Maximizing Three Piece Penile Prosthesis Length: Our Technique and Outcomes

Abstract

Abstract Three-piece inflatable penile prosthesis (IPP) is considered the gold standard surgical treatment for erectile dysfunction (ED). The most common cause of patient regret after penile prosthesis surgery is penile shortening. We sought to query a national database on average prosthesis length and describe our techniques to maximize cylinder sizes. We performed a retrospective review of the Coloplast database of 3-piece penile prosthesis cases performed over the span of 1 year nationally and by a single high volume surgeon and compared average cylinder lengths. Our review did not investigate whether adjunct tunical lengthening or girth enhancing procedures were performed. Between July 1, 2021 and June 27, 2022, 145 three piece penile prosthesis surgeries were performed at our institution. All were performed via a scrotal incision. Nationally, 32.8% were performed infrapubic while 58.1% were performed scrotal. The most prevalent cylinder length in our series was 22cm, compared to the most prevalent nationally of 20cm. Our technique to maximize cylinder length involves circumferential mobilization of the corporal bodies and corporal tissue sparing. Corporal tissue sparing is carried out by employing 9” Metzenbaum scissors rather than sequential dilators for corporal tunneling. The benefit of this approach is the ability to create a dorsal compartment to the level of the triangular ligament of the glans, thereby extending the space to the level of the midglans. This maneuver minimizes placement of the prosthesis anteriorly at the level of the fossa navicularis and prevents floppy glans that would otherwise compromise maximum cylinder length. Three piece penile prosthesis cylinder size can be maximized by circumferential mobilization of the corporal bodies, corporal sparing maneuvers, and the utilization of long Metzenbaum scissors for precise corporal tunneling.