Method of Use

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Methods:
The cavernotomes were used in nineteen patients with corporeal fibrosis. The etiology of the fibrosis was removal of previously infected prosthesis (15), extensive fibrosis from recurrent priapism secondary to sickle cell disease (2), pharmacologic injection program and subsequent Winter shunts (2). One of the patients whose prosthesis was removed for infection also had a tip erosion on the contralateral side necessitating the creation of a subcapsular space for the insertion of a new cylinder.

Surgical Technique:
After a small corporotomy is created, the cavernotomes are introduced and moved in an oscillating motion resulting in forward advancement. If more resection is needed, rotation of the cavernotomes will create a “shaving” action which removes 1 mm strips of fibrotic tissue.

  • Cutting can be done both in a longitudinal, up and down, movement, or in a “drilling” rotational movement.
  • The largest size (13 mm) corresponds to standard cylinder diameter. Dilation to 10 mm is necessary for insertion of the Furlow tool or the Mentor NB cylinder base. Dilation to 11 mm is necessary for the insertion of the AMS CXM base.
  • Internal cutting of the fibrosis obviates extensive corporotomies and results in quicker procedures.
  • The cavernotome’s design and oscillating advancement promote safe dilation without perforation.

Case Study

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Cavernotome being used to dilate fibrotic corpora


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All uses of the cavernotomes resulted in successful implantation of inflatable cylinders or semimalleable rods without urethral injury or corporal perforation.

  • Fifteen of the patients received downsized prosthesis (13 Alpha NB, 2 AMS 700 CXM).
  • Of the remaining four patients, three patients were implanted with Mentor Alpha 1 standard size cylinders, and 1 patient was implanted with an AMS semimalleable prosthesis.
  • Graft material was not required and only two patients required additional distal penile incisions for optimum cylinder tip placement.
  • Average operative time was 51 minutes (39-86 minutes range).

References

Bruce B. Garber, Caitlin Lim.  “Inflatable Penile Prosthesis Insertion in Men with Severe Intracorporal Fibrosis.” Current Urology  (2017)  10:92–96.

Michael Mooreville, Sorin Adrian, John R. Delk, and Steven K. Wilson.  “Implantation of Inflatable Penile Prosthesis in Patients with Severe Corporeal Fibrosis: Introduction of a New Penile Cavernotome.”  The Journal of Urology 162 (1999).

Steve K. Wilson. “Reimplantation of inflatable penile prosthesis into scarred corporeal bodies”. International Journal of Impotence Research (2003) 15, Suppl 5, S125-S128.