparing supine and standing penile length. Limitations of the current study include inability to evaluate erect length preoperatively owing to refractory ED, and subjectivity of patient and partner opinion. Conclusion Same-incision SPL-PPI appears to be a safe and effective procedure, with high patient and partner satisfaction rates.

Management of the anatomically complex penile implant candidate through an infrapubic incision: a review of surgical techniques and benefits

“…In those patients, we have become increasingly adept at removing this fat and exposing more penis at the time of penile prosthesis surgery. As others have noted, this can all be achieved through a single incision when the penile implant is placed through the dorsum rather than two incisions if the device were placed through a penoscrotal incision ( 25 , 26 ). In this surgery, a large elliptical shaped area of dystrophic suprapubic fat is removed and the resulting defect is then closed in multiple layers to create a single transverse incision as shown in a video and initial series that was recently published ( 27 ).…”

Penile shortening complaints in males with erectile dysfunction: a narrative review on penile lengthening procedures during penile prosthesis surgery

“…Lately, Hakky et al reported a technique that included panniculectomy with suction-assisted lipectomy and anchoring of herniated pubic skin to the abdominal wall (31). Most recently, two studies; Shaeer et al and Shah et al described the technique of the suprapubic lipectomy that can be utilized simultaneously with PP surgery with good postoperative outcomes (Figure 3G,H,I) (32,33).…”