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J. FRANÇOIS EID, MD: Good morning. This is Dr. FranÇois Eid here at New York Presbyterian Hospital, of the Weill Medical College in New York City. And today, we will perform a procedure which is commonly known as a inflatable penile prosthesis.
Now before we get into the details of the procedure, I'd like to talk a little bit about what it does. It provides patients with an erection so that they can make love again. So it's really, what we're doing is we're helping couples with their sexual life.
Now who are the patients who will benefit from this procedure the most are patients who no longer respond to initial therapy, such as Viagra or penile injection therapy. The important thing to realize is that when a man has an internal penile pump, he feels totally normal. He has full sensation. He can have an orgasm. Men who no longer have a prostate lose their ability to ejaculate with orgasm. But if a man has an internal penile pump because of diabetes, for example, he will have the ability to have an orgasm and ejaculation.
What we've done now is we've draped the patient in a sterile fashion. And after doing so, we bring in what we call a Scotch retractor. This will help us retract the opening. We've placed a catheter in the urethra in order to help with the anatomy and guide us. And you can see that the opening in the skin is going to be quite small.
We will now make the opening in the skin. Can I have a yellow Hokes please? It will take six of them. We have these special retractors which will help us do the procedure without having to change our position over and over again. So we've now reached the fascia of the penis, which is called the tunica albuginea. And we will make a small opening in the penis here, about really a much smaller than the opening in the skin. And that's the opening that we will use to insert the device. And that's going to be very deep centrally in the penis. And that's important, again, for both cosmesis and function.
What we're doing now is we're fashioning a space for the cylinder of the device. We will now measure that side and this side, which length of the cylinder we will have. Naturally every man wants the longest possible length, for some possible reason, but we will refrain from over-exuberance here and we will put something that will fit appropriately for the patient.
Now that we've completed the patient's left side, we turn our attention to the right side. And we will do the identical same procedure on the patient's right side. Now we measured a total length of 20 centimeters. And we will actually put a 19 centimeter device inside in order for the patient to have room for the device to expand.
The device has three components. And we have two of the three components right here. The cylinders, which fit in the penis, and the pump, which fits in the scrotum.
What will allow us to put this device to such a small opening is by pushing a suture through the head of the penis. And we will be able to slide this whole sleeve inside the penis through the small opening with the help of this suture which will push and pull the device in. Now the beauty of using these inflatable is that the whole procedure can be performed through a small opening. As you can see here in the penis, in the old days when we had to put these rigid prosthesis, we had to make a big opening in the penis. And that, of course, caused more pain and swelling.
We now turn our attention to the contralateral side. As you can see through the little opening, the sleeve we will now flip the device backward. Can I have a small wrench please? And Dr. Tesh will now slide the rear of the device. Again, you can visualize how small this opening is. Again, it will make for a much better result, less bleeding. Very nice.
We will now proceed with the placement of the pump. But before we do, so I would like to illustrate how this device works. By squeezing the ball here, the fluid is transferred through this tubing into the cylinders. And the release valve is activated by squeezing the sides of the long portion. So the patient will be able to palpate this, squeeze it that way to deflate and squeeze it. Squeeze the ball to inflate.
The second part of the procedure is placement of the pump in the strobe pouch. And again, we want to place this pump in a way that it will be accessible to the patient, so that he can activate it. On the other hand, we want to hide it so that the patient will have an acceptable cosmetic result. I find that the ideal position for the pump is on the midline between the two testicles. And Dr. Tesh will now make a small opening again, about a centimeter.
You can see that we've put this in the scrotum now. And you cannot really visually see this. And the pump is very well concealed, yet accessible to the patient.
The third part of the procedure is placing the reservoir that will hold the fluid while the patient is not sexually active. In order to put the reservoir, we locate the inguinal ring, and that's the area where men typically get a hernia. And what we're going to do, actually fashion, is we're going to make a hernia. A hernia is a hole in the wall of the abdominal musculature. And usually when men get a hernia, they have a little bit of either omentum or bowel sticking through the hernia. Now what we're going to do today is we're going to use the hernia to put the reservoir.
We will now put the fluid into the reservoir. And we start with 60 cc's of fluid. We need approximately 25 to give an erection for this patient. But again, we will put more fluid than needed just to be on the safe side.
As you can see, all we needed were three little stitches to close this opening. And that's it. The whole device is placed.
Now to obtain an erection, again, all he has to do is locate the pump which is behind the two testicles. And what he does, he gently squeezes the pump. And by gently squeezing the pump, if you could blot the incision for us, the penis slowly becomes rigid. And here's the erection. You can see the patient will be able to make love without difficulties.
Now to deflate the pump, one has to find the deactivating device, which is right here. And I will then I will illustrate how the deflation occurs. And you can see that the penis is getting softer. What I'm doing now is I'm with my right thumb I'm pressing on the deactivating part of the pump. And with my left hand I'm gently squeezing on the cylinders in order to make the penis flaccid.
Now what the patient will expect is that in the next two or three days, he needs to stay in bed as much as possible to minimize swelling. Patients can expect pain and discomfort for the first two to three days after the procedure. They are provided with painkillers for that. If the patient lies flat on his back, usually pain will not be present. Most of the pain, most of the complaint occurs in the evening and most of the time patients complain that it is the pump that is uncomfortable for the first 10 days. Gradually the pain goes away and there is definitely a trend of improvement. Around three weeks the patients feel comfortable enough so that they can begin lovemaking.
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SUMMARY
