BACKGROUND
The surgical management of the penile deformities observed in Peyronie's disease can be complex. It requires an accurate assessment of the penis in the erect state in order to evaluate the degree of curvature and wasting. It is also imperative to document penile lengths at the beginning and end of surgery in conjunction with overall surgical correction. An artificial erection is usually achieved by puncturing the corpora with a 21G butterfly needle and inflating the penis with normal saline. It is often necessary to inflate the penis repeatedly during surgery, thereby necessitating recurrent penile punctures. This may lead to haematoma formation that can complicate surgery and result in unsatisfactory postoperative appearances and pain.
TECHNIQUE
A tourniquet is applied to the base of the penis to minimise intraoperative bleeding and help provide occlusion to the corporal bodies. The penis is degloved using a subcoronal incision. A 22G venous cannula is sited into either corporal body through the glans (Figs 1 and 2), taking care not to injure the penile urethra. Following adequate placement, the cannula is secured to the foreskin with a suture and a non-return valve with a Luer lock connector is attached (Fig 3). The penis is inflated using 50ml of normal saline. The syringe can then be detached, refilled and reattached without dismantling the cannula mechanism.
Figure 1.
Cavernosal puncture using a 22G venous cannula
Figure 2.
Satisfactory positioning ensures the cannula rests in a single corporal body while avoiding injury to adjacent structures. A non-return valve with a Luer lock connector is attached.
Figure 3.
The cannula is secured in position by suturing it to the foreskin. Routine circumcision is performed at the end of the procedure.
DISCUSSION
We have described a simple and reproducible technique for achieving a safe cavernosal puncture that allows repeated inflation of the penis without recurrent positioning of the primary needle. This method allows the surgeon to repeatedly inflate the penis during Peyronie's disease surgery while minimising the risk of haematoma formation.
Reference
- 1.Kumar R, Nehra A. Surgical and minimally invasive treatments for Peyronie's disease. Curr Opin Urol. 2009;19:589–594. doi: 10.1097/MOU.0b013e3283314a87. [DOI] [PubMed] [Google Scholar]