Penoscrotal or Infrapubic? What is better for a penile implant placement?
Penoscrotal or Infrapubic? What is better for a penile implant placement?
I often get questions from patients who interested in a penile implant about the type and size of incision used. They may have seen videos of the surgical procedure online and indeed they are very different. The most common approaches are penoscrotal (between the junction of the penis and scrotum), infrapubic (right above the penis), or subcoronal (circular incision typically like a circumcision. There are certainly advantages and disadvantages to each approach. But the optimal approach depends on your individual factors. That is why I think it is extremely important to have a surgeon who is comfortable with and utilizes more than one technique.
Cosmetic Appearance – I believe that the penoscrotal and subcoronal approach provide the best cosmetic outcome. This is because the surgical scar typically hides within the natural line which divides the scrotum or your circumcision scar. The infrapubic approach can leave a subtle scar.
Adjunct procedures – Many men may benefit from an adjunct procedure at the time of their implant to improve the overall outcome or satisfaction. Some of the most common procedures that I perform at the time of implant surgery include scrotoplasty for scrotal webbing or penile tethering, suprapubic lipectomy to remove a large mons pannus or “FUPA”, or circumcision. If trying to combine one or more of these procedure, a certain approach for the implant placement might make more sense to decrease the number and size of incisions and possible complications.
Pump Placement – The pump is the most important part of the implant for our patients primarily because it’s component that you interact with the most in order to use the implant. Therefore, perfect pump placement at the time of surgery is key. Although this can be reliably accomplished with any surgical approach (penoscrotal, infrapubic, subcoronal), I’ve seen the most pump related issues after infrapubic placement by other surgeons. The pump can become high-riding and scar into a location which is difficult to use. Additionally, this can lead to excessive tubing on the side of the penis. Both can be uncomfortable for the patient and their partner and have a poor cosmetic result. This is one advantage to the penoscrotal approach where I am able to secure the pump using an internal absorbable suture.
Reservoir Placement – Placement of the reservoir can be challenging in men with a complicated surgical history (prostate removal, bladder removal, hernia repairs, kidney transplant). This may require a secondary incision called a counter-incision. With the infrapubic approach, we are able to directly visualize placement of the reservoir in the space behind the pubic bone or in between the ab muscles without making a secondary incision. This makes reservoir placement safer and can avoid injury to structures such as the bladder, blood vessels, bowels, etc.
Key point is that all three surgical approach (penoscrotal, infrapubic, and subcoronal) are designed to safely and reliably place a penile implant. Although there are some nuances that I have highlighted no one has been able to prove that one technique is better than another in terms of faster recovery, lower infection rates, larger implant sizing. I think it is extremely important to have a surgeon who is comfortable with and utilizes more than one technique to help provide you the best outcome with your penile implant surgery. Please contact me to schedule your consultation today to learn more about which approach would be the best suited for you.
-Dr. Patel
