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Background <p>Implantation of penile prosthesis in cases of fibrotic scarred corporeal tissue is one of the most challenging procedures in prosthetic urology. We present our work with implantation of semirigid penile prostheses in cases of severe scarred corporeal fibrosis using two types of cavernotomes, Uramix cavernotome (Uramix USA) and Shaeer`s coring cavernotome (ShC) either separately or combined.</p> Methods <p>Fourteen cases with severe scarred penile fibrosis underwent semirigid penile prosthesis implantation from September 2021 to May 2023. The institutional ethical committee approved the work that conforms to Helsinki declaration 2013. All participants were fully counseled about their condition and the necessity to redo the implantation with the possibility of postoperative complications together with cancelling the operation in case of dilatation failure.</p> Results <p>In most cases, proximal dilatation was more difficult than distal dilatation. In thirteen patients, penile prosthesis implantation was inserted bilaterally. In one post-priapism patient, dilatation was successful on one side only, and a single rod was implanted. Failure of dilatation of the contralateral side was due to atrophy and thinning-out of the corpus cavernosum. Urethral injury, distal perforation or crossing-over was not encountered. Proximal perforation was encountered in three cases, two by Uramix and one by ShC. Corporotomies were then extended, and the rear tip extender was sutured to the tunica albuginea by prolene sutures. In two cases, distal side perforations happened due to misdirection of ShC.</p> <p>In those two cases, penile degloving through the penoscrotal incision was done and the corporeal side perforations were sutured by absorbing sutures under vision. In only four patients, Uramix dilator was used alone to dilate the corpora. In the Uramix group, two patients had girth 12 mm implanted and two had girth 11 mm. In another four patients, the Uramix could not dilate the fibrotic corpora, so ShC was used to excavate the sclerotic cavernosal tissue.</p> Conclusion <p>It is recommended to start first with the Uramix dilators. If corporeal fibrosis is severe, ShC can then be used owing to the higher risk of corporeal perforation that is induced by ShC.</p>

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Evaluation of two different cavernotomes in challenging cases of severe penile fibrosis during semirigid penile prosthesis implantation: a prospective case-series study

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  • 发表日期：

    2025年11月24日

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  • Amr Elahwany,
  • Sameh Fayek GamalEl Din,
  • Abdelrahman Ahmed Aburahma,
  • Ahmed Ali Mohamed Keshk,
  • Ahmed Fawzy Megawer,
  • Galal Elshorbagy,
  • Mohamed Wael Ragab

摘要

Background

Implantation of penile prosthesis in cases of fibrotic scarred corporeal tissue is one of the most challenging procedures in prosthetic urology. We present our work with implantation of semirigid penile prostheses in cases of severe scarred corporeal fibrosis using two types of cavernotomes, Uramix cavernotome (Uramix USA) and Shaeer`s coring cavernotome (ShC) either separately or combined.

Methods

Fourteen cases with severe scarred penile fibrosis underwent semirigid penile prosthesis implantation from September 2021 to May 2023. The institutional ethical committee approved the work that conforms to Helsinki declaration 2013. All participants were fully counseled about their condition and the necessity to redo the implantation with the possibility of postoperative complications together with cancelling the operation in case of dilatation failure.

Results

In most cases, proximal dilatation was more difficult than distal dilatation. In thirteen patients, penile prosthesis implantation was inserted bilaterally. In one post-priapism patient, dilatation was successful on one side only, and a single rod was implanted. Failure of dilatation of the contralateral side was due to atrophy and thinning-out of the corpus cavernosum. Urethral injury, distal perforation or crossing-over was not encountered. Proximal perforation was encountered in three cases, two by Uramix and one by ShC. Corporotomies were then extended, and the rear tip extender was sutured to the tunica albuginea by prolene sutures. In two cases, distal side perforations happened due to misdirection of ShC.

In those two cases, penile degloving through the penoscrotal incision was done and the corporeal side perforations were sutured by absorbing sutures under vision. In only four patients, Uramix dilator was used alone to dilate the corpora. In the Uramix group, two patients had girth 12 mm implanted and two had girth 11 mm. In another four patients, the Uramix could not dilate the fibrotic corpora, so ShC was used to excavate the sclerotic cavernosal tissue.

Conclusion

It is recommended to start first with the Uramix dilators. If corporeal fibrosis is severe, ShC can then be used owing to the higher risk of corporeal perforation that is induced by ShC.