Our modified approach for infrapubic inflatable penile prosthesis implantation: step-by-step technique and intraoperative identification of the penile dorsal neurovascular bundle through indocyanine-green (ICG) enhanced imaging

Federico Deho’1, Nicolo’ Schifano1, Sara Baldini1, Antonio Aversa2, Paolo Capogrosso1, Gabriele Antonini1

Penile implant, infrapubic approach, neurovascular bundle, indocyanine green

Even though the infrapubic approach presents with shorter operative times, faster time-to-device-activation, optimal cosmesis and similar complication rates as compared to the penoscrotal approach, scarce adoption of this surgical access is due to a range of reasons including concerns regarding possible injury to the penile dorsal neurovascular bundle (NVB), perceived difficulties of scrotal pump placement, and suboptimal corporal exposure. This video covers step-by-step our modified approach for the minimally-invasive infrapubic technique for inflatable penile prosthesis placement (IPP), focussing on analysing in detail each of these concerns. A preliminary artificial erection facilitates an easier identification of the tunica albuginea of the corpora cavernosa and of the dorsal NVB which runs along the midline between the corpora. The medial stay sutures are placed toward the ischial tuberosity and laterally to the NVB, which is maintained undamaged on the centre of the corpora. Indocyanine-green (ICG) enhanced high-definition imaging using the IMAGE1 S Rubina® (KARL STORZ SE & Co., Tuttlingen, Germany) was adopted to enhance the viewers’ understanding regarding any possible intraoperative damage of the NVB, which is felt unlikely to happen when anatomical landmarks are identified properly and IPP is performed in expert hands.

None.

The authors have nothing to disclose

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